Treatment of Guillain-Barré Syndrome

Abstract

Treatment required for GBS ranges from the full panoply of modern intensive care in severely paralysed ventilated patients to gentle reassurance in an outpatient setting in patients with minor sensory symptoms and signs. It would be desirable to predict at an early stage which patients were likely to become severely affected and take a long time to recover. Treatment could then be concentrated on this poor prognosis group, leaving patients who were destined to make a reasonably rapid and complete recovery untreated. Unfortunately assessing prognosis at an early stage is difficult. Attempts have been made to define a pure form of GBS with a uniformly benign prognosis by insisting on absence of sensory deficit and sphincter disturbance (Osler and Sidell 1960). In other studies the presence of sensory deficit and sphincter disturbance bore no relation to outcome (Marshall 1963). In general and not surprisingly the more severe the motor deficit at the nadir of the disease the greater has been the risk of residual disability (Peterman et al. 1959; Pleasure et al. 1969; Löffel et al. 1977). Patients whose weakness is so severe that they require ventilation have a distinctly worse prognosis than those who do not. The outcome of 71 carefully documented patients who had taken part in therapeutic trials was studied: 20 died or were left with persistent deficit after 12 months and of these 16 (80%) had required ventilation. On the other hand 51 recovered to be able to work again and only 13 (26%) had required ventilation (P<0.001) (Winer et al. 1985). Similarly in a prospective study 59% of 32 patients who required ventilation and only 22% of 64 who did not were left with persistent deficit (P<0.001) (Winer et al. 1988) (Table 8.1).