Guillain-Barré syndrome medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Priyamvada Singh, MBBS [2]
Overview
With prompt treatment of plasmapheresis followed by immunoglobulins and supportive care, the majority of patients will regain full functional capacity. However, death may occur if severe pulmonary complications and dysautonomia are present.
Medical therapy
- There is no cure for Guillain-Barré syndrome. However, many treatments are available to help reduce symptoms, treat complications, and speed up recovery.
Intensive care management
- When symptoms are severe, the patient will need to go to the hospital for breathing help, treatment, and physical therapy.
- Supportive care with monitoring of all vital functions is the cornerstone of successful management in the acute patient.
- Of greatest concern is respiratory failure due to paralysis of the diaphragm.
- Early intubation should be considered in any patient with
- A vital capacity (VC) <20 ml/kg,
- A Negative Inspiratory Force (NIF) <-25 cmH2O
- More than 30% decrease in either VC or NIF within 24 hours
- Rapid progression of disease
- Autonomic instability
Immunotherapy
- Once the patient is stabilized, treatment of the underlying condition should be initiated as soon as possible.
- Either high-dose intravenous immunoglobulins (IVIg) at 400mg/kg for 5 days or plasmapheresis can be administered, as they are equally effective and a combination of the two is not significantly better than either alone.
- Therapy is no longer effective after 2 weeks after the first motor symptoms appear, so treatment should be instituted as soon as possible.
- High-dose immunoglobulin therapy (IVIg) is used to reduce the severity and length of Guillain-Barré symptoms. In this case, the immunoglobulins are added to the blood in large quantity, blocking the antibodies that cause inflammation.
- IVIg is usually used first because of its ease of administration and safety profile, with a total of five daily infusions for a total dose of 2 g/kg body weight (.4kg each day).
- The use of intravenous immunoglobulins is not without risk, occasionally causing hepatitis, or in rare cases, renal failure if used for longer than five days.
- If plasmapheresis is chosen, a dose of 40-50 mL/kg plasma exchange (PE) is administered four times over a week. A method called plasmapheresis is used to remove proteins, called antibodies, from the blood.
- The process involves taking blood from the body, usually from the arm, pumping it into a machine that removes the antibodies, then sending it back into the body.
- Glucocorticoids have NOT been found to be effective in GBS.
Other treatments for preventing complications
- Blood thinners may be used to prevent blood clots.
- If the diaphragm is weak, breathing support or even a breathing tube and ventilator may be needed.
- Pain is treated aggressively with anti-inflammatory medicines and narcotics, if needed.
- Proper body positioning or a feeding tube may be used to prevent choking during feeding if the muscles for swallowing are weak.
Social Perspective
A fundamental part of hospital treatment should fall on the family. As hospitals reduce healthcare it becomes impossible to care for patients around the clock. Patients that reach total paralysis are unable to signal or call for help and this is where family care becomes so important. Family members provide care and support that patients desperately need and medical staff sometimes don't understand or are unable to provide. Due to inactivity the body loses tone and flexibility. It's suggested that learning Range of Motion from medical staff and using stretches and keeping the joints pliable will aid the patient to recover sooner than letting them lay in a vegetative position. This also helps with circulation and the onset of bedsores. Bedsore prevention mattresses provide comfort to the patient if the family is unable to maintain 24 hour care. This is important because hospital recovery from Guillain-Barre can last from weeks to months.