Treatment of Guillain-Barré Syndrome
The treatment of Guillain-Barré Syndrome focuses on reducing the immune system’s attack on the nervous system, managing symptoms, and supporting vital functions until recovery begins. Because the treatment of Guillain-Barré Syndrome must often start before a definitive diagnosis is confirmed, rapid hospital admission and close monitoring are essential. Most people improve with early intervention, but the course can be unpredictable and vary widely from one individual to another.
Guillain-Barré Syndrome (GBS) is a serious medical emergency. Therefore, treatment must begin as early as possible—ideally within the first two weeks after symptoms appear. At this stage, doctors act quickly because early treatment leads to better outcomes. First, they use immunotherapy to stop the immune system from causing more damage to the nerves.
Then, they provide supportive care to manage other problems. For example, patients may develop breathing difficulties or unstable blood pressure. In such cases, immediate care becomes even more important. Additionally, because GBS can worsen quickly, doctors often start treatment before confirming the diagnosis.
As a result, patients receive both protection against further nerve injury and support for vital body functions. Over time, with early action and consistent care, most people begin to recover. Although the speed of recovery varies from person to person, early treatment gives the best chance for a full return to health.
1. Hospital Admission and Monitoring
Most patients with GBS require hospitalisation. The decision is based on:
Degree of weakness or progression rate
Breathing or swallowing difficulties
Autonomic dysfunction (blood pressure or heart rate instability)
Inability to walk unassisted
Hospitalisation ensures access to intensive care if needed, including respiratory support, cardiac monitoring, and physical therapy.
2. Immunotherapy
There are two main immunomodulatory treatments for Guillain-Barré Syndrome, both aimed at interrupting the autoimmune process:
a. Intravenous Immunoglobulin (IVIG)
A standard first-line treatment
Administered over 5 days
IVIG is a purified solution of donor antibodies that neutralises harmful antibodies and modulates immune response
Generally well-tolerated with mild side effects (headache, fever, rash)
IVIG is as effective as plasma exchange and often preferred due to its ease of use, especially in children.
b. Plasma Exchange (Plasmapheresis)
Removes harmful antibodies and immune components from the blood
Typically performed every other day over a two-week period
Requires specialised equipment and vascular access
Equally effective as IVIG, but slightly more invasive
Plasma exchange is more commonly used in adults and may be preferred in certain subtypes or where IVIG is contraindicated.
Note: Corticosteroids, once used in treatment, are now discouraged as they have not shown consistent benefit in GBS and may delay recovery.
3. Supportive Care
Supportive care plays a central role in the treatment of Guillain-Barré Syndrome. Depending on the severity, this may include:
a. Respiratory Support
Up to 30% of patients experience respiratory failure and require mechanical ventilation
Regular monitoring of vital capacity and oxygen levels is critical
Respiratory therapists help prevent pneumonia and aid with weaning off ventilation
b. Cardiac Monitoring
Autonomic dysfunction can cause arrhythmias, labile blood pressure, or sudden cardiac arrest
Continuous ECG and blood pressure monitoring are needed in ICU settings
c. Nutritional and Hydration Support
Patients with swallowing difficulty may need nasogastric feeding or intravenous fluids
Nutritional needs must be balanced with recovery goals
d. Bladder and Bowel Management
Some patients experience urinary retention or constipation
Catheterisation, laxatives, or enemas may be needed under supervision
e. Pain Management
GBS can be painful due to nerve inflammation and muscle cramps
Medications may include gabapentin, pregabalin, paracetamol, or low-dose opioids
4. Physiotherapy and Rehabilitation
Rehabilitation is a vital component of the treatment of Guillain-Barré Syndrome, particularly during the recovery phase.
Goals of rehabilitation include:
Preventing muscle atrophy through passive and active exercises
Improving mobility and coordination
Promoting independence in daily tasks
Managing fatigue and improving energy efficiency
Therapy should begin as soon as the patient stabilises and continue for weeks or months, depending on recovery.
5. Psychological Support
The emotional impact of GBS is often underestimated. Patients may experience:
Depression, anxiety, or post-traumatic stress from ICU admission
Fear of recurrence or disability
Body image issues, especially in those with facial paralysis or prolonged immobility
Supportive counselling, peer groups, or mental health professionals can provide essential relief and guidance.
6. Paediatric Considerations
Children typically recover faster than adults but still require:
Close hospital monitoring
Early mobilisation and play-based therapy
Reassurance and age-appropriate education to reduce fear
Parental support and clear communication are key in paediatric care settings.
7. Prognosis and Long-Term Management
Most people begin recovery within 2–4 weeks of symptom plateau. However:
60–80% make a near-full or full recovery within one year
10–15% have long-term disability
5–10% may experience relapse or chronic symptoms
Long-term management may include:
Ongoing physiotherapy
Pain management
Occupational therapy for vocational reintegration
Regular follow-ups with neurology and rehabilitation specialists
Conclusion | Treatment of Guillain-Barré Syndrome
Treating Guillain-Barré Syndrome requires a two-part approach. First, doctors stop the immune system from damaging the nerves using IVIG or plasma exchange. Then, they provide intensive supportive care to manage symptoms and help the body recover. With early treatment and regular rehabilitation, most people regain their independence. Above all, a clear, compassionate care plan—tailored to the patient’s needs—is key to successful recovery in both children and adults.
