Initial Treatment

Initial treatment is supportive. Plasma exchange (PE) or intravenous immunoglobulins (IVIG) are indicated in the treatment of GBS patients who are severely affected (unable to walk). Corticosteroids are of no proven benefit.

Patients should have regular monitoring of lung function – the more severely affected will require respiratory support and must be managed in the intensive care unit (ICU).

The effect of GBS on autonomic function should not be forgotten, and initially continuous cardiac monitoring and regular blood pressure readings should be taken.

Specific scenarios are explained below.

Severely affected patients (unable to walk)

PE or IVIG should be initiated for more severely affected patients, ideally within the first two weeks of symptoms.

A Cochrane review did not find either treatment better than the other, nor was the combination of both treatments superior to either treatment alone.

No benefit has been demonstrated in the use of oral corticosteroids. Trials of intravenous corticosteroids have shown some benefit but this has not reached statistical significance.

Mildly affected patients (able to walk)

Although there is some evidence that treatment with PE may be beneficial, there are no adequate trials to support the use of IVIG or PE in GBS patients who retain the ability to walk.

Miller Fisher syndrome (MFS)

The final outcome of MFS is generally good.

There are no randomised controlled trials of IVIG or PE usage, and what trials there are show little benefit.