The severity of Guillain-Barré Syndrome varies widely from case to case. Sometimes it can be merely annoying, with minor numbness and weakness spreading not much further than the hands. Other times, Guillain-Barré can be devastating or even fatal.
Because of this uncertainty, doctors usually ask someone they suspect has Guillain-Barré syndrome to stay in the hospital so they can be closely watched until the symptoms improve. It can be difficult to predict exactly how long this will take. Most people with Guillain-Barré syndrome reach their weakest point within two or three weeks after they first notice their symptoms.
In order to observe how the disease is changing someone's ability to breathe, measurements of breathing are taken frequently. Those measures usually include the forced vital capacity or the negative inspiratory force, which measure how well someone can beathe out or in, respectively. Frequent examinations may also be done to ensure the patient is not getting significantly weaker.
If the weakness progresses to a certain point, monitoring may have to happen in an intensive care unit, where mechanical ventilation can be started quickly if necessary. Additional measures can be taken to keep an eye on autonomic features, such as heart rate and rhythm.
After the weakness has started to improve, some amount of rehabilitation can occur while still in the hospital as arrangements are made for any additional support required.
There is no cure for Guillain-Barré syndrome, but the attack can be tempered by filtering problematic antibodies out of the blood with plasmapheresis or by giving intravenous immunoglobulins (IVIg) in order to neutralize antibodies.
Plasmapheresis, also known as plasma exchange, involves the liquid part of blood (rather than blood cells) being removed and replaced with plasma that is antibody-free. This process is usually done between three to five times, usually with a day in between sessions in order for the body to readjust to the new plasma. Risks are few, but include blood problems.
IVIg is an injected immunoglobulin that has been shown to shorten the time it takes for someone to recover from Guillain-Barré, although no one knows exactly why it works. The amount of risk is similar to plasmapharesis, but rather than blood problems, IVIg may lead to allergic reactions, hepatitis, or kidney problems.
Research shows that IVIg and plasmapheresis are equally good at treating Guillain-Barré syndrome, and there's no clear benefit to doing both together. In severe cases, some doctors will still sometimes do plasma exchange followed by IVIg.
While in the hospital, medical staff will keep a close eye on people with Guillain-Barré syndrome to ensure that the weakness does not interfere with such important functions as swallowing safely and breathing. If the Guillain-Barré progresses to this point, then it may be necessary to intubate the patient and put them on mechanical ventilation.
Recovery and Prognosis
Most people recover well from Guillain-Barré syndrome, but this varies between cases. Some forms, such as AMSAN, require a longer time to recover. The more severe the case is, the longer the recovery time. Nerves take a long time to grow back -- just millimeters a day -- and if the damage is extensive, it can take up to a year or more to regain function. In some cases, some deficits, such as difficulty with small finger movements or residual numbness, will remain.
Physical and occupational therapy is frequently required for patients to recover fully. Occupational therapists help find equipment and other methods to keep people as independent as possible, whereas physical therapists help with walking and mobility. Speech and language therapists may be required if the muscles around the mouth and throat have been involved.
Guillain-Barré can be a serious disorder, but over 95% of the time, people recover to some degree. Relapse is uncommon, with percentages quoted as being between 2-6%. The path can be long and challenging, but in the end, most people are able to leave Guillain-Barré behind them.
Ropper AH, Samuels MA. Adams and Victor's Principles of Neurology, 9th ed: The McGraw-Hill Companies, Inc., 2009. McCabe MP, O'Connor EJ.
Yuen T. So, Continuum: Peripheral Neuropathies, Immune-Mediated Neuropathies, Volume 18, Number 1, February 2012