neurologic disorders
Guillain Barré Syndrome (GBS)
Treatment of GBS
Intensive supportive care IV immune globulin (IVIG) or plasma exchange Guillain-Barré syndrome is a medical emergency,requiring constant monitoring and support of vital functions, typically in an intensive care unit. Forced vital capacity should be measured frequently so that respiration can be assisted if necessary; if vital capacity is < 15 mL/kg, endotracheal intubation is indicated. Inability to lift the head off the pillow by flexing the neck is another danger sign; it frequently develops simultaneously with phrenic nerve (diaphragm) weakness. If oral fluid intake is difficult, IV fluids are given as needed to maintain a urine volume of at least 1 to 1.5 L/day. Extremities should be protected from trauma and from the pressure of bed rest. Heat therapy helps relieve pain, making early physical therapy possible. Immobilization, which may cause ankylosis and contractures, should be avoided. Passive full-range joint movement should be started immediately, and active exercises should be initiated when acute symptoms subside. Low molecular weightheparin(LMWH) helps prevent deep venous thrombosis in bedbound patients. Several randomized trials and meta-analyses have reported that LMWH is more effective than low-dose unfractionatedheparin(typically given as 5000 units twice a day) and has a similar risk of bleeding. Given early, IVIG 2 g/kg over 1 to 2 days or, more slowly, as 400 mg/kg IV once a day for 5 consecutive days is the treatment of choice; it has some benefit up to 1 month from disease onset. Plasma exchange helps when done early; it is used if IVIG is ineffective. Plasma exchange shortens the disease course and hospital stay, and reduces mortality risk and incidence of permanent paralysis. However, it may cause hypotension due to large fluid shifts, and IV access may be difficult or cause complications. Plasma exchange removes any previously administered IVIG, negating its benefits, and so should never be done during or soon after use of IVIG. Waiting at least 2 to 3 days after stopping IVIG is recommended. Do not give corticosteroids in Guillain-Barré syndrome because they may worsen outcome. Corticosteroids do not improve and may worsen the outcome. 