Guillain-Barré syndrome. Clinical manifestations and directions for treatment.

Guillain-Barré syndrome (GBS) is the commonest cause of acute neuromuscular paralysis in the developed world today. Patients present most commonly with a rapidly ascending paralysis together with sensory symptoms and variable autonomic involvement. The diagnosis is clinical, but lumbar puncture and nerve conduction studies are helpful in excluding other conditions. The improvement in prognosis in recent years is largely due to advances in respiratory intensive care management. Careful monitoring of cardiorespiratory function and in particular regular measurements of the vital capacity will help to predict which patients will require elective ventilation to prevent impending neuromuscular respiratory failure. The paralysed patient is susceptible to all the complications of immobility, in particular venous thromboembolism and hypostatic pneumonia, and good nursing care and physiotherapy are therefore mandatory. Autonomic involvement may predispose to cardiac arrhythmias and labile blood pressure. The prolonged nature of the illness predisposes to psychiatric complications, particularly depression, and this should be treated appropriately. Specific treatment is aimed at reducing the period of maximum disability. Both plasma exchange (PE) and intravenous immune globulin (IVIg) have been shown to be effective in randomised controlled trials. A multicentre trial is currently under way to determine whether PE or IVIg or PE followed by IVIg is the most effective treatment for this condition. Steroids alone have not been shown to be of value, although a trial is under way comparing the combination of IVIg and methylprednisolone with IVIg alone. The prognosis of GBS is generally good, with about 80% of patients making a full recovery, although about 5% die of complications.(ABSTRACT TRUNCATED AT 250 WORDS)