Definitions of the ratings of recommendations (A, B, C, U) and the class of evidence for therapy (Class I-IV) are provided at the end of the "Major Recommendations" field.
Does initial immunotherapy hasten recovery?
Plasma exchange (PE)
- PE is recommended in nonambulant patients within 4 weeks of onset (Level A recommendation, Class II evidence) and for ambulant patients within 2 weeks of onset (Level B recommendation, limited Class II evidence).
- The effects of PE and intravenous immunoglobulin (IVIg) are equivalent (see below).
- There is insufficient evidence to recommend the use of cerebrospinal fluid (CSF) filtration (Level U recommendation, limited Class II evidence).
Immunoabsorption
- The evidence is insufficient to recommend the use of immunoabsorption (Level U recommendation, Class IV evidence).
Intravenous immunoglobulin (IVIg)
- IVIg is recommended for patients with Guillain-Barre syndrome (GBS) who require aid to walk within 2 (Level A recommendation) or 4 weeks from the onset of neuropathic symptoms (Level B recommendation derived from Class II evidence concerning PE started within the first 4 weeks and Class I evidence concerning the comparisons between PE and IVIg started within the first 2 weeks).
- The effects of IVIg and PE are equivalent.
Combination treatments
- Sequential treatment with PE followed by IVIg (Level A recommendation, Class I evidence) or immunoabsorption followed by IVIg (Level U recommendation, Class IV evidence) is not recommended.
Steroids
- Corticosteroids are not recommended for the treatment of patients with GBS (Level A recommendation, Class I evidence).
Are there special issues in the management of children with GBS?
- PE or IVIg are treatment options for children with severe GBS (Level B recommendation derived from Class II evidence in adults).
Definitions:
Class of Evidence for Therapy
Class I: High quality randomized controlled trials (RCTs).
Class II: Prospective matched group cohort studies or randomized controlled trials lacking adequate randomization concealment or blinding or potentially liable to attrition or outcome ascertainment bias.
Class III: Other studies such as natural history studies.
Class IV: Uncontrolled studies, case series or expert opinion.
Strength of the Recommendations
A = established as effective, ineffective, or harmful or as useful/predictive or not useful/predictive.
B = probably useful/predictive or not useful/predictive for the given condition in the specified population.
C = possibly effective, ineffective, or harmful or as useful/predictive or not useful/predictive.
U = data inadequate or conflicting. Treatment, test, or predictor unproven.