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Supportive Care for Patients With Guillain-Barré Syndrome
Richard A. C. Hughes, MD;
Eelco F. M. Wijdicks, MD;
Estelle Benson;
David R. Cornblath, MD;
Angelika F. Hahn, MD;
Jay M. Meythaler, MD;
John T. Sladky, MD;
Richard J. Barohn, MD;
James C. Stevens, MD
Arch Neurol. 2005;62:1194-1198.
A multidisciplinary consensus group searched MEDLINE from 1966 to May 2003, extracted relevant references, and prepared recommendations on supportive care for Guillain-Barré syndrome. In the absence of randomized controlled trials, we agreed on recommendations by consensus based on observational studies and expert opinion. In the acute phase in bed-bound adult patients, the group recommended the use of heparin and graduated pressure stockings to prevent deep vein thrombosis, monitoring for blood pressure, pulse, autonomic disturbances, and respiratory failure, and the timely institution of artificial ventilation and tracheostomy. Pain management is difficult, but carbamazepine or gabapentin may help. The cautious use of narcotic analgesics may be needed. Disabled patients should be treated by a multidisciplinary rehabilitation team and should receive an assistive exercise program. Persistent fatigue following Guillain-Barré syndrome is common and may be helped by an exercise program. Because of a very small and possibly only theoretical increase in the risk of recurrence following immunization, the need for immunization should be reviewed on an individual basis. More research is needed to identify optimal methods for all aspects of supportive care.
Author Affiliations: Department of Clinical Neuroscience, King’s College, London, England (Dr Hughes); Department of Neurology, Mayo Clinic, Rochester, Minn (Dr Wijdicks); Guillain-Barré Syndrome Foundation International, Wynnewood, Pa (Mrs Benson); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Md (Dr Cornblath); London Health Sciences Center, London, Canada (Dr Hahn); Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham (Dr Meythaler); Division of Neurology, Emory University School of Medicine, Atlanta, Ga (Dr Sladky); Department of Neurology, University of Kansas Medical Center, Kansas City (Dr Barohn); and Fort Wayne Neurological Center, Fort Wayne, Ind (Dr Stevens).
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