Guillain Barré syndrome

Signs & Symptoms

  • pain, numbness, paresthesia or weakness of the limbs
  • typically rapidly progressive (may worsen within hours) and symmetric course
  • nevertheless atypical presentation is possible: eg. cranial nerve involvement, dyspnea, swallowing impairment, pain syndrome


  • GBS is a clinical diagnosis! Don’t wait with treatment untill all assessments have been done
  • Neurological consult
    • EMG
    • Lumbar puncture after brain imaging: typically elevated protein with normal white blood cell count
  • Blood analysis: CMV, mycoplasma, hepatitis E, campylobacter jejuni, anti-ganglioside antibodies
  • Swallowing analysis
  • Pulmonary function tests with vital capacity and maximum inspiratory/expiratory pressures; respiratory function should be evaluated 6 x pd
  • ECG


  • IVIg therapy (0,4g/kg for 5 days)
  • Discussion corticoid treatment
  • Plasmapheresis (ideally 5 x with total exchange volume of 5 plasma volumes in 2 weeks)
  • IVIg therapy may be repeated
  • FU in accordance with local neurologists
  • Consider location of care where ventilatory support is available (required in 15-30% of idiopathic cases)
  • Close FU of patient: monitoring of respiratory function at least 6 x pd + (ECG) monitoring in order to detect autonomic dysfunction
  • DVT prevention
Corticoid treatment discussion

Not indicated for idiopathic GBS, however some case reports (eg Wilgenhof S et al, Annals of Oncology 2011) show interesting results with ICPI induced GBS with methylprednisolone 1-2mg/kg. Among the neurology community discussion is ongoing if ICPI induced GBS is similar to chronic inflammatory demyelinating polyneuropathy (CIDP). The latter has a similar symptoms as GBS but has a slower onset and in contrast to GBS, for CIDP corticoids are indicated.

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CMV: Cytomegalovirus
DVT: Deep Venous Thrombosis
EEG: Electro EncephaloGram
GBS: Guillain-Barré Syndrome
ICPi: Immune Checkpoint Blockade Inhibition
EMG: ElectroMyoGram
IVIg: IntraVeneous Immunoglobulins