Guillain-Barré syndrome in adults: Treatment and prognosis
- 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 "Guillain-Barré syndrome in adults: Clinical features and diagnosis" and "Guillain-Barré syndrome in children: Epidemiology, clinical features, and diagnosis" and "Guillain-Barré syndrome in children: Treatment and prognosis".)
APPROACH TO INITIAL CARE
Supportive care for patients with Guillain-Barré syndrome (GBS) is extremely important due to the associated risk of respiratory failure and autonomic dysfunction with potentially severe cardiovascular involvement. Patients in the progressive phase of GBS require close monitoring of respiratory and cardiovascular function, often in the intensive care unit. (See 'Supportive care' below.)
Treatment with plasma exchange or intravenous immune globulin (IVIG) is indicated for most patients with GBS because these treatments accelerate recovery. We recommend treatment with plasma exchange or IVIG for nonambulatory adult patients with GBS who are within four weeks of symptom onset. In addition, we suggest treatment with plasma exchange or IVIG for ambulatory adult patients with GBS who are not yet recovering within four weeks of symptom onset. The choice between plasma exchange and IVIG is dependent on local availability and on patient preference, risk factors, and contraindications. (See 'Disease-modifying treatment' below.)
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.
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- APPROACH TO INITIAL CARE
- SUPPORTIVE CARE
- Respiratory failure
- Autonomic dysfunction
- Cardiovascular management
- - Blood pressure
- - Arrhythmias
- Bowel and bladder care
- Pain control
- DISEASE-MODIFYING TREATMENT
- Plasma exchange
- - Dosing and side effects
- Intravenous immune globulin
- - Dosing and side effects
- CLINICAL COURSE AND PROGNOSIS
- Prognostic factors
- - Electrodiagnostic studies
- Long-term outcome
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS