Table of contents
Guillain-Barré syndrome
What's new
Updated 2023 EAN/PNS guidelines for the diagnosis and management of Guillain-Barré syndrome.
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of Guillain-Barré syndrome are prepared by our editorial team based on guidelines from the Peripheral Nerve Society (PNS/EAN 2023), the American Academy of Family Physicians (AAFP 2013), and the American Academy of Neurology (AAN 2011,2003).
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Screening and diagnosis
Diagnostic criteria: as per AAFP 2013 guidelines, use the following diagnostic criteria to establish the diagnosis of GBS:
progressive, relatively symmetrical weakness with decreased or absent myotatic reflexes
symptoms reached maximal intensity within 4 weeks of onset
other possible causes are excluded.
B
Classification and risk stratification
Diagnostic investigations
History and physical examination: as per EAN/PNS 2023 guidelines, elicit history of antecedent events (especially diarrhea, respiratory infection, or fever) to support the diagnosis of GBS, especially if there is clinical uncertainty about the diagnosis.
E
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Serologic testing
Electrodiagnostic testing
Diagnostic imaging
Respiratory assessment
Diagnostic procedures
Respiratory support
Mechanical ventilation
As per EAN/PNS 2023 guidelines:
Consider initiating elective ventilation when the FVC is ≤ 20 mL/kg. Initiate elective ventilation when the FVC is ≤ 10 mL/kg.
E
Consider initiating elective mechanical ventilation if the maximum expiratory pressure is < 30 cmH₂O or the maximum inspiratory pressure is < 40 cmH₂O if measured.
E
Medical management
Choice of treatment: as per EAN/PNS 2023 guidelines, offer treatment with either IVIG or plasma exchange (no preference).
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IVIG
Corticosteroids
Other agents
Management of pain
Management of fatigue
Inpatient care
Inpatient supportive care
As per AAFP 2013 guidelines:
Initiate anticoagulation and offer graduated compression stockings to prevent venous thrombosis in hospitalized patients with acute GBS.
B
Monitor hospitalized patients with acute GBS for autonomic disturbances, including changes in BP and HR (especially bradycardia) and respiratory, bowel, and bladder dysfunction.
B
Nonpharmacologic interventions
Therapeutic procedures
Plasma exchange: as per EAN/PNS 2023 guidelines, initiate plasma exchange as soon as possible in patients with GBS unable to walk unaided (GBS-DS grade ≥ 3) and within 4 weeks from onset.
A
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Immunoadsorption
CSF filtration
Neuromuscular electrical stimulation
Specific circumstances
Pediatric patients: as per AAN 2003 guidelines, offer plasmapheresis or IVIG in pediatric patients with severe GBS.
B
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Patients with acute-onset chronic inflammatory demyelinating polyradiculoneuropathy