The Guillain-Barré syndrome: diagnosis, treatment and prognosis

The diagnosis of Guillain-Barré syndrome is usually not difficult, but criteria and possible pitfalls have been discussed. General care is still very important, but at present specific treatments are also available. For practical reasons high-dose immunoglobulins may be preferred above plasma-exchange. Moreover in a large study in the Netherlands of 150 patients it was shown that immunoglobulins were significantly superior with respect to the main outcome criterion and several secondary outcome criteria. In treating individual patients it is important to know that many patients do not have a favourable course and that such a course may be predicted. Also the individual patient may deteriorate further during and after treatment. In general this should not lead to a switch in treatment modality.