Intensive Care and Treatment of Severe Guillain–Barré Syndrome

Abstract

Guillain–Barré syndrome (GBS) is an acute polyneuropathy mostly characterized by acute flaccid paralysis with or without sensory/autonomous nerve dysfunction. Current immuno therapies including intravenous immunoglobulin (IVIg), plasma exchange (PE), and newly developed biological drugs benefit patients by alleviating hyperreactive immune responses. Up to 30% of patients develop respiratory failure during hospitalization and require mechanical ventilation and intensive care. Immunotherapies, mechanical ventilation, supportive care, and complication management during the intensive care unit (ICU) stay are equally emphasized. The most important aspect of intensive care and treatment of severe GBS, that is, mechanical ventilation, has been extensively reviewed elsewhere. In contrast to immunotherapies, care and treatment of GBS in the ICU setting are largely empirical. In this review, we intend to stress the importance of intensive care and treatment, other than mechanical ventilation in patients with severe GBS. We summarize the up-to-date knowledge of pharmacological therapies and ICU management of patients with severe GBS. We aim to answer some key clinical questions related to the management of severe GBS patients including but not limited to: Is IVIg better than PE or vice versa? Whether combinations of immune therapies benefit more? How about the emerging therapies promising for GBS? When to perform tracheal intubation or tracheostomy? How to provide multidisciplinary supportive care for severe cases? How to avert life-threatening complications in severe cases?

Dynamic Changes in Central and Peripheral Neuro-Injury vs. Neuroprotective Serum Markers in COVID-19 Are Modulated by Different Types of Anti-Viral Treatments but Do Not Affect the Incidence of Late and Early Strokes

“…NCAM-1 levels remained elevated during and after the onset of COVID-19, suggesting evidence of ongoing peripheral nerve injury. The next step is to link the severity of GBS to NCAM-1 levels to describe the correlation between these markers and the degree of clinical symptoms [ 131 , 132 , 133 ].…”

Guillain–Barré Syndrome in COVID-19—The Potential Role of NCAM-1 and Immunotherapy

“…The onset and progression of GBS has previously been related to certain neuroinflammation characteristics of well-studied neurological disorders [3]. The release of peripheral injury markers seems to be a natural consequence of the autoantibody binding, intrathecal immune system activation, or cytotoxicity [3,18]. While certain markers such as apolipoprotein E (ApoE) seem to be found in decreased levels in patients' CSF, both the plasma and CSF levels of others (interleukin 37 (IL-37), interleukin 17A (IL-17A), interferon gamma (IFN-γ), and tumor necrosis factor alpha (TNF-α)) seem to be significantly higher following the onset of GBS symptoms [19,20].…”

“…He had weak bilateral hand grip, no movement in bilateral lower extremities, intact sensation and proprioception throughout, and absent reflexes except in bilateral wrist extensors. His respiratory strength declined, and he required bilevel positive airway pressure ventilation (day 2) and intubation (day 3) (Figure 2) [18]. Cervical, thoracic, and lumbar spine magnetic resonance imaging was completed on day 4 and revealed no definite leptomeningeal, spinal cord, or nerve root enhancement.…”

“…Lumbar puncture performed on day 4 revealed an opening pressure of 27 cmH 2 O, CSF protein of 117 mg/dL (normal 15-45 mg/dL), CSF white blood cells of 2/µL (normal 0-5/µL), and 115/µL red blood cells (normal 0/µL). Plasmapheresis (PLEX) was initiated on day 3 [18]. Intravenous immunoglobulins were thought to have a theoretical contraindication in the setting of possible hypercoagulability due to COVID-19.…”

Case Report: Abnormal ECG and Pantalgia in a Patient With Guillain–Barré Syndrome

“…Autonomic dysfunction involving cardiovascular abnormalities during the course of GBS is universally acknowledged (1, 5, 7-9), and it is suggested that T-wave inversion can be observed in 12.5% of patients with GBS (5). Furthermore, pantalgia, including atypical chest pain, is a common and often severe symptom in the whole spectrum of GBS (4,9).…”