Guillain-Barré syndrome natural history, complications, and prognosis


 * Associate Editors-In-Chief: Priyamvada Singh, MBBS [mailto:psingh@perfuse.org]

Overview
Guillain-Barré syndrome (GBS) is an acute, autoimmune, polyradiculoneuropathy affecting the peripheral nervous system, usually triggered by an acute infectious process. Approximately 80% of patients have a complete recovery within a few months to a year, although minor findings may persist. A patient's outcome is most likely to be very good when the symptoms go away within 3 weeks after they first started. Complications like paralysis, respiratory failure and hypotension can be seen in these patients.

Natural history

 * Most of the time recovery starts after 4th week from the onset of the disease.
 * Approximately 80% of patients have a complete recovery within a few months to a year, although minor findings may persist, such as areflexia.
 * About 5-10% recover with severe disability, with most of such cases involving severe proximal motor and sensory axonal damage with inability of axonal regeneration.
 * However, this is a grave disease and despite all improvements in treatment and supportive care, the death rate among patients with this disease is still about 2-3% even in the best intensive care units.
 * Worldwide, the death rate runs slightly higher (4%), mostly from a lack of availability of life support equipment during the lengthy plateau lasting 4 to 6 weeks, and in some cases up to 1 year, when a ventilator is needed in the worse cases.
 * About 5-10% of patients have one or more late relapses, in which case they are then classified as having chronic inflammatory demyelinating polyneuropathy (CIDP).

Prognosis

 * Recovery can take weeks or years.
 * Approximately 80% of patients have a complete recovery within a few months to a year, although minor findings may persist, such as areflexia.
 * About 5–10% recover with severe disability, with most of such cases involving severe proximal motor and sensory axonal damage with inability of axonal regeneration.
 * A patient's outcome is most likely to be very good when the symptoms go away within 3 weeks after they first started.
 * According to the National Institute of Neurological Disorders and Stroke, about 30% of patients still have some weakness after 3 years. Mild weakness may persist for some people.
 * Despite all improvements in treatment and supportive care, the death rate is still about 2–3% even in the best intensive care units.
 * Worldwide, the death rate runs slightly higher (4%), mostly from a lack of availability of life support equipment during the lengthy plateau lasting four to six weeks, and in some cases up to one year, when a ventilator is needed in the worst cases.
 * About 5–10% of patients have one or more late relapses, in which case they are then classified as having chronic inflammatory demyelinating polyneuropathy (CIDP).
 * Poor prognostic factors include age over 40 years, history of preceding diarrheal illness, requiring ventilator support, high anti-GM1 titre, and poor upper limb muscle strength.

Complications related to disease

 * Breathing difficulty (respiratory failure) due to involvement of respiratory system.
 * Low or unstable blood pressure (due to autonomic system involvement)
 * Paralysis or paresis (Permanent loss of movement of an area)

Complications caused due to immobility

 * Contractures of joints or other deformity
 * Deep vein thrombosis (blood clots
 * Increased risk of infections
 * Sucking food or fluids into the lungs (aspiration)
 * Pneumonia