eMedicine Specialties > Emergency Medicine > Neurology

Guillain-Barre Syndrome: Follow-up

Author: Andrew C Miller, MD, Chief Resident and Clinical Assistant Instructor, Departments of Emergency Medicine and Internal Medicine, State University of New York Downstate Medical Center, Kings County Hospital Center
Coauthor(s): Razi M Rashid, MD, MPH, Intern, Department of Internal Medicine, St John's Hospital and Medical Center, Detroit, Michigan; Richard H Sinert, DO, Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center
Contributor Information and Disclosures

Updated: Jul 1, 2009

Follow-up

Further Inpatient Care

  • Admission to the ICU should be considered for all patients with labile dysautonomia, an FVC of less than 20 mL/kg, or severe bulbar palsy.42
  • Any patients exhibiting clinical signs of respiratory compromise, in any degree, also should be admitted to an ICU.42
  • The risk of sepsis and infection can be decreased by use of minimal sedation, frequent physiotherapy, and mechanical ventilation with positive end expiratory pressure where appropriate.42
  • The risk of DVT and pulmonary embolus may be minimized by administration of heparin or a low molecular weight heparin and intermittent pneumatic compression devices.42
  • The use of cardiac telemetry and pacing in the case of severe bradycardia may help to reduce the risk of cardiac morbidity and mortality.42
  • Pain may be symptomatically improved by frequent passive limb movements, gentle massage, frequent position changes, and use of carbamazepine and gabapentin.43,42
  • Narcotics should be used judiciously because patients may already be at risk for ileus.42

Further Outpatient Care

  • Physical therapy and occupational therapy may be beneficial in helping patients with Guillain-Barré syndrome to regain their baseline functional status.10,42

Transfer

  • Transfer may be appropriate if a facility does not have the proper resources to care for patients who may require prolonged intubation or prolonged intensive care.

Complications

  • With modern methods of respiratory management, most complications result from long-term paralysis. Possible complications include the following:
    • Persistent paralysis
    • Respiratory failure, mechanical ventilation
    • Hypotension or hypertension
    • Thromboembolism, pneumonia, skin breakdown
    • Cardiac arrhythmia
    • Ileus
    • Aspiration
    • Urinary retention
    • Psychiatric problems such as depression and anxiety
    • Nephropathy reported in pediatric patients44

Prognosis

  • Poor prognosis for patients with Guillain-Barré syndrome is associated with rapid progression of symptoms, advanced age, prolonged ventilation (>1 mo), and severe reduction of action potentials on neuromuscular testing.
  • Published reports indicate full recovery may be expected in 50-95% of patients with Guillain-Barré syndrome.
  • Long-term follow-up studies show nearly 50% of patients exhibit histological and clinical residual neuropathies years after the initial syndrome. Patients may have residual motor and sensory dysfunction.45
  • Increased CSF levels of neurone-specific enolase and S-100b protein are associated with longer duration of illness.1  
  • A longer-lasting increase in IgM anti-GM1 predicts slow recovery.1
  • Neurologic sequelae
    • Reported incidence of permanent neurologic sequelae ranges from 10-40%.
    • The worst-case scenario is tetraplegia within 24 hours with incomplete recovery after 18 months or longer.
    • The best-case scenario is mild difficulty walking, with recovery within weeks.
    • The usual scenario is peak weakness in 10-14 days with recovery in weeks to months. Average time on a ventilator (without treatment) is 50 days.
    • Recent studies report that patients with Guillain-Barré syndrome may exhibit long-term differences in pain intensity, fatigability, and functional impairment compared with healthy controls.46
  • Mortality
    • Most cases of mortality are due to severe autonomic instability or from the complications of prolonged intubation and paralysis.47,48,49,29
    • Mortality rates range from 5-10%.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to anticipate dysrhythmias and autonomic instability
  • Failure to anticipate progressive respiratory failure
  • Failure to correctly diagnose Guillain-Barré syndrome in patients with a variant form of the disease or in those with a normal CSF protein
  • Failure to provide adequate DVT prophylaxis in a patient that develops a DVT and/or pulmonary embolism

Special Concerns

  • The leading cause of death in elderly patients with Guillain-Barré syndrome is arrhythmia.
  • Recurrence of Guillain-Barré syndrome is rare but has been reported in 2-5% of patients.50
  • Variants of Guillain-Barré syndrome may present with pure motor dysfunction or acute dysautonomia.
  • The Miller-Fisher syndrome is a variant of Guillain-Barré syndrome in which the initial symptoms include ataxia, ophthalmoplegia, and areflexia.
 


More on Guillain-Barre Syndrome

Overview: Guillain-Barre Syndrome
Differential Diagnoses & Workup: Guillain-Barre Syndrome
Treatment & Medication: Guillain-Barre Syndrome
Follow-up: Guillain-Barre Syndrome
References
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Further Reading

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Keywords

Guillain-Barre syndrome, Guillain-Barré syndrome, GBS, nervous system, myelin sheath, neuropathy, nerves, causes, symptoms, treatment, viral infection, weakness, autoimmune disease, acute inflammatory demyelinating polyneuropathy, AIDP, acute motor axonal neuropathy, AMAN, acute motor-sensory axonal neuropathy, AMSAN, Miller-Fisher syndrome, MFS, acute panautonomic neuropathy, pharyngeal-brachial-cervical variant, pure sensory variant, Campylobacter jejuni, IVIG, plasmapheresis, acute flaccid paralysis

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Contributor Information and Disclosures

Author

Andrew C Miller, MD, Chief Resident and Clinical Assistant Instructor, Departments of Emergency Medicine and Internal Medicine, State University of New York Downstate Medical Center, Kings County Hospital Center
Andrew C Miller, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Physicians, American Medical Association, Emergency Medicine Residents Association, Islamic Medical Association of North America, Medical Society of the State of New York, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Razi M Rashid, MD, MPH, Intern, Department of Internal Medicine, St John's Hospital and Medical Center, Detroit, Michigan
Disclosure: Nothing to disclose.

Richard H Sinert, DO, Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center
Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Edward A Michelson, MD, Program Director, Associate Professor, Department of Emergency Medicine, University Hospital Health Systems in Cleveland
Edward A Michelson, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

J Stephen Huff, MD, Associate Professor, Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia Health Sciences Center
J Stephen Huff, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM, Director of Emergency Services, Director of Chest Pain Center, Department of Emergency Medicine, Ft Sanders Sevier Medical Center
Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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