Guillain-Barré syndrome natural history, complications, and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Priyamvada Singh, MBBS [2]

Overview

Approximately 80% of patients have a complete recovery within a few months to a year, although minor findings may persist. A patient's outcome is most likely to be very good when the symptoms go away within 3 weeks after they first started. Complications like paralysis, respiratory failure and hypotension can be seen in these patients.

Natural History, Complications, and Prognosis

Natural history

• Most of the time recovery starts after 4th week from the onset of the disease.
• Approximately 80% of patients have a complete recovery within a few months to a year, although minor findings may persist, such as areflexia.
• About 5-10% recover with severe disability, with most of such cases involving severe proximal motor and sensory axonal damage with inability of axonal regeneration.
• However, this is a grave disease and despite all improvements in treatment and supportive care, the death rate among patients with this disease is still about 2-3% even in the best intensive care units.
• Worldwide, the death rate runs slightly higher (4%), mostly from a lack of availability of life support equipment during the lengthy plateau lasting 4 to 6 weeks, and in some cases up to 1 year, when a ventilator is needed in the worse cases.
• About 5-10% of patients have one or more late relapses, in which case they are then classified as having chronic inflammatory demyelinating polyneuropathy (CIDP).

Complications

• Common complications of GBS include:
  • respiratory failure
  • Autonomic failure
  • Bulbar pulsy
  • Deep vein thrombosis
  • Cardiac arrhythmia
  • Pain
  • Urinary retention
  • Ileus
  • Persistent fatigue

Prognosis

• Recovery can take weeks or years.
• Approximately 80% of patients have a complete recovery within a few months to a year, although minor findings may persist, such as areflexia.
• About 5–10% recover with severe disability, with most of such cases involving severe proximal motor and sensory axonal damage with inability of axonal regeneration.
• A patient's outcome is most likely to be very good when the symptoms go away within 3 weeks after they first started.
• According to the National Institute of Neurological Disorders and Stroke, about 30% of patients still have some weakness after 3 years. Mild weakness may persist for some people.
• Despite all improvements in treatment and supportive care, the death rate is still about 2–3% even in the best intensive care units.
• Worldwide, the death rate runs slightly higher (4%), mostly from a lack of availability of life support equipment during the lengthy plateau lasting four to six weeks, and in some cases up to one year, when a ventilator is needed in the worst cases.
• About 5–10% of patients have one or more late relapses, in which case they are then classified as having chronic inflammatory demyelinating polyneuropathy (CIDP).
• Poor prognostic factors include age over 40 years, history of preceding diarrheal illness, requiring ventilator support, high anti-GM1 titre, and poor upper limb muscle strength.