Therapy

The treatment is carried out symptomatically under intensive medical supervision. This means that the function of the heart and lungs in particular are continuously monitored. If necessary, a pacemaker and respiration may be necessary.

Nutrition may have to be ensured by administering nutrients and fluids through a vein (infusions). Furthermore, physiotherapy, psychological care and prophylactic measures to prevent pressure ulcers, blood clot formation (thrombosis), joint stiffness (contractures) and pneumonia are important components of therapy. Drug therapy consists of the high-dose administration of antibodies (7-S-immunoglobulin G 0.4g/kgkgKG/day) via a vein for 5 days.

Cortisone preparations are only used in the chronic form of Guillain-Barré syndrome. If the disease progresses and walking ability is severely restricted (walking distance less than 5 m without assistance), plasmapheresis is performed 5 – times every 2 days.In plasmapheresis, the blood fluid (plasma) is separated from the blood cells. The plasma can then be purified and returned to the patient together with the cells. Alternatively, the cells can be returned together with foreign plasma, plasma substitute, etc. Plasmapheresis leads to a faster recovery of symptoms and to a shorter ventilation time.

Prognosis

The recovery takes weeks to months. The neurological deficits regress in reverse order. The lethality (mortality) depends on the care and is currently below 5%.

Prognostically unfavorable is a ventilation obligation lasting more than one month. In about 70% of the cases, Guillain-Barré syndrome heals with motor weaknesses and reflex deficits, but without hindering daily life. 5 – 15% retain impairing disabilities. In about 4% of cases, after months or years, the disease reappears (relapse).

Complications

Cardiac arrest (asystole) is a complication of Guillain-Barré syndrome, which is caused by a conduction disorder of the nerve cells in the heart. Due to the pathological alteration of special nerve fibers (autonomic neuropathy), which are responsible for a heart rate appropriate to the situation, the heart is thrown out of rhythm. The result is cardiac arrhythmia, in which the heart beats too fast (tachycardia), too slowly (bradycardia) or no longer at all (asystole).

In this situation, a pacemaker or resuscitation (resuscitation) may be necessary for a certain time. Since the pathological change in specific nerve fibers (autonomic neuropathy) affects not only those fibers that move to the heart, but also, for example, those that move to the lungs, respiratory paralysis can also occur. If this is the case, the patient must be ventilated to ensure an adequate supply of oxygen to the lungs. The paralysis (paresis) that occurs in Guillain-Barré syndrome can lead to the formation of blood clots, thrombosis and pulmonary embolism because the blood tends to clot more easily due to the lack of movement. The lack of exercise also promotes the development of pressure sores (bedsores, decubitus), joint stiffness (contractures) and pneumonia.