Guide for GP's
Guillain-Barré Syndrome support groups exist in most major cities and are valuable in providing long term assistance to patients. In the acute stages of the disease patients are usually reassured by talking to others who have endured the same experience and made a good recovery.
On returning home from hospital, care will be shared between the specialist, the GP and rehabilitation specialists. The GP will be responsible for primary care: managing any complications or recurrent illness, providing support and encouragement to the patient and family, or coordinating phone care and physiotherapy.
Nerve conduction studies are usually abnormal in Guillain-Barré Syndrome, with marked slowing of motor conduction and impaired sensory conduction. Lumbar puncture is usually performed to confirm the diagnosis; typically the CSF protein is elevated and white cell concentration is not increased. Other investigations performed routinely include full blood count, erythrocyte sedimentation rate, serum electrolytes, creatinine and urea, blood glucose, and serological tests for HIV and Lyme disease. The presence of a high white sell count in the cerebrospinal fluid (greater than 30x106/L) should raise the suspicion of HIV infection.
- Guillain-Barré Syndrome should be considered as a diagnosis in anyone presenting with acute or subacute progressive weakness.
- Common initial symptoms are back pain, paraesthesia and weakness.
- Bilateral facial weakness should alert the clinician to the diagnosis.
- Respiratory paralysis may develop rapidly and the patient should be admitted to hospital as soon as the diagnosis is suspected.
- Plasmapheresis and intravenous immunoglobulin shorten the duration of the illness and reduce the frequency and severity of complications.
- Twenty per cent of patients will have residual physical disability requiring long-term management and GP supervision at home.