Guillain-Barré syndrome (GBS) is an acute polyradiculoneuropathy with a highly variable clinical course and outcome. Intravenous immunoglobulin (IVIg) and plasma exchange are proven effective treatments, but the efficacy has been demonstrated mainly on motor improvement in adults with a typical and severe form of GBS. In clinical practice, treatment dilemmas may occur in patients with a relatively mild presentation, variant forms of GBS, or when the onset of weakness was more than 2 weeks ago. Other therapeutic dilemmas may arise in patients who do not improve or even progress after initial treatment. We provide an overview of the current literature about therapeutic options in these situations, and additionally give our personal view that may serve as a basis for therapeutic decision-making.
- GUILLAIN-BARRE SYNDROME
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Contributors CV was responsible for the collection of all articles, interpretation and summarising of literature, and writing of the manuscript. PAvD was involved in the interpretation of literature, critical revision of the manuscript and study supervision. BCJ contributed to the manuscript concept and design, interpretation of literature, critical revision of the manuscript and study supervision.
Competing interests PAvD conducted the IVIg/Methylprednisolone RCT and the GRAPH study in patients with GBS and MFS. He is the principal investigator (PI) of the ongoing Second IVIg Dose trial in patients with GBS with a poor prognosis (SID-GBS trial). He is the coauthor of several Cochrane studies in GBS. BCJ received research support from the Netherlands Organization for Health Research and Development, Erasmus MC, Prinses Beatrix Spierfonds, GBS-CIDP Foundation International, CSL-Behring, and Grifols and is the PI of the International GBS Outcome Study (IGOS).
Provenance and peer review Not commissioned; externally peer reviewed.