Treatment of Guillain-Barré Syndrome

First-Line Immunotherapy

The American College of Neurology recommends initiating intravenous immunoglobulin (IVIg) at 0.4 g/kg body weight daily for 5 consecutive days as first-line treatment for any patient with GBS who cannot walk unaided, starting as early as possible within 2 weeks of symptom onset 1, 2
IVIg is the preferred first-line treatment over plasma exchange because it is easier to administer, more widely available, has higher completion rates, and has better tolerability with fewer complications—particularly important in children and pregnant women 1, 2

Apply the "20/30/40 rule" to identify patients at imminent risk of respiratory failure: vital capacity <20 ml/kg, maximum inspiratory pressure <30 cmH₂O, and maximum expiratory pressure <40 cmH₂O 1, 2, 3
Single breath count ≤19 predicts need for mechanical ventilation 3, 4

Admit to ICU if any of the following are present: evolving respiratory distress with imminent respiratory insufficiency, severe autonomic cardiovascular dysfunction, severe swallowing dysfunction or diminished cough reflex, or rapid progression of weakness 4

Treatment-related fluctuations (TRFs) occur in 6-10% of patients within 2 months of initial improvement and represent disease reactivation while the inflammatory phase continues 1, 3, 5
For TRFs, repeat the full course of IVIg or switch to PE, though evidence supporting this is limited 1, 2, 5

Continuous ECG monitoring for arrhythmias, blood pressure monitoring for hypertension/hypotension, and monitor bowel and bladder function 3, 4
Assess muscle strength using Medical Research Council grading scale and document functional disability using GBS disability scale 3, 4
Pain is common—recognize and treat early as it significantly impacts quality of life 3, 5

Initiate early rehabilitation with a multidisciplinary team including physiotherapists, occupational therapists, speech therapists, and dietitians 1, 3, 5
Include range-of-motion exercises, stationary cycling, walking, and strength training, and monitor exercise intensity closely—overwork causes fatigue 1

80% of patients regain independent walking ability at 6 months 2, 5
Mortality is 3-10%, primarily from cardiovascular and respiratory complications 2, 5
Risk factors for mortality: advanced age and severe disease at onset 2, 5