How is Guillain Barre syndrome treated?
Corticosteroids are not indicated in Guillain Barre syndrome.
Plasma exchange (PE) and intravenous immunoglobulin (IVIG) started within 2 weeks of the illness equally improve the degree and rate of recovery.
The Quality Standards Subcommittee of the AAN (2003) recommends treatment with PE for nonambulant patients within 4 weeks of symptom onset; it should also be considered for ambulant patients within 2 weeks of symptom onset.
Efficacy of the two treatments appears to be equal in all subsets of Guillain Barre syndrome, except perhaps IgG anti-GMI-positive patients, who usually present with AMAN and for whom IVIG may be somewhat superior.
Because IVIG offers the advantages of greater ease and convenience as well as greater safety of administration at similar costs, it is now considered the treatment of first choice.
There is no added benefit from combining the two treatments. Immunoabsorption is an alternative to PE and obviates the need to use human blood products.
Good supportive care is an essential part of Guillain Barre syndrome management (e.g., monitoring for and management of autonomic dysfunction, respiratory failure, and cardiovascular instability).
Forty percent of hospitalized patients with Guillain Barre syndrome require inpatient rehabilitation, and patients may also require long-term follow-up for lingering symptoms (e.g., severe fatigue or sensory disturbances).
The prognosis in Miller–Fisher syndrome and Bickerstaff brainstem encephalitis is usually excellent, and therefore the role of IVIG or PE in the recovery from these conditions remains uncertain.
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