Guillain-Barre syndrome: A review and analysis of current neurorehabilitation approaches and outcomes

The Guillain-Barre Syndrome (GBS) is the most common form of an acquired acute inflammatory polyradiculoneuropathy in the United States, with an average annual incidence of 1.5 per 100,000 persons. The demyelinating form is the most common; however, other forms exist, including acute motor axonal neuropathy (AMAN), acute motor sensory axonal neuropathy (AMSAN), the Miller Fisher syndrome, and acute pandysautonomia. Although the precise cause of GBS is unknown, it is believed to result from an autoimmune-mediated attack against the peripheral nerve. Clinically, it usually presents as an acute, progressive, symmetrical ascending quadriparesis with areflexia. Sensory and autonomic pathways, cranial nerves, and depressed respiratory function may also be involved. The diagnosis is based on clinical presentation, cerebrospinal fluid (CSF) examination, and electrodiagnostic studies. Acute treatment consists of hemodynamic and respiratory stabilization, management and prevention of medical co-morbidities, and either plasma exchange or intravenous IgG therapy. Roughly 75% of all patients achieve good recovery; however, up to 20% may be left with significant disability. In spite of effective therapies, mortality is nearly 5%, and approximately 40% of patients hospitalized with GBS will require admission to an inpatient rehabilitation facility. In this review, we examine the current literature regarding effective treatment strategies, rehabilitation outcomes, and functional scales used. We advocate a multidisciplinary approach, addressing both the immediate and long-term medical and psychosocial issues faced by patients with Guillain-Barre syndrome. Emphasis should be placed on identifying patients likely to have suboptimal recovery, treatment and prevention of medical complications, and addressing psychosocial factors, such as returning to work and quality of life.