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Guillain-Barré syndrome

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).


1.Screening and diagnosis

Diagnostic criteria: 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
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2.Classification and risk stratification

Prognosis: assess the risk of poor outcome at an early stage of the disease in patients with GBS.
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3.Diagnostic investigations

History and physical examination: 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.
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  • Serologic testing

  • Electrodiagnostic testing

  • Diagnostic imaging

  • Respiratory assessment

4.Diagnostic procedures

Cerebrospinal fluid analysis: as per EAN 2023 guidelines, perform CSF examination, particularly when the diagnosis is uncertain or when an alternative diagnosis needs to be ruled out.
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5.Respiratory support

Mechanical ventilation
Consider initiating elective ventilation when the FVC is ≤ 20 mL/kg. Initiate elective ventilation when the FVC is ≤ 10 mL/kg.
Consider initiating elective mechanical ventilation if the maximum expiratory pressure is < 30 cmH₂O or the maximum inspiratory pressure is < 40 cmH₂O if measured.

6.Medical management

Choice of treatment: as per EAN 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

7.Inpatient care

Inpatient supportive care
Initiate anticoagulation and offer graduated compression stockings to prevent venous thrombosis in hospitalized patients with acute GBS.
Monitor hospitalized patients with acute GBS for autonomic disturbances, including changes in BP and HR (especially bradycardia) and respiratory, bowel, and bladder dysfunction.

8.Nonpharmacologic interventions

Insufficient evidence to recommend for or against exercise training for fatigue.
Insufficient evidence to recommend for or against pranayama yoga and meditation techniques for the treatment of GBS.

9.Therapeutic procedures

Plasma exchange: as per EAN 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.
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  • Immunoadsorption

  • CSF filtration

  • Neuromuscular electrical stimulation

10.Specific circumstances

Pediatric patients: offer plasmapheresis or IVIG in pediatric patients with severe GBS.

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  • Patients with acute-onset chronic inflammatory demyelinating polyradiculoneuropathy

11.Follow-up and surveillance

Rehabilitation: initiate physiotherapy, occupational therapy, speech therapy, and rehabilitation treatment during the acute phase (already during hospital admission) in patients with GBS.
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