Diagnosis and management of Guillain–Barré syndrome in ten steps

Autor: Badrul Islam, Thirugnanam Umapathi, Mario Emilio Dourado, Melissa R. Mandarakas, Pieter A. van Doorn, James J. Sejvar, Susumu Kusunoki, Carlos A. Pardo, Cristiane Soares, Hugh J. Willison, Ricardo Reisin, Eppie M. Yiu, Francisco de Assis Aquino Gondim, Sonja E. Leonhard, Nortina Shahrizaila, Bart C. Jacobs, Maria Lucia Brito Ferreira, Richard A. C. Hughes, Yuzhong Wang, David R. Cornblath, Kathleen Bateman
Přispěvatelé: Neurology, Immunology
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Zdroj: Nature Reviews. Neurology
Nature Reviews Neurology, 15(11), 671-683. Nature Publishing Group
ISSN: 1759-4766
1759-4758
Popis: Guillain–Barré syndrome (GBS) is a rare, but potentially fatal, immune-mediated disease of the peripheral nerves and nerve roots that is usually triggered by infections. The incidence of GBS can therefore increase during outbreaks of infectious diseases, as was seen during the Zika virus epidemics in 2013 in French Polynesia and 2015 in Latin America. Diagnosis and management of GBS can be complicated as its clinical presentation and disease course are heterogeneous, and no international clinical guidelines are currently available. To support clinicians, especially in the context of an outbreak, we have developed a globally applicable guideline for the diagnosis and management of GBS. The guideline is based on current literature and expert consensus, and has a ten-step structure to facilitate its use in clinical practice. We first provide an introduction to the diagnostic criteria, clinical variants and differential diagnoses of GBS. The ten steps then cover early recognition and diagnosis of GBS, admission to the intensive care unit, treatment indication and selection, monitoring and treatment of disease progression, prediction of clinical course and outcome, and management of complications and sequelae.
In this Consensus Statement, Leonhard et al. provide a globally applicable guideline for the diagnosis and management of Guillain–Barré syndrome, including information on early recognition of the disease, prediction of clinical course and outcome, and management of complications and sequelae.
Key points Classic Guillain–Barré syndrome (GBS) is an acute-onset ascending sensorimotor neuropathy, but the disease can present atypically or as a clinical variant.Abnormal results in electrophysiological studies and a combination of an increased protein level and normal cell count in cerebrospinal fluid are classic features of GBS, but patients with GBS can have normal results in both tests, especially early in the disease course.Respiratory function should be monitored in all patients as respiratory failure can occur without symptoms of dyspnoea.Intravenous immunoglobulin and plasma exchange are equally effective in treating GBS; no other treatments have been proven to be effective.The efficacy of repeat treatment in patients who have shown insufficient clinical response is uncertain; nevertheless, this practice is common in patients who show deterioration after an initial treatment response.Clinical improvement is usually most extensive in the first year after disease onset and can continue for >5 years.
Databáze: OpenAIRE
Externí odkaz: