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Guillain-Barré syndrome

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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
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Classification and risk stratification

Prognosis: as per EAN/PNS 2023 guidelines, assess the risk of poor outcome at an early stage of the disease in patients with GBS.
E
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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

CSF analysis: as per EAN/PNS 2023 guidelines, perform CSF examination, particularly when the diagnosis is uncertain or when an alternative diagnosis needs to be ruled out.
E
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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).
E
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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

Exercising
As per EAN/PNS 2023 guidelines:
Insufficient evidence to recommend for or against exercise training for fatigue.
I
Insufficient evidence to recommend for or against pranayama yoga and meditation techniques for the treatment of GBS.
I

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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More topics in this section

  • 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

Follow-up and surveillance

Rehabilitation: as per EAN/PNS 2023 guidelines, initiate physiotherapy, occupational therapy, speech therapy, and rehabilitation treatment during the acute phase (already during hospital admission) in patients with GBS.
E
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