Patients with Guillain-Barré syndrome have better recovery if they are given one of two treatments to calm their immune system: plasma exchange (also known as plasmapheresis) or intravenous immunoglobulin. Both are equally effective, but intravenous immunoglobulin is easier to give.
In plasma exchange, blood is removed from the patient with a machine similar to a dialysis machine. The cells in the blood are returned to the patient, but the plasma, or the liquid portion of the blood, is not. The body can quickly replace the plasma that is removed. Plasma exchange may help patients with Guillain-Barré syndrome by removing antibodies or other components in the plasma that injure nerve insulation or nerves.
In intravenous immunoglobulin therapy, patients are given large doses of antibodies derived from plasma from many different donors. Intravenous immunoglobulin may help patients with Guillain-Barré syndrome by blocking the action of antibodies that can injure nerve insulation or nerves.
About 10% of patients with Guillain-Barré syndrome will get worse again about three weeks after treatment, but their symptoms are usually not as severe as when they first got sick. Studies are underway to determine the best treatment for these patients who relapse. Some experts recommend repeating the same therapy as the patient was initially given.
“Supportive care” is also very important for patients with Guillain-Barré syndrome. Supportive care includes careful monitoring of breathing and swallowing, use of a ventilator (if necessary), and prevention or treatment of complications like pneumonia, blood clots in the veins of the legs, and bed sores. Pain control, and physical and occupational therapy are also critical.
What kind of recovery is expected in patients with Guillain-Barré syndrome?
Most patients with Guillain-Barré syndrome worsen for the first two weeks, are then stable for about two weeks, followed by improvement. About 60% of patients with Guillain-Barré syndrome recover completely, and about 84% regain the ability to walk by themselves at one year post-illness. About 4% of patients die, even with treatment in intensive care units. Prognosis for recovery is worse in people who had a gastrointestinal illness like Campylobacter infection as their trigger for Guillain-Barré syndrome, in older people, in people whose weakness came on quickly or who have severe weakness when they come to the hospital, and in people who need a ventilator.