Guillain-Barré Syndrome: Progress in Diagnosis, Biomarkers, Neuroimaging and Management

Guillain-Barré syndrome (GBS) is the leading cause of acute flaccid paralysis worldwide and represents a heterogenous spectrum of acute autoimmune polyradiculoneuropathies. Over the past decade, large international cohorts and advances in neuroimmunology have improved understanding of its clinical subtypes, infectious triggers, and pathophysiology. This review summarises recent progress across key aspects of diagnosis, prognostication, and treatment. We first describe updated perspectives of clinical heterogeneity including GBS variants and geographical variability, and the recognition of autoimmune nodopathies as an important differential diagnosis. We then discuss updated knowledge on antecedent infections including Campylobacter jejuni and anti-ganglioside antibodies, as well as the revised role of electrodiagnosis, as an exclusively diagnostic tool rather than allowing definite and meaningful subtype classification. Established prognostication models such as Erasmus GBS Outcome Score and Erasmus GBS Respiratory Insufficiency Score as well as emerging fluid biomarker candidates spanning biochemical, immunological, nerve-structural markers are reviewed. Advances in neuroimaging that aid in diagnosis and subtyping of GBS are also discussed. Finally, we highlight the evidence reaffirming intravenous immunoglobulin or plasma exchange as current standard-of-care and critically evaluate ongoing and recently completed trials including complement inhibitors.