Peripheral neuropathy Guillain Barré Syndrome
Signs & Symptoms
Symptomatology may be very atypical: eg. cranial nerve involvement, dyspnea, swallowing impairment, pain syndrome -weakness may worsen within hours
Evaluation
- GBS is a clinical diagnosis! Don’t wait with treatment untill all assessments have been done
- EMG
- Lumbar puncture after brain imaging: typically elevated protein with normal white blood cell count
- CMV, mycoplasma, hepatitis E, campylobacter jejuni serology, check presence of anti-GQ1b antibodies
- Swallowing analysis
- Pulmonary function tests with vital capacity and maximum inspiratory/expiratory pressures; respiratory function should be evaluated 6 x pd
- ECG
Management
- IVIg therapy
- Plasmapheresis or IVIg therapy might be repeated
- FU in accordance with local neurologists
- Corticoid treatment discussion
- Consider location of care where ventilatory support is available (required in 15-30% of idiopathic cases)
- Close FU of patient: monitoring of respiratory function at least 6 x pd + (ECG) monitoring in order to detect autonomic dysfunction
- DVT prevention
Corticoid treatment discussion
Not indicated for idiopathic GBS, however some case reports show interesting results with ICPI induced GBS with methylprednisolone 1-2mg/kg (check literature). Among the neurology community discussion is ongoing if ICPI induced GBS is similar to chronic inflammatory demyelinating polyneuropathy (CIDP). The latter has a similar symptoms as GBS but has a slower onset and in contrast to GBS, for CIDP corticoids are indicated.
Abbrevations
CMV: Cytomegalovirus
DVT: Deep Venous Thrombosis
EEG: Electro EncephaloGram
GBS: Guillain Barré Syndrome
ICPi: Immune Checkpoint Blockade Inhibition
EMG: ElectroMyoGram
IVIg: IntraVeneous Immunoglobulins
