Guillain-Barre Syndrome

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Treatment

GBS is considered a medical emergency and most patients are admitted to the hospital soon after diagnosis. If the patient's breathing seems to be at risk, he or she is usually managed in an intensive care unit (ICU). Although GBS can improve spontaneously, there are a number of treatments that facilitate recovery.

Like GBS, CIDP can improve spontaneously. However, recovery may be very slow and the illness can either get progressively better or worse, or can follow a relapsing/remitting course.

Most patients with GBS and CIDP are treated with plasmapheresis or immunoglobulin. Corticosteroids may be used to treat CIDP but are not used to treat GBS, as it worsens rather than improves the condition.

Plasmapheresis
Patients diagnosed early in the course of the disease and those who are acutely ill often respond well to blood plasma exchange (plasmapheresis). In this procedure, blood is withdrawn and passed through a series of filters that separate the different types of blood cells. The blood cells are then suspended in donor or synthetic plasma and returned to the patient's body. The patient's plasma is discarded.

Plasmapheresis is thought to remove the substances that damage myelin. It can shorten the course of GBS, alleviate symptoms, and prevent paralysis.

Immunoglobulin
Large doses of immunoglobin given intravenously can help shorten the duration of symptoms. This treatment is just as effective as plasmapheresis. It often is preferred to plasmapheresis because it does not require insertion of a large venous catheter.

Overall, about 70% of patients respond to plasmapheresis or immunoglobin. There is no evidence of additional benefit from treatment with both procedures.

Medications
Muscle and joint pain can be treated with over-the-counter analgesics such as aspirin. If necessary, stronger pain medication (e.g., acetaminophen with hydrocodone) may be prescribed. Muscle spasms can be controlled with relaxants such as diazepam (Valium®).

Unpleasant sensation problems, such as painful tingling, can be treated with tricyclic antidepressants or anticonvulsants such as gabapentin (Neurontin®).

Corticosteroids, which often effectively treat the symptoms of autoimmune disorders, actually worsen Guillain-Barre syndrome and should not be used. However, they often are used to treat CIDP.

Physical therapy
Before recovery begins, caregivers move the patient's arms and legs to prevent stiffness. After symptoms subside, the rehabilitation team will prescribe an active exercise routine to help regain muscle strength and independence. Training with adaptive devices, such as a wheelchair or braces, give the patient mobility.

Hydrotherapy
Whirlpool therapy (hydrotherapy) may help relieve pain and be useful in retraining the movement of affected limbs.

Counseling
Counseling often is suggested to reassure patients diagnosed with GBS or CIDP and to help them feel positive about their treatment and recovery.

Prognosis

Patients may remain in the hospital for several months and recovery may take a year or more. Most patients recover completely, but some have residual weakness, numbness, and occasional pain. A small number are unable to resume their normal occupation.

Fewer than 5% of GBS patients die. Those fatalities usually result from cardiovascular or respiratory complications. Death resulting from CIDP is rare.

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