Manage your Conditions in 10 Steps

Diagnosis and management of Guillain–Barré syndrome in ten steps

Nature Reviews Neurology: https://www.nature.com/articles/s41582-019-0250-9; Published Sept 20, 2019. Explanation of the above referenced article below.https://creativecommons.org/licenses/by/4.0/

Authors: Sonja Leonhard, Melissa Mandarakas, Francisco de Assis Aquino Gondim, Kathleen Bateman, Maria Lúcia Ferreira, David Cornblath, Pieter van Doorn, Mario Dourado, Richard Hughes, Badrul Islam, S Kusunoki, Carlos Pardo, Ricardo Reisin, Jim Sejvar, Nortina Shahrizaila, Cristiane Soares, Thirugnanam Umapathi, Yuzhong Wang, Eppie Yiu, Hugh Willison, and Bart Jacobs.

Previously, no international clinical guidelines for the diagnosis and management of the Guillain-Barré syndrome (GBS) existed. This was problematic, as clinical presentation and disease course may vary extensively between patients, management can be difficult, and clinicians are often confronted with diagnostic and treatment dilemmas. Furthermore, the incidence of GBS may suddenly and dramatically increase, as was seen recently during the Zika virus epidemic in during 2015-2016 in Latin America and the Caribbean. To accommodate for this unmet need and to support clinicians, especially during new outbreaks of GBS, we developed a globally-applicable, simple and practical clinical guideline for GBS.

This guideline is based on current literature and international expert consensus, presenting a 10-step approach to facilitate use in clinical practice. These 10 steps cover the most important aspects of diagnosis, treatment, monitoring, prognosis and long-term management. Furthermore, tables and figures are provided that give an overview of diagnostic criteria, clinical variants and differential diagnoses of GBS. These are helpful resources for busy clinicians, that can be printed and used at the bedside. To complement the paper, we have finalized a web-based resource that presents the information in an easy-to-access online format (downloads a PDF). 

Diagnosis

1. When to suspect GBS

  • Rapidly progressive bilateral limb weakness and/or sensory deficit
  • Hypo/areflexia
  • Facial or bulbar palsy
  • Ophthalmoplegia and ataxi

2. How to diagnose GBS

  • Check diagnostic criteria
  • Exclude other causes
  • Consider
    • Routine laboratory test
    • CSF examination
    • Electrophysiological studies

Acute Care

3. When to Admit to ICU

One or more:

  • Rapid progression of weakness
  • Severe autonomic or swallowing dysfunction
  • Evolving respiratory distress
  • EGRIS >4

4. When to Start Treatment

One or more:

  • Inability to walk >10 m independently
  • Rapid progression of weakness
  • Severe autonomic or swallowing dysfunction
  • Respiratory insufficiency

5. Treatment options

  • Intravenous immunoglobulin (0.4 g/kg daily for 5 days
  • Plasma exchange (200-250 ml/kg for 5 sessions)

6. Monitoring

Regularly assess:

  • Muscle strength
  • Respiratory function
  • Swallowing function
  • Autonomic function
    • Blood pressure
    • Heart rate/rhythm
    • Bladder/bowel control

7. Early complications

  • Choking
  • Constipation
  • Cardiac arrhythmia
  • Corneal ulceration
  • Infections
  • Dietary deficiency
  • Deep vein thrombosis
  • Hyponatraemia
  • Pain
  • Pressure ulcers
  • Delirium
  • Compression neuropathy
  • Depression
  • Limb contractures
  • Urinary retention

8. Clinical Progression

  • Treatment-related fluctuation: Repeat the same treatment
  • No initial response or recovery: No evidence for repeating treatment

Long-Term Care

Predicting Outcome

  • Calculate mEGOS on admission
  • Recovery can continue >3 years after onset
  • Recurrence is rare (2-5%)

Rehabilitation

  • Start rehabilitation programme early
  • Manage long-term complaints: fatigue, pain and psychological distress
  • Contact GBS patient organization

Ten-Step Guide in Additional Languages:

Portugese
Spanish
Chinese

Are you a Healthcare Professional caring for patients with GBS, CIDP, MMN or related conditions?

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