Peripheral neuropathy Guillain Barré Syndrome

Signs & Symptoms

Symptomatology may be very atypical: eg. cranial nerve involvement, dyspnea, swallowing impairment, pain syndrome -weakness may worsen within hours


  • GBS is a clinical diagnosis! Don’t wait with treatment untill all assessments have been done
  • EMG
  • Lumbar puncture after brain imaging: typically elevated protein with normal white blood cell count
  • CMV, mycoplasma, hepatitis E, campylobacter jejuni serology, check presence of anti-GQ1b 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
  • Plasmapheresis or IVIg therapy might be repeated
  • FU in accordance with local neurologists
  • Corticoid treatment discussion
  • 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 show interesting results with ICPI induced GBS with methylprednisolone 1-2mg/kg (check literature). 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.



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