Immediate Management by the GP
If the clinical features suggest Guillain-Barré Syndrome, the patient should be sent immediately to a hospital where respiratory support is available. If the diagnosis is considered but there are no abnormal signs the patient should be told to contact the doctor immediately if weakness or difficulty in breathing develop, and should be reviewed the following day.
Vital capacity should be measured every two to four hours in the initial stages. Tracheostomy and artificial ventilation may be necessary. Careful nursing is important, particular attention being paid to the care of skin, bladder, bowels, mouth, pharynx and trachea. Bowel and urinary tract infections require prompt treatment. Intravenous or intragastric feeding may be necessary. Splints to prevent foot and wrist drop may also be required, and physiotherapy should be commenced immediately.
A number of large trials have demonstrated the effectiveness of plasmapheresis which should be commenced as early as possible, certainly within the first two weeks; 200 to 250mL/kg should be exchanged over a 7-14 day period. Albumin or artificial plasma solutions are used to restore intravascular volume. Intravenous human immunoglobulin
A number of studies have demonstrated that high dose intravenous human immunoglobulin (0.4 g/kg daily for 5 days) is equally effective, safer and more readily administered than plasmapheresis. However, in Australia it is very expensive and difficult to obtain.
Corticosteroids and Immunosuppressive Drugs
There is no evidence that corticosteroids and immunosuppressive therapy are of any benefit in Guillain-Barré Syndrome.
Early arrangements need to be made for physiotherapy. Some patients are only mildly affected and make a rapid recovery. Others are left with residual disability for example, hand weakness, foot-drop and the need for walking aids. This latter group will require long term rehabilitation.
Being completely paralysed and requiring ventilatory support is a terrifying experience and patients need to be given a full account of their illness, the likely duration of their paralysis and the strong likelihood of very good recovery. Special counselling may be necessary.