GUILLAIN-BARRÉ SYNDROME: EVIDENCE-BASED THERAPEUTIC STRATEGIES
Keywords:
Guillain-Barré Syndrome, Immunotherapy, Prognosis, Rehabilitation, Biomarkers, Complement SystemAbstract
Guillain-Barré syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy and the leading cause of acquired neuromuscular paralysis in adults, with a low incidence but a significant impact on morbidity, mortality, and functional disability. This narrative review, based on recent international guidelines and high-impact studies, discusses in an integrated manner acute therapeutic strategies, prognostic stratification, rehabilitation, and emerging therapies. In acute treatment, intravenous immunoglobulin (IVIg) and plasmapheresis (PLEX) show globally equivalent efficacy in accelerating functional recovery when used within the therapeutic window, while the isolated use of corticosteroids and the routine repetition of a second course of IVIg are not recommended. Risk stratification using validated scores, such as EGRIS/EGBS, EGOS, and mEGOS, allows estimation of the probability of mechanical ventilation and independent ambulation, and should be used in a complementary way to clinical judgment. In the subacute and chronic phases, supervised and multidisciplinary rehabilitation plays a central role, particularly in reducing fatigue, improving strength and quality of life, compared to unsupervised home programs. In the field of molecular therapies, complement inhibitors, especially C1q blockade, and agents targeting FcRn, still under investigation, are emerging. Simultaneously, neurofilament light chain (NfL) is emerging as an important biomarker of axonal damage and functional prognosis. Together, these advances point to a future of more personalized management of GBS, without negating the need for rigorous application of already established evidence.
