Diagnosis and management of Guillain–Barré syndrome in ten steps

Sabah Bari ’24

Figure 1. Nerve cells developing that function to process and transmit information which can be damaged in Guillain Barre.

Guillain-Barré syndrome (GBS) is a rare autoimmune disease characterized by an overactive immune system that causes damage to peripheral nerves, leading to loss of sensorimotor function starting at the extremities and spreading to the torso. Some symptoms of GBS are potentially fatal, such as respiratory failure, cardiac arrhythmias, blood pressure instability, which are all directly involved with the autonomic nervous system. The mortality rate for patients with GBS is estimated to be 3 to10% .  GBS is usually triggered by infections; in fact, the Zika virus epidemic in French Polynesia, Latin America and Carribean has been connected to recent increases in GBS cases. After the Zika virus outbreak, a new guideline was prepared with global variation to share specific clinical and research expertise. International experts identified a ten-step diagnosis and treatment plan for GBS after examination of abnormal electrophysiology results, increased levels of protein and normal cell count in cerebrospinal fluid in GBS patients. 

 The main concern for the diagnosis and treatment plan was being able to recognize the disease early in its progression, before any life threatening symptoms occur. Due to GBS being aggressive and rapidly progressive, patients can become  fully disabled within two weeks of disease onset. Therefore, steps 1-5 of the plan relate to when to suspect the presence of the disease and how to treat the disease and steps 6-10 involve disease management. After a patient is diagnosed with GBS, he or she is expected to start treatment if there are no complications, which requires the patient to be admitted to the ICU. Intravenous immunoglobulin and plasma exchange have been proven to be essential for recovery and can be used through steps 4-10. Since there had not been any previous international procedures for GBS diagnosis and treatment, the creation of this guideline arose from the efforts of clinical neurologists across the globe and was meant to be easily adopted for medical practice.

It is important to understand the correlation between an epidemic outbreak and the increased incidence of other diseases. With the advantage of globalization through technology, health officials were able to share their experiences to create a solidated process to diagnose and create a treatment plan for GBS. Experts were able to agree on the three main features of GBS and also had the mindfulness to understand that test results can be normal early in disease onset, which is a major factor that must not be overlooked in the diagnosis of disease. 

Work(s) cited:

[1] Leonhard, S.E., Mandarakas, M.R., Gondim, F.A.A. et al. Diagnosis and management of Guillain–Barré syndrome in ten steps. Nat Rev Neurol 15, 671–683 (2019). https://doi.org/10.1038/s41582-019-0250-9

[2] Image retrieved from: https://ccsearch.creativecommons.org/photos/fef3d6de-d622-4e7b-97d1-ded1fba52ec5

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