When Guillain-Barré syndrome progresses to the point where a patient can no longer walk unaided, or when additional features of severe disease are present, timely intervention is critical. This page summarises the clinical scenario and points to the full structured regimen.

Clinical Scenario

This protocol applies to patients who are unable to walk unaided (GBS disability score grade 3 or more) and are within 4 weeks from onset of weakness. It also covers patients who remain able to walk unaided but have developed swallowing difficulties or autonomic disturbances, features that indicate the need for active treatment.

Treatment Approach

For patients in this clinical situation, immediate initiation of specific immunotherapy is strongly supported. Two established treatment modalities are considered equally appropriate first-line options — the full regimen details, exchange parameters, and decision points for choosing between them are contained in the complete protocol.

References

DOI: 10.1111/jns.12594

The TF strongly recommends starting PE as soon as possible in GBS patients unable to walk unaided (GBS-DS grade 3 or more) and within 4 weeks from onset.
The TF strongly recommends starting IVIg as soon as possible in patients unable to walk unaided (GBS-DS grade 3 or more) if still within the first 2 weeks from onset of weakness.
The TF suggests (GPP) that patients still able to walk but having features like swallowing difficulties of autonomic disturbances are also eligible for treatment.
The TF weakly recommends the most frequently used and proven effective standard course of IVIg rather than other dosing schedules or longer treatment courses.
The TF strongly recommends four to five exchanges over 1-2 weeks in patients who are severely disabled (unable to walk unaided, bedridden or ventilated).
There is no preference for treatment with IVIg or PE.

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Treatment of Guillain-Barré Syndrome When Unable to Walk Unaided (GBS Disability Score Grade 3 or More)