Patient handout

Guillain-Barré Syndrome

PRODUCTION

1. Your condition

This handout is for guillain-barré syndrome. Your care team identified this based on: symmetric ascending limb weakness over hours–4 weeks (brighton 2011).

Other reasons your team may use this plan: areflexia / hyporeflexia on exam (brighton 2011); glove-and-stocking paresthesia (aan 2012); bulbar dysphagia / dysarthria (igos doets 2018).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
ivig	0.4 g/kg/d × 5 d (total 2 g/kg)	IV	daily × 5 d	EAN/PNS 2023 — IVIG and PLEX equivalent; check IgA pre-IVIG (Cochrane Hughes 2014)
plasmapheresis	5 sessions over 7–10 days (every other day)	IV	5 sessions q2 days	Cochrane Hughes 2014 — 5 sessions reduces ventilation; alternative when IgA deficient (EAN/PNS 2023)

Plan: GBS — IVIG/PLEX + supportive bundle

3. When to call your provider

Contact your care team if any of the following happen:

Worsening or new weakness >8 weeks post-GBS → CIDP workup (EAN/PNS 2023)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

FVC <20 mL/kg OR NIF magnitude <30 cmH2O OR rapid decline OR severe bulbar weakness; ~1/3 of GBS patients require MV (AAN 2012; EGRIS Walgaard 2010 PMID 20517939)(life-threatening)
Loss of ambulation within 7 days of onset OR weakness progression to maximal nadir in 24–48 h (IGOS Doets 2018 PMID 30247567)
Dysphagia, dysarthria, choking on saliva, facial diplegia — aspiration risk + airway compromise (AAN 2012)
Paroxysmal bradycardia/tachycardia, BP swings >40 mmHg, ileus, urinary retention, sudden cardiac arrhythmia (IGOS Doets 2018)
GBS variant: acute inflammatory demyelinating polyneuropathy — ~85% of Western cases; ascending weakness + areflexia; NCS shows segmental slowing + conduction block + prolonged distal latencies + temporal dispersion (AAN 2012; van Doorn 2008 PMID 18848313)
GBS variant: acute motor axonal neuropathy — common in Asia post-Campylobacter; pure motor; NCS reduced CMAP without slowing (axonal); anti-GM1/GD1a antibodies positive (IGOS Doets 2018 PMID 30247567)
GBS variant: acute motor + sensory axonal neuropathy — severe axonal loss in motor AND sensory fibers; worse prognosis; often residual disability; longer recovery (van Doorn 2008 PMID 18848313)(life-threatening)
GBS variant: Bickerstaff brainstem encephalitis — overlapping with Miller-Fisher: encephalopathy + brainstem signs + anti-GQ1b; cross-sectional spectrum with MFS (van Doorn 2008 PMID 18848313)
GBS variant: pharyngeal-cervical-brachial — bulbar + neck + upper limb weakness predominant; sparing legs initially; ICU concern for airway compromise (van Doorn 2008 PMID 18848313)

5. Follow-up

Neuro rehab planning, vaccine-delay advice, CIDP watch if recurrence, psychology support (NICE 2024)

6. Sources

Guideline: 2023 EAN/PNS Guideline on Diagnosis and Treatment of GBS (van Doorn/Van den Bergh, Eur J Neurol 2023, PMID 37814552) + Brighton case definition validation (Fokke, Brain 2014, PMID 24163275) + IGOS prognostic (mEGOS/EGRIS) + Cochrane Hughes IVIG / Cochrane Raphaël PLEX