Guide for GP's

Clinical Course and Prognosis

The interval from onset to peak disability may vary from hours to weeks. About 30% reach their maximum deficit within seven days; others progress for up to four weeks. About 60% of cases are unable to walk at the height of their illness. Respiratory function is impaired in over half of the patients and about 20 to 30% will require assisted ventilation. The mortality rate is about 5%, the most common causes of death being complications of respiratory failure, pulmonary embolism, cardiac arrhythmias, autonomic failure and infections.

In about one third of patients the first signs of recovery occur within two weeks and in about one third recovery begins between the second and fourth weeks; in the remainder of patients, up to three months may elapse before definite improvement is evident. About 70 to 80% of patients make a good recovery with little or no residual disability. The remainder have varying degrees of distal muscle wasting and weakness.

Management

Management of Guillain-Barré Syndrome is outlined below.

• Admit to hospital
• Monitor vital capacity
• Treat respiratory failure:
  • artificial ventilation
  • intubation
  • tracheostomy
• Specific therapy:
  • plasmapheresis
  • intravenous immunoglobulin
• Intragastric or intravenous feeding may be necessary
• General nursing care:
  • skin
  • bowels
  • bladder
  • eyes
  • mouth
  • pharynx
• Prevent deep venous thrombosis:
  • subcutaneous heparin 5,000 units b.d.
• Physical therapy:
  • physiotherapy
  • splints
  • walking aids
  • rehabilitation
• Psychological support and communication
• Guillain-Barré Syndrome support groups