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neuro.gbs-aidp.v1

Guillain-Barré Syndrome — AIDP (classic demyelinating)

neurologyacuteadultpediatricpregnancyacuteinpatient
Start encounter →Print handoutPRODUCTION

Phase C shard-3 neuro wave-12 recovery (2026-05-15): authored at SCAFFOLDED — no AIDP-specific workup in clinical-tools-registry.ts (only workup.gbs registered for the shared GBS-spectrum pathway). AIDP = ~85% of Western GBS; classic demyelinating pattern (segmental slowing + conduction block + prolonged distal latencies + temporal dispersion + reduced F-wave persistence). 5 setting playbooks: home (EMS recognition + no sedation) → ed (Brighton + EGRIS + LP + NCS) → icu (20-30-40 rule + autonomic monitoring) → inpatient (treatment-related fluctuation watch + CIDP transition surveillance) → outpatient (rehab + CIDP surveillance + vaccine-delay). 8 severity_triggers: classic_ascending_areflexia, bulbar_aspiration, respiratory_failure_FVC<20, autonomic_arrhythmia_BP_lability, rapidly_progressive_24-48h, pregnancy_aidp, pediatric_aidp, CIDP_transition_>8wk. 6 PMID evidence anchor: Hughes Cochrane IVIG (25238327), Raphael Cochrane PLEX (22786475), van Doorn 2011 (25023340), Fokke Brighton criteria validation Brain 2013 (24163275), EGRIS Walgaard Ann Neurol 2010 (20517939), mEGOS Walgaard 2011 (21403108). IVIG vs PLEX equivalent per Hughes Cochrane 2014; do NOT combine. Steroids alone NOT effective in AIDP/GBS (Hughes Cochrane 2014). Avoid succinylcholine — use rocuronium + sugammadex. Schema-blocked: calc.egris, calc.megos, calc.brighton, calc.mrc_sum_score, calc.gbs_disability_scale, workup.aidp_ncs_pattern — surfaced in depth bundle as cross-shard tickets. Sibling siblings: neuro.gbs-aman.v1 (same-commit), neuro.gbs-miller-fisher.v1 (same-commit), neuro.gbs.core.v1 (parent PRODUCTION engine), neuro.mg-crisis.core.v1 (real engine), neuro.transverse-myelitis.v1 (real engine). Promotion to INTEGRATED requires AIDP-specific NCS cascade + IVIG/PLEX cascade in clinical-tools-registry.

Entry points (6)

  • symptom
    Classic ascending symmetric areflexic weakness + glove-and-stocking paresthesia (Brighton 2011 PMID 24163275)
    classic_ascending_symmetric_areflexic_weakness
  • history
    Preceding infection 1-6 wk prior (Campylobacter / CMV / EBV / Mycoplasma / Zika) (van Doorn 2011 PMID 25023340)
    preceding_infection_6wk
  • imaging
    NCS demyelinating pattern: segmental slowing + conduction block + prolonged distal latencies + temporal dispersion + reduced F-wave persistence (van Doorn 2011 PMID 25023340)
    ncs_demyelinating_pattern
  • symptom
    Bulbar weakness with dysphagia / dysarthria / choking (AAN 2012)
    bulbar_aspiration_risk
  • symptom
    Respiratory failure — FVC <20 mL/kg or NIF magnitude <30 cmH2O (20-30-40 rule; AAN 2012)
    respiratory_decline_fvc_under_20
  • symptom
    Autonomic instability — paroxysmal bradycardia/tachycardia, BP swings >40 mmHg (IGOS Doets 2018 PMID 30247567)
    autonomic_dysregulation

Required inputs (12)

  • agerequired
    demographic • used at CONTEXT
    Age + pregnancy/pediatric status drive treatment selection and dose (EAN/PNS 2023)
  • preceding_infection_6wkrequired
    history • used at CONTEXT
    Preceding infection in 60-70% of AIDP; informs variant + tx urgency (van Doorn 2011 PMID 25023340)
  • weakness_pattern_ascending_symmetricrequired
    symptom • used at FRAME
    Ascending symmetric pattern + areflexia is Brighton level 1 anchor for AIDP (Brighton 2011 PMID 24163275)
  • mrc_sum_scorerequired
    symptom • used at RISK_STRATIFICATION
    MRC sum 0-60 quantifies severity + tracks progression (AAN 2012)
  • fvc_nifrequired
    vital • used at RED_FLAGS
    20-30-40 rule — FVC <20 mL/kg or NIF magnitude <30 cmH2O triggers elective intubation (AAN 2012)
  • hrrequired
    vital • used at RED_FLAGS
    Autonomic — paroxysmal tachy/brady, asystole risk (IGOS Doets 2018)
  • sbprequired
    vital • used at RED_FLAGS
    Autonomic BP swings — labile HTN/hypotension (IGOS Doets 2018)
  • csf_protein_cell_countrequired
    lab • used at INITIAL_WORKUP
    Albumino-cytologic dissociation — present in ~50% wk1, 75% wk2 (AAN 2012)
  • iga_levelrequired
    lab • used at INITIAL_WORKUP
    IgA deficiency screen before IVIG (anaphylaxis risk) (EAN/PNS 2023)
  • mri_spine_with_contrastrequired
    imaging • used at INITIAL_WORKUP
    Exclude transverse myelitis / cord compression; enhancing nerve roots support GBS (NICE 2024)
  • ncs_emg_demyelinatingrequired
    imaging • used at BRANCHING_WORKUP
    Demyelinating pattern confirms AIDP vs AMAN/AMSAN (van Doorn 2011 PMID 25023340)
  • pregnancy_testrequired
    lab • used at INITIAL_WORKUP
    Required pre-IVIG/PLEX in reproductive-age females (EAN/PNS 2023)

12-phase flow (12)

  1. 1FRAME
    Confirm AIDP — symmetric ascending areflexic weakness + preceding infection + demyelinating NCS (Brighton 2011 PMID 24163275; van Doorn 2011 PMID 25023340)
    inputs: weakness_pattern_ascending_symmetric
    advance: AIDP-compatible pattern; cord compression excluded
  2. 2ENTRY
    Ascending areflexic weakness ± preceding infection (Brighton 2011)
    inputs: age, preceding_infection_6wk
    advance: AIDP entry features captured
  3. 3CONTEXT
    Vitals (FVC/NIF, HR, BP), bulbar exam, autonomic screen, pregnancy status (EAN/PNS 2023)
    inputs: fvc_nif, hr, sbp, mrc_sum_score
    advance: Neuromuscular + autonomic baseline complete
  4. 4RED_FLAGS
    Respiratory failure (FVC <20, NIF magnitude <30), bulbar airway compromise, autonomic instability → ICU + intubation (AAN 2012)
    inputs: fvc_nif, hr, sbp
    actions: workup.gbs
    advance: Airway secured/stable + ICU allocated
  5. 5INITIAL_WORKUP
    CSF (protein/cell count), MRI spine with gad, CBC/CMP/LFT, IgA, pregnancy test, HIV (EAN/PNS 2023)
    inputs: csf_protein_cell_count, mri_spine_with_contrast, iga_level, pregnancy_test
    actions: panel.cbc, panel.renal, panel.lft, panel.coag
    advance: CSF + MRI back; IgA documented pre-IVIG
  6. 6BRANCHING_WORKUP
    NCS/EMG demyelinating pattern (segmental slowing + conduction block) confirms AIDP; stool Campylobacter if AMAN suspected (van Doorn 2011)
    inputs: ncs_emg_demyelinating
    advance: AIDP electrodiagnostic pattern confirmed
  7. 7DIFFERENTIAL
    AIDP (this engine) vs AMAN (route gbs-aman) vs MFS (route gbs-miller-fisher) vs MG crisis vs botulism vs tick paralysis vs CIDP (>8 wk) (van Doorn 2011)
    advance: AIDP phenotype confirmed
  8. 8RISK_STRATIFICATION
    EGRIS (Walgaard 2009 PMID 20517939) ventilation prediction; mEGOS (Walgaard 2011 PMID 21403108) outcome prognostication; MRC sum + GBS disability scale (AAN 2012)
    inputs: mrc_sum_score
    actions: calc.nihss
    advance: EGRIS + disability scale documented
  9. 9TREATMENT
    IVIG 0.4 g/kg/d × 5 d OR PLEX 5 sessions q48h (equivalent per Hughes Cochrane 2014 PMID 25238327; do NOT combine; NO steroids alone); DVT prophylaxis; neuropathic pain; SLP
    inputs: iga_level
    advance: Immunomodulation started + supportive bundle initiated
  10. 10DISPOSITION
    ICU if EGRIS ≥5 / FVC <20 / autonomic instability; neuro ward otherwise with serial FVC q4-6h (NICE 2024)
    inputs: fvc_nif
    advance: Level-of-care decision made
  11. 11MONITORING
    q4-6h FVC/NIF, continuous ECG (autonomic), serial MRC + disability score; watch treatment-related fluctuation wk 2-3 (EAN/PNS 2023)
    inputs: fvc_nif, mrc_sum_score
    actions: panel.cbc
    advance: Monitoring plan documented
  12. 12FOLLOWUP
    Neuro rehab, vaccine-delay advice, CIDP surveillance (>8 wk recurrence), psychology (NICE 2024)
    advance: Rehab + outpatient neurology follow-up scheduled