GBS

• related: Neurology
• tags: #neuro

Classic GBS (AKA AIDP) presents as a progressive, symmetric ascending weakness or paralysis, often a few days to a week after a respiratory or gastrointestinal infection (especially Campylobacter jejuni).  About one-third of patients have no history of antecedent illness.  As the weakness ascends (eg, difficulty walking with 3/5 strength in the lower extremities compared with 4/5 strength in the upper extremities in this patient), ==bulbar symptoms== (eg, ophthalmoplegia, facial diplegia, dysarthria, dysphasia) and respiratory compromise can develop.  Back pain can be a presenting feature of GBS as the disease targets primarily the proximal nerves and nerve roots in either the cervical or lumbar spine.  Although GBS is primarily a motor polyneuropathy, patients can have mild sensory symptoms such as paresthesias and sensory ataxia.  GBS patients also are at risk of developing dysautonomia (eg, tachycardia, diaphoresis, sluggish pupils).  Examination shows absent reflexes.

Lumbar puncture is indicated in all suspected GBS patients to rule out infectious etiologies and document elevated cerebrospinal protein with a normal cerebrospinal fluid white blood cell count (albuminocytologic dissociation).  However, lumbar puncture may not be diagnostic in some GBS patients as it may take up to a week after symptom onset to see the abnormal findings.  Nerve conduction study and electromyography are also indicated to confirm the diagnosis and estimate prognosis.

Treatment is mainly supportive, with plasma exchange or intravenous immunoglobulin.  Current evidence does not recommend corticosteroids as they are not beneficial.  Most patients recover within several weeks to months.

• high risk of respiratory failure: frequent measure vital capacity and negative inspiratory force (same for myasthenia crisis)
• plasma exchange or IVIG to combat antibodies against nerves
• Patients with GBS should receive plasma exchange or IVIG if:
  • Nonambulatory
  • Within 4 weeks of symptom onset
• Those who are ambulatory and recovering generally do not require treatment.
• Transverse myelitis is typically treated with high-dose glucocorticoids, not GBS

Prognosis

The manifestations of Guillain-Barré syndrome (GBS) tend to evolve as follows:

• 2 weeks of progressive motor weakness that can lead to paralysis
• 2-4 weeks of plateaued symptoms
• Slow, spontaneous recovery over months

At a year after symptom onset, 85% of patients with GBS have regained the ability to walk and nearly 60% have had full, spontaneous neurologic recovery. Although patients with GBS typically recover without intervention, treatment with plasma exchange or intravenous immunoglobulin shortens the time to recovery by approximately 50%.