Treatment and prognosis of Guillain-Barré syndrome in adults
- Francine J Vriesendorp, MD
Francine J Vriesendorp, MD
- Professor of Neurology
- SUNY Upstate Medical University
The acute immune-mediated polyneuropathies are classified under the eponym Guillain-Barré syndrome (GBS), after the authors of early descriptions of the disease. GBS is an acute monophasic paralyzing illness usually provoked by a preceding infection.
The treatment and prognosis of GBS in adults will be discussed here. Other aspects of GBS are discussed separately. (See "Clinical features and diagnosis of Guillain-Barré syndrome in adults" and "Guillain-Barré syndrome in children: Epidemiology, clinical features, and diagnosis" and "Guillain-Barré syndrome in children: Treatment and prognosis".)
Supportive care is extremely important in Guillain-Barré syndrome (GBS) since up to 30 percent of patients develop neuromuscular respiratory failure requiring mechanical ventilation . In addition, autonomic dysfunction may be severe enough to require intensive care unit (ICU) monitoring . Thus, many patients with GBS are initially admitted to the ICU for close monitoring of respiratory, cardiac, and hemodynamic function. Less severely affected patients can be managed in intermediate care units, and mildly affected patients can be managed on the general ward with telemetry, along with monitoring of blood pressure and vital capacity every four hours.
Prophylaxis for deep vein thrombosis, bladder and bowel care, physical and occupational therapy, and psychological support are essential. Low molecular weight heparin and support stockings are recommended until patients are able to walk independently . Adequate pain control is necessary. (See 'Pain control' below.)
Issues related to the respiratory management of patients with neuromuscular weakness are also discussed separately. (See "Respiratory muscle weakness due to neuromuscular disease: Clinical manifestations and evaluation".)
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- SUPPORTIVE CARE
- Respiratory failure
- Autonomic dysfunction
- Cardiovascular management
- - Blood pressure
- - Arrhythmias
- Bowel and bladder care
- Pain control
- DISEASE MODIFYING TREATMENT
- Plasma exchange
- Intravenous immune globulin
- Other therapies
- Choice of therapy
- - Guideline recommendations
- - Doses and side effects
- Retreatment for poor response or relapse
- CLINICAL COURSE
- Prognostic factors
- - Electrophysiology
- Long-term outcome
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS