Running head: GUILLAIN-BARRE SYNDROME
Treatment Literature Review: Guillain-Barre Syndrome
Amanda DiPierro & Trisha Reyes
State University of New York Institute of Technology
1
GUILLAIN-BARRE SYNDROME
2
Guillain-Barre Syndrome
Introduction
Guillain-Barre Syndrome (GBS) is a rare disorder that consists of several neuropathic
conditions (Walling & Dickson, 2013). French physicians, Guillain, Barre, and Strohl first
identified GBS in 1916. In the past, GBS was thought to be a single disorder. It has since been
determined that in actuality, it is a group of acquired autoimmune disorders that has several
variant forms (Domino, 2014).
GBS is an autoimmune attack on the peripheral nervous system and is believed to be
triggered by an acute infection (NINDS, 2011). Nerves become inflamed and cause progressive
muscle weakness, loss of sensation and reflexes, and even paralysis (Dunphy, Winland-Brown,
Porter, & Thomas, 2011). GBS can progress rapidly and can quickly become a medical
emergency (Caple & Schub, 2013; NINDS, 2011). In less severe cases, many people will
experience complete recovery with no lingering effects. Other individuals may experience
permanent residual effects (Dunphy, et al., 2011).
Purpose Statement
The purpose of this literature review is to perform an integrative analysis of the most
recent literature. The focus of this literature review is aimed at finding current guidelines for
treatment and management of Guillain-Barre Syndrome. The goal is to provide insight and
direction for facilities and health care providers in order to improve quality of care and quality of
life for those patients who develop GBS. This literature review is a summary of the current
guidelines and evidence-based practices used to manage and adequately treat Guillain Barre
Syndrome.
GUILLAIN-BARRE SYNDROME
3
Methodology
The objective of this paper is to review and collect current and relevant literature
regarding the treatment and management of Guillain Barre Syndrome. Articles deemed relevant
were located and accessed via the State University of New York Institute of Technology, Cayan
Library electronic database. The primary databases explored were inclusive of CINAHL-Plus,
MedlinePlus, and PubMed. Additional searches were performed utilizing Google scholar,
Centers for Disease Control, National Institute of Neurological Disorders and Stroke, and
Medscape. Secondary searches were also conducted on the literature deemed relevant.
Key search terms utilized to execute this literature review were ‘Guillain Barre
Syndrome’, ‘Guillain Barre’, ‘Guillain Barre Syndrome treatments’, ‘Guillain Barre Syndrome
management’, ‘Guillain Barre Syndrome treatment and management’, ‘apheresis’, ‘Guillain
Barre Syndrome causes’, and ‘Guillain Barre Syndrome clinical manifestations’. Articles
reviewed were limited to peer reviewed articles between the years of 2008-2014. Relevant
literature prior to this timeframe was reviewed with the purpose of determining preceding
treatments and guidelines, if any. A selection of over 30 articles was made initially. These
articles were sorted, reviewed, and summarized for the purposes of this paper. An analysis of 10
individual studies on the treatment and management of Guillain Barre Syndrome was completed
collaboratively (see Appendix A).
Literature Review
Background
Guillain Barre Syndrome is considered an uncommon occurrence (Walling & Dickson,
2013). However, GBS can ultimately result in death or permanent disability when not addressed
GUILLAIN-BARRE SYNDROME
4
in a timely manner (Walling & Dickson, 2013). Symptoms include acute peripheral neuropathy
and acute neuromuscular paralysis (Domino, 2014; Pountney, 2009).
Early symptoms typically present as weakness and tingling in the legs or hands. This
worsens over several days (Lehman, et al., 2012). Sensory and motor functions become notably
diminished (Lehmann, et al., 2012). Symptoms travel upward to the arms and upper body and
progressively increase in severity. In severe cases, muscle weakness progresses to paralysis
(NINDS, 2011). Tendon reflexes are reduced or absent and cranial nerves can also be affected
(Lehman, et al., 2014). Paralysis can interfere with the respiratory and cardiac systems;
ultimately causing death if left untreated (NINDS, 2011). Health care providers must be familiar
with the clinical manifestations of GBS. Early recognition, diagnosis, and treatment of GBS can
significantly improve patient outcomes (Walling & Dickson, 2013).
Treatment
There are few treatment modalities available for managing patients with GBS. There is
no direct cure for GBS (NINDS, 2011). Treatment of Guillain Barre Syndrome is aimed at
symptom management, reducing disease severity and preventing complications (Lehman, et al.,
2012). GSB can complicate quickly and become life threatening if left untreated (Lehman, et al.,
2012)
Across the literature, the gold standard for alleviating disease manifestations and
shortening duration includes immunomodulant treatments (Lehman, et al., 2014) This includes
either intravenous immunoglobulin (IVIG) or plasmapheresis. According to the evidence based
guidelines of treatment that are provided by the American Academy of Neurology (2013),
treatment with plasma exchange (PE) or intravenous immunoglobulin therapy (IVIg) can both
GUILLAIN-BARRE SYNDROME
5
accelerate the recovery time and reduce severity of GBS. Both plasma exchange and IVIG are
considered equal in efficacy (Lehman, et al., 2012).
The American Academy of Neurology guidelines do not recommend the combination of
these two treatments. The specific recommendations are PE for non-ambulatory adult patients
with GBS who start treatment within four weeks of the onset of neuropathic symptoms and
ambulatory patients who start treatment within two weeks of the onset of neuropathic symptoms.
IVIg is recommended for non-ambulatory adult patients who start treatment within two to four
weeks of the onset of symptoms (American Academy of Neurology, 2013).
Plasma Exchange. Plasma exchange works by removing antibodies from the
bloodstream and replacing them with normal plasma (El-Bayoumi et al., 2011). Plasma exchange
was the first therapy deemed effective by randomized controlled studies (Harms, 2011; Pritchard,
2010). In the United States, most PE procedures are performed for neurologic, immunologic, or
hematologic diseases (REFERNCE).
Studies reveal that plasma exchange has been shown to tremendously improve the
outcome for GBS patients when compared to supportive care (Raphael, Chevret, Hughes, &
Annane, 2012). The benefit of PE was observed in patients with varying severities of the illness.
Patients being treated with PE had improved recovery times. They had shortened mechanical
ventilator times, decreased risk of infection, cardiovascular instability and cardiac arrhythmias
(Raphael, et al., 2012).
Similarly, a comparative study of children found that the children who received PE had a
shorter period of ventilation (El-Bayoumi et al., 2011). It was also been demonstrated that the
long term benefits of PE include an increase in the number of patients who demonstrate full
motor recovery after 1 year (Raphael et al., 2012).
GUILLAIN-BARRE SYNDROME
6
Intravenous Immunoglobulin. IVIg is used to treat multiple immune mediated
neurological diseases (Patwa, Chaudhry, Katzberg, Rae-Grant, & So, 2012). The mechanism of
IVIg results from the prevention of antibody production both in vivo and in vitro (El-Bayoumi et
al., 2011). Hughes, Swan, & Doorn (2012) found that the administration of IVIg to patients with
severe GBS speeds the recovery process and is equally, if not more, effective as PE. Currently,
the most common IVIg dose is 2g/kg splint evenly over a 5 day span, however optimal dosing
regimens remain unknown due to a lack of sufficient data (Harms, 2011 & Patwa et al., 2012).
Similarities and differences. Some similarities and differences exist in the literature in
regard to the preferred treatment between IVIG and PE. Although both are considered equally
effective, most studies show IVIG is most often preferred (Pritchard, 2010; Winters, 2013;
Woodward, 2011). IVIG is currently the first-line treatment used for GBS (Buzzigoli, et al.,
2010). IVIG is considered to be more readily available, easier to administer, cost effective and is
thought to have less adverse reactions (Pritchard, 2010; Winters, 2013; Woodward, 2011).
Patwa et al. (2012) found that patients who were given IVIg took only 27 days to achieve
a 1-grade improvement, while patients who were administered PE took 41 days. Patwa et al.
(2012) determined that there is insufficient data to support the benefit of IVIg in the treatment of
children with GBS. Similarly, El-Bayoumi et al. (2011) found that children who received IVIg
did not recover as quickly as those receiving PE. Patwa et al., 2012 suggests that the benefit of
treating children with IVIg is reasonable to consider based on the positive outcome in adults,
although there is not enough reliable data to support this.
Buzzigoli, et al (2010) argues that PE may have potential benefits over IVIG. Studies
have shown that people who fail to improve with IVIG therapy, were given PE and responded
effectively. In addition, people who suffer from familial and recurrent GBS tend to respond
GUILLAIN-BARRE SYNDROME
7
better to PE rather then IVIG as well (Buzzigoli, et al., 2010). Plasma exchange has also been
determined to cost significantly less than IVIG (Winters, et al., 2011).
Combination Therapy. Similarities exist in the literature in regard to combined
therapies, using both IVIG and PE. Across the review of literature, combined therapy has shown
not to provide any further benefits or improvement in comparison to individual therapies
(Buzzigoli, et al., 2010; Pritchard, 2010; Walling & Dickson, 2013). In addition, the American
Academy of Neurology guidelines do not recommend treatment with the combination of PE and
IVIg. Hughes, Swan, & Van Doorn (2012), found that IVIg in combination with PE is not
significantly more effective than either given individually. Pernat, Buturovic-Ponikvar, Svigelj,
& Ponikvar (2009) have also argued that a combination of therapy offers no significant
advantages. Winer (2013) also argues that a combination if IVIg with steroids and/or plasma
exchange is of no benefit. Patwa et al., (2012) advises against the IVIg combined with PE.
Research by El-Bayoumi et al. (2011) argues in contrast. El-Bayoumi et al. (2011) suggests that
patients with rapidly progressing GBS who require mechanical ventilation will respond well to
both IVIg and plasma exchange.
Corticosteroids. In the past, corticosteroids were considered the mainstay of treatment
for GBS (Lancet, 1993). However, current data suggests that this treatment is not beneficial and
should no longer be considered a modality for treatment (Patwa et al., 2012; Walling & Dickson,
2013). Walling & Dickson (2013) found that patients who were treated with various forms and
dosages of corticosteroids showed no difference in mortality or disability between those patients
who were given a placebo. Similarly, Netto, et al. (2011) states that corticosteroids are generally
avoided in the treatment of GBS due to negative impact on degenerative muscle and risk for
gastrointestinal bleeding. Walling & Dickson (2013) also suggested that there was a potential
GUILLAIN-BARRE SYNDROME
8
delay in long-term recovery when treated with corticosteroids. However, Pritchard (2010) states
that steroids are not considered contraindicated in GBS treatment if they are deemed necessary
for any other symptom management. There is limited research available in regard to the reasons
behind using corticosteroids in treatment at all.
Prevention of complications. Many serious complications can arise from GBS. The
morbidity and morality associated with GBS is directly correlated with modifiable risk factors
(Netto, et al., 2011). These complications can essentially be prevented or quickly identified
when GBS is managed appropriately.
GBS can be highly unpredictable and present erratically (Netto, et al., 2011). Therefore,
patients presenting with rapidly progressing symptoms of GBS should be immediately admitted
to the hospital and closely observed (Pritchard, 2010). Pritchard (2010) suggests admitting GBS
patients to the ICU and putting them on cardiac monitor to assess for any arrhythmias. These
patients need to have their vital signs assessed frequently until they regain mobility (Pritchard,
2010). Neurology and the anesthesia teams should be quickly consulted upon admission (Netto,
et al., 2011).
Amongst the literature, preventing respiratory arrest and death are the most predominant
goals of treatment (Lehman, et al., 2012; Pritchard, 2010). Up to twenty-five percent of people
have respiratory involvement (Lehman, et al., 2012). Woodland (2013) suggests routinely
measuring a forced vital capacity (FVC) in order to evaluate respiratory status and to prepare for
mechanical ventilation if respiratory failure is deemed imminent. Other criteria for mechanical
ventilation include hypoxia and low PaCO2 (Netto, et al., 2011). Respiratory arrest can
ultimately be prevented if GBS treated quickly and efficiently.
GUILLAIN-BARRE SYNDROME
9
Once respiratory function is maintained, persistent evaluation is essential. Continual
oxygen saturation monitoring and baseline blood gases should be routinely evaluated to measure
respiratory function (Pritchard, 2010). Chest x-rays and swallowing assessments should be
implemented to prevent further respiratory complications, such as pneumonia (Pritchard, 2010;
Walling & Dickson, 2013). The literature provided a comprehensive audit of GBS-related
deaths, revealing that pneumonia was the most common causative agent (Netto, et al., 2011).
GBS can also lead to other dangerous and emergent situations. Two-thirds of people
exhibit autonomic dysfunction (Lehmann, et al., 2012). This may result in cardiac arrhythmias,
labile blood pressure and pulse and gastrointestinal impairment (Lehmann, et al., 2012).
Literature suggests patients be placed on cardiac telemetry for continuous monitoring during the
acute phases of GBS (Pritchard, 2010; Woodland, 2013). The most common cardiovascular
complications are sinus tachycardia, bradycardia and dangerous fluctuation in blood pressures
(Woodland, 2013). Hypokalemia secondary to plasma exchange has also shown to play a role in
cardiac arrhythmias (Netto, et al., 2013). Therefore, monitoring for electrolytes imbalances is
pertinent following immunomodulatory intervention.
Most studies recommend placing the patients on a prophylactic anticoagulant to reduce
the risk of developing a thromboembolism secondary to paralysis and immobility (Lehman, et
al., 2012; Walling & Dickson, 2013). Intermittent compression devices and range of motion
exercise should also be routinely implemented as well (NINDS, 2011, Walling & Dickson,
2013). Health care providers should be continually monitoring for signs and symptoms of
thrombosis development throughout the treatment course (Caple & Schub, 2013).
Supportive. People endure an array of physical and psychological manifestations that
require supportive management. Eighty percent of GBS patients suffer from neuropathic and
GUILLAIN-BARRE SYNDROME
10
nociceptive pain secondary to inappropriate nerve impulses, which can be excruciating (NINDS,
2011; Walling & Dickson, 2013). Pain should be treating using NSAIDs and opioid
medications. Opioid medications should be used with caution when autonomic symptoms of
GBS are exhibited (Walling & Dickson, 2013). Literature also recommends treating pain with
Neurontin or Tegretol as an additive agent to the analgesic regimen (Walling & Dickson, 2013).
Chronic pain can also be treated with tricyclic anidepressants and tramadol. Neurontin and
tegretol can be used long-term as well (Walling & Dickson, 2013).
Physical disability and weakness can prolong for an extensive amount of time. Thirtyfive percent of people inflicted with GBS may experience moderate to severe residual paresis
(Netto, et al., 2011). Rehabilitation is an essential component of the comprehensive treatment
plan. Physical therapy and occupational therapy should begin as soon as patients regain strength
in their limbs (Caple & Schub, 2013; NINDS, 2011).
In addition to treating the acute phases of GBS, the autonomic and paralytic effects of
GBS may result in several other issues. Management of GBS also includes restoring bowel and
bladder dysfunction, promoting adequate nutrition, preventing skin breakdown and attending to
psychological needs (Woodland, 2013; Walling & Dickson, 2013) Communication may be
impaired secondary facial paralysis or respiratory impairment (Woodland, 2013). Means of
nonverbal communication should be utilized in order to properly communicate when speech is
impaired (Caple & Schub, 2013).
The literature suggests that psychological support is a crucial element of treating GBS.
Patients need to be educated that recovery can be slow. It can take up to two years for patients to
fully recover (Pritchard, 2010). Patients need continual encouragement and reassurance to
maintain compliant with rehabilitating measures (Pritchard, 2010). Caple and Schub (2013)
GUILLAIN-BARRE SYNDROME
11
suggest consulting mental health for emotional support and counseling. In addition, the GBS
Support Group and US Foundation International are support groups that provide useful tools,
group therapies, online resources and phones lines to assist patients with coping (Pritchard,
2010).
Conclusion
Health care providers must be familiar with the signs and symptoms, as well as the
current management for Guillain-Barre Syndrome. Mostly importantly, health care providers
must be aware that GBS can be life threatening if not treated appropriately. Anyone presenting to
the office with rapidly progressing weakness that had recently endured the flu or a respiratory or
gastrointestinal infection should be worked up for GBS. Early diagnosis and proper management
of GBS can significantly improve patient outcomes (Walling & Dickson, 2013).
GUILLAIN-BARRE SYNDROME
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References
AAN Guideline Summary for CLINICIANS IMMUNOTHERAPY FOR GUILLAIN-BARRÉ
SYNDROME (2013). Retrieved from
http://tools.aan.com/professionals/practice/pdfs/gbs_guide_aan_mem.pdf
Burns, T. (2008). Guillain-Barre Syndrome. Seminars in Neurology, 28(2), 152-67.
Centers for Disease Control and Prevention (CDC). (2012). Guillain-Barre Syndrome. Retrieved
from http://www.cdc.gov/flu/protect/vaccine/guillainbarre.htm
Caple, C. & Schub, T. (2013) Guillain-Barre Syndrome. Cinhal Informational Systems.
Retreived from CINHAL Plus with Full Text.
Domino, F. (2014). The 5 Minute Clinical Consult. 22nd Ed. Lippincott Williams & Wilkins.
Double-blind trial of intravenous methylprednisolone in Guillain-Barrésyndrome. GuillainBarréSyndrome Steroid Trial Group. (1993). Lancet, 341(8845), 586.
Dunphy, L., Winland Brown, J., Porter, B. & Thomas, D. (2011). Primary Care: The art and
science of advanced practice nursing. 3rd edition. Philadelphia: F. A. Davis.
El-Bayoumi, M. A., El-Refaey, A. M., Abdelkader, A. M., El-Assmy, A., Alwakeel, A. A., & ElTahan, H. M. (2011). Comparison of intravenous immunoglobulin and plasma exchange
in treatment of mechanically ventilated children with Guillain Barre syndrome: a
randomized study. Critical Care, 15(4), R164-9.
Gonzalez-Suarez, I., Sanz-Gallego, I., Rodriguez de Rivera, F. J., & Arpa, J. (2013). GuillainBarre syndrome: natural history and prognostic factors: a retrospective review of 106
cases. BMC Neurology, 13(1), 95.
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Harms, M. (2011). Inpatient management of Guillain-Barre syndrome. Neurohospitalist, 1(2),
78-84.
Hughes, R.A., Swan, A.V., & van Doorn, P.A. (2012) Intravenous immunoglobulin for
Guillain-Barre syndrome. Cochrane Database System, 7. doi:
10.1002/14651858.CD002063.pub5.
Incecik, F., Herguner, M. & Altunbasak, S. (2011). Guillain-Barre syndrome in children. Neurol
Sci, 32. 381-385. Doi: 10.1007/s10072-010-0434-y
National Institute of Neurological Disorders and Stroke (NINDS) (2011). Guillain-Barre
syndrome fact sheet. Retrieved from
http://www.ninds.nih.gov/disorders/gbs/detail_gbs.htm
Netto, A. B., Taly, A. B., Kulkarni, G. B., Rao, U. & Rao, S. (2011). Mortality in mechanically
ventilated patients of Guillian Barre syndrome. Annals of Indian Academy of Neurology,
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Netto, A. B., Taly, A. B., Kulkarni, G. B., Rao, U. & Rao, S. (2011). Prognosis of patients with
Guillain-Barre syndrome requiring mechanical ventilation. Neurology India, 59(5); 707711. DOI: 10.4103/0028-388.686545
Patwa, H. S., Chaudhry, V., Katzberg, H., Rae-Grant, A. D., & So, Y. T. (2012). Evidencebased guideline: intravenous immunoglobulin in the treatment of neuromuscular
disorders: report of the therapeutics and technology assessment subcommittee of the
American Academy of Neurology. Neurology, 78, 1009-1015.
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Pernat, A. M., Buturovic-Ponikvar, J., Svigelj, V., & Ponikvar, R. (2009). Guillain-Barre
Syndrome treated by membrane plasma exchange and/or immunoadorption. Therapeutic
Apheresis and Dialysis, 13(4), 310-313.
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from CINAHL Plus with Full Text.
Raphael, J.C., Chevret, S., Hughes, R.A., & Annane, D. (2012). Plasma exchange for GuillainBarre Syndrome. Cochrane Database System Review 7. doi:
10.1002/14651858.CD001798.pub2.
Sriganesh, K., Netto, A., Kulkarni, G., Taly, A., Rao, G. (2013). Seasonal variation in the clinical
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GUILLAIN-BARRE SYNDROME
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Appendix A
Literature Review Grid
Studies
Focus
Subjects
Pop-
Age
Method
Findings
49 -143
months
of age
This is a
prospective
randomized
study.
GBS that is progressing
rapidly and requires
mechanical ventilation
responds well to both
IVIg and plasma
exchange. However, it is
suggested within this
study that plasma
exchange is more useful
as a specific treatment
for children who have
rapidly progressing
GBS and need
mechanical ventilation.
Childre
n and
adults,
specific
age
ranges
not
availabl
e.
Data
collection
and
analysis of
randomized
and quasirandomized
trials.
This review
provides evidence that,
in severe disease, IVIg
that is started within two
weeks of onset hastens
recovery as much as PE.
Adverse events were not
significantly more
frequent with either
treatment but IVIg is
significantly much more
likely to be completed
than PE.
ulatio
n
ElBayoum
i, ElRefaey,
Abdelka
der, ElAssmy,
Alwake
el, & ElTahan
(2011)
Compariso
n of the
treatment
outcome of
IVIg and
PE in
children
with GBS
who
require
MV.
Hughes,
Swan,
& van
Doorn,
(2012)
The
objective
of this
review was
to
determine
the efficacy
of IVIg for
Guillain
Barre
Syndrome
Children
N=41
with GBS
that
needed
mechanica
l
ventilation
within 14
days of
onset who
were
admitted to
pediatric
intensive
care unit at
Mansoura
University
Children
Hospital in
Mansoura,
Egypt.
All of the
N=536
participant
s were
severely
affected by
GBS.
GUILLAIN-BARRE SYNDROME
16
Raphael
,
Chevret,
Hughes,
&
Annane,
(2012)
To assess
the effects
of plasma
exchange
for treating
GuillainBarré
syndrome.
children
and adults
with
varying
degrees of
severity of
GBS.
N=649 Childre
n and
adults,
specific
age
ranges
not
provide
d.
Gonzale
zSuarez,
SanzGallego,
Rodrigu
ez de
Rivera,
& Arpa
(2013)
The focus
of this
review was
to attempt
to identify
the factors
associated
with a poor
outcome
from GBS.
The
authors
aimed to
collect and
identify
epidemiological,
clinical,
therapeutical, and
evolutinary
data.
The focus
of this
review was
to evaluate
plasma
immunoadsorption
and
membrane
plasma
exchange
as
Patients
diagnosed
with GBS
or MFS
between
the years
of 20002010
N=106 0-85
years of
age
Patients
diagnosed
with GBS,
severely
paralyzed,
who were
treated
with
plasma
exchange
and
immune-
N=19
Pernat,
Buturov
icPonikva
r,
Svigelj,
&
Ponikva
r (2009)
14-76
years of
age
A metaanalysis of
6
controlled
randomized
and quasirandomized
trials.
The findings of this This
review concluded that
there was significantly
more improvement with
plasma exchange than
supportive care alone in
adults with GuillainBarré syndrome without
an increase in serious
adverse events.
A retroThere was no difference
spective
between genders; 41%
review of
were diagnosed in the
hospital
winter; infectious
records
antecedent preceding
from La
onset of weakness, 38%
Paz
identified respiratory
University tract infection, 27% had
Hospital in GI infection, 1%
Madrid,
vaccination; 30% had no
Spain,
previous illness;
between
Prognosis proved worse
the years of for elder patients, severe
2000-2010. deficits at onset, injured
cranial nerves, and
axonal lesion patterns in
the nerve conduction
studies.
A
retrospectiv
e study of
patients
treated at
the
University
Medical
Center
Ljubljana
who were
treated for
This analysis
determined that a high
number of immunoadsorption in addition to
plasma exchange
treatments can be safely
and effectively
administered to patients
with GBS. If patients
have already
deteriorated to the point
where mechanical
GUILLAIN-BARRE SYNDROME
Netto,
A.,
Taly,
A.,
Kulkarn
i, G.,
Rao, U.
& Rao,
S.
(2011)
Netto,
A.,
Taly,
A.,
Kulkarn
i, G.,
Rao, U.
& Rao,
S.
(2011)
Incecik,
F.,
Hergune
r, M. &
Altunba
sak, S.
(2011)
17
treatment
modalities
for patients
diagnosed
with GBS.
adsorption
GBS
between
the years of
1998-2008.
Modifiable
factors that
can reduce
the
morbidity
and
mortality
of GBS pts
requiring
mechanical
ventilation
To
determine
the factors
related to
GBS
deaths
GBS pts
requiring
mechanica
l
ventilation
N=173 Mean
age
=33.5
Retrospecti
ve case
report
between
the yrs
1997-2007
GBS pts
requiring
mechanica
l
ventilation
N=273 No ages
determi
ned.
Retrospective
analysis of
case record
between
1984 and
2007
Risk factors identified
were the elderly,
pneumonia,
hypokalemia, and
dysautonomia
To
determine
how
children
manifest
GBS and
what
factors
Children
with GBS
N=46
Retrospecti
ve analysis
Children tend to have a
better prognosis in
comparison to adults.
IVIG and PE did not
show to impact
prognosis significantly.
Median
age 6
ventilation is needed,
IVIg with supportive
therapy is generally not
beneficial.
Both IVIg and plasma
exchange are accepted
treatments fro GBS,
neither has been
determined to be better
than the other. This
study also found that
immunoadsorption may be the
best course of treatment
for individuals who do
not respond to plasma
exchange.
Appropriately managing
modifiable risk factors,
such as pulmonary
dysfunction, autonomic
defects, and sepsis can
significantly reduce the
morbidity and mortality
of GBS.
GUILLAIN-BARRE SYNDROME
influence
their
prognosis
Winters, To
J.,
compare
Brown, the costs
D.,
between
Hazard, IVIG and
E.,
PE
Chainan
i, A. &
Andrzej
ewski,
C.
(2011)
Sriganes To
h, K.,
determine
Netto,
if the
A.,
season a pt
Kulkarn undergoes
i, G.,
GBS
Taly,
influences
A., Rao, recovery
G.
rate.
(2013).
Financial
N/A
data from
2
institutions
.
18
N/A
Pts
N=184 32+-21
admitted to
ICU with
GBS
Cost
analysis
IVIG was deemed to
cost significantly more
than PE
Review
and
analysis of
case
records
There was a seasonal
correlation with the
duration of mechanical
ventilation. Pts admitted
in the spring recovered
faster than pts admitted
in the winter.
GUILLAIN-BARRE SYNDROME
19
Appendix B
Ten Multiple Choice Questions
1. What age group does Guillain-Barre Syndrome most often effect?
A-Elderly
C-Late adolescents
B-Young Adults
D-All of the above
ANSWER: D-All of the above
2. Symptoms generally travel in which direction or pattern?
A- Top to bottom
C-Right to left
B- Left to right
D- Bottom to top
ANSWER: D- Bottom to top
3. Common viruses associated with GBS include:
A- Varicella Zoster
C- cytomegalovirus
B- Epstein Barr virus
D- All of the above
ANSWER: D- All of the above
4. Most common bacteria associated with GBS include:
A- Mycoplasma pneumonia
C- Neither of these
B- Campylobacter jejuni
D- Both of these
ANSWER: B- Campylobacter jejuni
5. A method used to reduce the symptoms of GBS include:
A- Plasma exchange
C- This is not possible
B- IV immunoglobulin
D- Both A & B
ANSWER: D- Both A & B
6. Which of the following commonly precedes GBS onset?
GUILLAIN-BARRE SYNDROME
20
A- Respiratory or GI infection
C- Flu vaccination
B- Myocardial infarction
D- Hyperglycemia
ANSWER: A- Respiratory or GI infection
7. If GBS is diagnosed; the APN should…
A- Send pt home with Lortab and Neurontin.
B- Admit pt to ICU for acute monitoring.
C- Obtain an EKG, if normal then send home.
D. Have the pt follow up with neurology within 1-2 weeks.
ANSWER: B- Admit pt to ICU for acute monitoring.
8. Symptoms of GBS usually progress within what time frame?
A- 4 months
C- 4 weeks
B- 4 years
D- 4 days
ANSWER: C- 4 weeks
9. GBS progresses as:
A- Descending asymmetrical weakness
B- Ascending asymmetrical weakness
C- Descending symmetrical weakness
D- Ascending symmetrical weakness
ANSWER: D- Ascending symmetrical weakness
10. Complications of GBS include:
A- cardiac arrhythmias
C- respiratory failure
B- pulmonary emboli
D- all of the above
ANSWER: D- all of the above