Summary
Guillain-Barré syndrome (GBS) is the commonest cause of acute neuromuscular paralysis in the developed world today. Patients present most commonly with a rapidly ascending paralysis together with sensory symptoms and variable autonomic involvement. The diagnosis is clinical, but lumbar puncture and nerve conduction studies are helpful in excluding other conditions. The improvement in prognosis in recent years is largely due to advances in respiratory intensive care management. Careful monitoring of cardiorespiratory function and in particular regular measurements of the vital capacity will help to predict which patients will require elective ventilation to prevent impending neuromuscular respiratory failure.
The paralysed patient is susceptible to all the complications of immobility, in particular venous thromboembolism and hypostatic pneumonia, and good nursing care and physiotherapy are therefore mandatory. Autonomic involvement may predispose to cardiac arrhythmias and labile blood pressure. The prolonged nature of the illness predisposes to psychiatric complications, particularly depression, and this should be treated appropriately.
Specific treatment is aimed at reducing the period of maximum disability. Both plasma exchange (PE) and intravenous immune globulin (IVIg) have been shown to be effective in randomised controlled trials. A multicentre trial is currently under way to determine whether PE or IVIg or PE followed by IVIg is the most effective treatment for this condition. Steroids alone have not been shown to be of value, although a trial is under way comparing the combination of IVIg and methylprednisolone with IVIg alone.
The prognosis of GBS is generally good, with about 80% of patients making a full recovery, although about 5% die of complications. As yet, there is no specific additional treatment that can be given to patients in poor prognostic groups, and it is only with a better understanding of the immunopathological mechanisms underlying GBS that more effective and more specific therapies will become available.
Similar content being viewed by others
References
Hughes RAC, Rees JH. Guillain-Barré syndrome. Curr Opin Neurol 1994; 7: 386–92.
Arnason BGW, Soliven B. Acute inflammatory demyelinating polyradiculoneuropathy. In: Dyck PJ, Thomas PK, Griffin JW, et al., editors. Peripheral neuropathy. 3rd ed. Philadelphia: WB Saunders, 1993: 1437–97.
McKhann GM, Cornblath DR, Griffin JW, et al. Acute motor axonal neuropathy: a frequent cause of acute flaccid paralysis in China. Ann Neurol 1993; 33: 333–42.
Sliman NA. Outbreak of Guillain-Barré syndrome associated with water pollution. BMJ 1978; 1: 751–2.
Rees JH, Gregson NA, Griffiths PL, et al. Campylobacter jejuni and Guillain-Barré syndrome. Q J Med 1993; 86: 623–34.
Steele JG, Gladstone RM, Thanasophon S, et al. Mycoplasma pneumoniae as a determinant of the Guillain-Barré syndrome. Lancet 1969; 2: 710.
Dowling PC, Cook SB. Role of infection in Guillain-Barré syndrome: laboratory confirmation of herpes virus in 41 cases. Ann Neurol 1981; 9 Suppl.: 44–55.
Gautier-Smith PC. Neurological complications of glandular fever (infectious mononucleosis). Brain 1965; 88: 323.
Gross FJ, Mindel JS. Pseudotumor cerebri and Guillain-Barré syndrome associated with human immunodeficiency virus infection. Neurology 1991; 41: 1845–6.
Knittel TH, Ramadori G, Mayet WJ, et al. Guillain-Barré syndrome and human diploid cell rabies vaccine. Lancet 1989; 1: 1334–5.
Schonberger LB, Bregman DJ, Sullivan-Bolynai JZ, et al. Guillain-Barré syndrome following vaccination in the National Influenza Immunization program, United States 1976–1977. Am J Epidemiol 1979; 110: 105–23.
Fagius J, Osterman PO, Siden A, et al. Guillain-Barré syndrome following zimelidine treatment. J Neurol Neurosurg Psychiat 1985; 48: 65–9.
Dick DJ, Raman D. The Guillain-Barré syndrome following gold therapy. Scand J Rheumatol 1982; 11: 119–23.
Knezevic W, Quintner J, Mataglia FL, et al. Guillain-Barré syndrome and pemphigus foliaceus associated with D-penicillamine therapy. Aust N Z J Med 1984; 14: 50–2.
Arrowsmith JB, Milstein JB, Kuritsky JN, et al. Streptokinase and the Guillain-Barré syndrome. Ann Intern Med 1985; 103: 302.
Chakraborty TK, Ruddell WS. Guillain-Barré neuropathy during treatment with captopril. Postgrad Med J 1987; 63: 221–2.
Hory B, Blanc D, Boillot A, et al. Guillain-Barré syndrome following danazol and corticosteroid therapy for hereditary angioedema. Am J Med 1985; 79: 111–5.
Loizou LA, Boddie HG. Polyradiculoneuropathy associated with heroin abuse. J Neurol Neurosurg Psychiatry 1978; 41: 855–7.
Palace JA, Hughes RAC. Guillain-Barré syndrome with persistent severe disability: relationship to hyperacute Guillain-Barré syndrome. Eur J Neurol 1994; 1: 21–7.
Miller Fisher. An unusual variant of acute idiopathic polyneuritis (syndrome of ophthalmoplegia, ataxia and areflexia). N Engl J Med 1956; 255: 57–65.
Guillain G, Barré JA, Strohl A. Sur un syndrome de radiculonevrité avec hyperalbuminose du liquide céphalo-rachidien sans réaction cellulaire: remarques sur les caractères cliniques et graphiques des réflexes tendineux. Bull Soc Med Hop Paris 1916; 40: 1462–70.
Willison HJ, Veitch J, Paterson G, et al. Miller Fisher syndrome is associated with serum antibodies to GQ1b ganglioside. J Neurol Neurosurg Psychiat 1993; 56: 204–6.
Gregson NA, Koblar S, Hughes RAC. Antibodies to gangliosides in Guillain-Barré syndrome: specificity and relationship to clinical features. Q J Med 1993; 86: 111–7.
Ropper AH, Shahani BT. Pain in Guillain-Barré syndrome. Arch Neurol 1984; 41: 511–4.
Guillain-Barré Syndrome Study Group. Plasmapheresis and acute Guillain-Barré syndrome. Neurology 1985; 35: 1096–104.
French Cooperative Group in Plasma Exchange in Guillain-Barré Syndrome. Efficiency of plasma exchange in Guillain-Barré syndrome: role of replacement fluids. Ann Neurol 1987; 22: 753–61.
Hughes RAC, Newsom-Davis JM, Perkin GD, et al. Controlled trial of predisolone in acute neuropathy. Lancet 1978; 2; 750–3.
Kleyweg RP, van der Meché FGA, Meulstee J. Treatment of Guillain-Barré syndrome with high-dose gammaglobulin. Neurology 1988; 38; 1639–41.
Van der Meché FGA, Schmitz PIM, Dutch Guillain-Barré Study Group. A randomised trial comparing intravenous immune globulin and plasma exchange in Guillain-Barré syndrome. N Engl J Med 1992; 326: 1123–9.
Sekul EA, Cupler EJ, Dalakas MC. Aseptic meningitis associated with high-dose intravenous immunoglobulin therapy: frequency and risk factors. Ann Intern Med 1994; 121: 259–62.
Pasatiempo AMG, Kroser JA, Rudnick M, et al. Acute renal failure after intravenous immunoglobulin therapy. J Rheumatol 1994; 21: 347–9.
Castro LHM, Ropper AH. Human immune globulin infusion in Guillain-Barré syndrome: worsening during and after treatment. Neurology 1993; 43: 1034–6.
Irani DN, Cornblath DR, Chaudhry V, et al. Relapse in Guillain-Barré syndrome after treatment with human immune globulin. Neurology 1993; 43: 872–5.
Epstein MA, Sladky JT. The role of plasmapheresis in childhood Guillain-Barré syndrome. Ann Neurol 1990; 28: 65–9.
Shahar E, Murphy EG, Roifman CM. Benefit of intravenously administered immune serum globulin in patients with Guillain-Barré syndrome. J Pediatr 1990; 116: 141–4.
Vajsar J, Sloane A, Wood E, et al. Plasmapheresis vs intravenous immunoglobulin treatment in childhood Guillain-Barré syndrome. Arch Pediatr Adolesc Med 1994; 148: 1210–2.
Guillain-Barré Syndrome Steroid Trial Group. Double-blind trial of intravenous methylprednisolone in Guillain-Barré syndrome. Lancet 1993; 341: 586–9.
Dutch Guillain-Barré Study Group. Treatment of Guillain-Barré syndrome with high dose immune globulins combined with methylprednisolone: a pilot study. Ann Neurol 1994; 35: 749–52.
Archelos JJ, Mäurer M, Jung S, et al. Suppression of experimental allergic neuritis by an antibody to the intercellular adhesion molecule ICAM-1. Brain 1993; 116: 1043–58.
Winer JB, Hughes RAC, Osmond C. Aprospective study of acute idiopathic neuropathy: I. Clinical features and their prognostic value. J Neurol Neurosurg Psychiat 1988; 51: 605–12.
Yuki N, Taki T, Inagaki F, et al. A bacterium lipopolysaccharide that elicits Guillain-Barré syndrome has a GM1 ganglioside-like structure. J Exp Med 1993; 178: 1771–5.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Rees, J. Guillain-Barré Syndrome. Drugs 49, 912–920 (1995). https://doi.org/10.2165/00003495-199549060-00005
Published:
Issue Date:
DOI: https://doi.org/10.2165/00003495-199549060-00005