This is the current release of the guideline.

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)

1. 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).
2. The effects of PE and intravenous immunoglobulin (IVIg) are equivalent (see below).
3. There is insufficient evidence to recommend the use of cerebrospinal fluid (CSF) filtration (Level U recommendation, limited Class II evidence).

Immunoabsorption

1. The evidence is insufficient to recommend the use of immunoabsorption (Level U recommendation, Class IV evidence).

Intravenous immunoglobulin (IVIg)

1. 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).
2. The effects of IVIg and PE are equivalent.

Combination treatments

1. 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

1. 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?

1. 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.

None provided

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

Not applicable: The guideline was not adapted from another source.

2003 Sep 23

American Academy of Neurology - Medical Specialty Society

American Academy of Neurology (AAN)

Quality Standards Subcommittee of the American Academy of Neurology

Quality Standards Subcommittee Members: Gary Franklin, MD, MPH (Co-Chair); Catherine Zahn, MD (Co-Chair); Milton Alter, MD, PhD; Stephen Ashwal, MD; Richard M. Dubinsky, MD; Jacqueline French, MD; Michael Glantz, MD; Gary Gronseth, MD; Deborah Hirtz, MD; Robert G. Miller, MD; James Stevens, MD; and William J. Weiner, MD

Not stated

This is the current release of the guideline.

This summary was completed by ECRI on February 12, 2004.

This NGC summary is based on the original guideline, which is copyrighted by the American Academy of Neurology.