Management of acute neuromuscular paralysis

The diagnosis of acute neuromuscular paralysis includes central nervous system disorders, peripheral neuropathy, neuromuscular conduction block and muscle disease. Identification of the cause is largely a clinical problem but neurophysiological investigations are often essential and a few specific tests are helpful. The commonest cause is Guillain-Barré syndrome. Special precautions, especially monitoring vital capacity, must be taken to detect respiratory failure and avoid atelectasis and chest infection. In acute neuropathy there is an additional danger of cardiac arrhythmias which requires continuous electrocardiographic monitoring. Prolonged artificial ventilation should be supervised by a specialist multidisciplinary intensive care team. Specific treatment depends on the diagnosis: for Guillain-Barré syndrome, intravenous immunoglobulin is preferred to plasma exchange on the basis of similar efficacy but greater convenience; steroids are not helpful; for myasthenia gravis, anticholinesterases and prednisolone may need to be supplemented with intravenous immunoglobulin or plasma exchange; for polymyositis, steroids are the mainstay of treatment. During convalescence patients require understanding and support in coping with residual disability.