Guillain-Barré syndrome: a review of immunotherapy, rehabilitation, and long-term outcomes


  • Bayan M. Ali Department of Neurology, King Abdullah Medical Complex, Jeddah, Saudi Arabia
  • Ahmed A. Alghamdi Department of Emergency Medicine, King Abdullah Hospital, Bisha, Saudi Arabia
  • Wadha R. Alanazi Department of Respiratory Therapy, Al Yamamah Hospital, Riyadh, Saudi Arabia
  • Asma A. Alsamti Department of Respiratory Therapy, Al Yamamah Hospital, Riyadh, Saudi Arabia
  • Abdulaziz F. Allahyani College of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
  • Mohammed M. Altalhi Department of Pharmaceutical Care, United Pharmacy, Jeddah, Saudi Arabia
  • Ali A. Alghamdi College of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
  • Shubaily F. Alareef Department of Pharmaceutical Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia
  • Ali H. Alsedrah College of Medicine, Jagiellonian University, Krakow, Poland
  • Mosaed S. Algarbo Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
  • Mohammed A. Alshehri Department of Physiotherapy, Abha International Private Hospital, Abha, Saudi Arabia



Guillain-Barré syndrome, Autoimmune disorder, Immunotherapy, Plasmapheresis, Intravenous immunoglobulin, Rehabilitation, Autoimmune response, Neuropathy


Guillain-Barré syndrome (GBS) is a complex autoimmune disorder characterized by the rapid onset of motor weakness and sensory disturbances, often precipitated by preceding infections. GBS is considered a rare disorder, with an estimated annual incidence ranging from 0.6 to 4.0 cases per 100,000 individuals. It constitutes a medical emergency due to its potential for severe disability or mortality. The hallmark clinical features of GBS include progressive symmetric muscle weakness and sensory disturbances. Diagnosis relies on clinical evaluation, cerebrospinal fluid analysis, and electrodiagnostic studies, with the Brighton criteria providing standardized diagnostic criteria. The hallmark clinical features include progressive symmetric muscle weakness, sensory deficits, and areflexia or hyporeflexia. The management of GBS primarily involves supportive care and immunomodulatory therapies. Plasmapheresis, or plasma exchange, and intravenous immunoglobulin (IVIG) are the mainstay treatments aimed at modulating the immune response and shortening the illness duration. Rehabilitation, encompassing physical and occupational therapy, is pivotal for restoring functionality and improving long-term outcomes.


Van den Berg B, Walgaard C, Drenthen J, Fokke C, Jacobs BC, Van Doorn PA. Guillain–Barré syndrome: pathogenesis, diagnosis, treatment and prognosis. Nat Rev Neurol. 2014;10(8):469-82.

Rana AQ, Morren JA, Rana AQ, Morren JA. Guillain-Barré Syndrome. Neurol Emerg Clin Pract. 2013;47-53.

Koga M. Experimental approach in research of Guillain–Barré syndrome: a range of pathogeneses mediated by molecular mimicry. Clin Exp Neuroimmunol. 2018;9(2):93-100.

Fokke C, van den Berg B, Drenthen J, Walgaard C, van Doorn PA, Jacobs BC. Diagnosis of Guillain-Barré syndrome and validation of Brighton criteria. Brain. 2014;137(1):33-43.

Wachira VK, Farinasso CM, Silva RB, Peixoto HM, de Oliveira MRF. Incidence of Guillain-Barré syndrome in the world between 1985 and 2020: a systematic Review. Glob Epidemiol. 2023;100098.

Hughes RA, Rees JH. Clinical and epidemiologic features of Guillain-Barré syndrome. J Infect Dis. 1997;176(2):S92-8.

Hughes RAC. Plasma exchange versus intravenous immunoglobulin for Guillain‐Barré syndrome. Therapeutic Apheresis. 1997;1(2):129-30.

Yadav N, Pragati, Dwivedi MK. Microorganisms in Pathogenesis and Management of Guillain–Barré Syndrome (GBS). In: Role of Microorganisms in Pathogenesis and Management of Autoimmune Diseases: Volume II: Kidney, Central Nervous System, Eye, Blood, Blood Vessels & Bowel. Springer. 2023;177-94.

Nyati KK, Prasad KN. Role of cytokines and Toll-like receptors in the immunopathogenesis of Guillain-Barré syndrome. Mediators Inflamm. 2014;758639.

Kieseier BC, Hartung H-P. Therapeutic strategies in the Guillain-Barré syndrome. Paper presented at: Seminars in Neurology. 2003.

Abbas M, Robert HM, Mehmood A, Ali N, Ayaz MA. Plasmapheresis in the Treatment of Guillain-Barre Syndrome; Outcomes and Complications. J Postgrad Med Institute. 2020;34(3).

Ortiz-Salas P, Velez-Van-Meerbeke A, Galvis-Gomez CA. Human immunoglobulin versus plasmapheresis in Guillain–Barre syndrome and myasthenia gravis: a meta-analysis. J Clin Neuromusc Dis. 2016;18(1):1-11.

Plasmapheresis and acute Guillain‐Barré syndrome. Neurology. 1985;35(8):1096-104.

Cortese I, Chaudhry V, So Y, Cantor F, Cornblath D, Rae-Grant A. Evidence-based guideline update: plasmapheresis in neurologic disorders: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2011;76(3):294-300.

Plasma exchange in Guillain‐Barré syndrome: one‐year follow‐up. French Cooperative Group on Plasma Exchange in Guillain-Barré Syndrome. Ann Neurol. 1992;32(1):94-7.

Chevret S, Hughes RA, Annane D. Plasma exchange for Guillain‐Barré syndrome. Cochrane Database Syst Rev. 2017(2).

Hughes R, Wijdicks E, Barohn R, Benson E, Cornblath DR, Hahn AF, et al. Practice parameter: immunotherapy for Guillain–Barré syndrome: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2003;61(6):736-40.

Schröder A, Linker RA, Gold R. Plasmapheresis for neurological disorders. Exp Rev Neurotherap. 2009;9(9):1331-9.

Efficiency of plasma exchange in Guillain-Barré syndrome: role of replacement fluids. French Cooperative Group on Plasma Exchange in Guillain-Barré syndrome. Ann Neurol. 1987;22(6):753-61.

van der Meché FG, Schmitz PI. A randomized trial comparing intravenous immune globulin and plasma exchange in Guillain-Barré syndrome. Dutch Guillain-Barré Study Group. N Engl J Med. 1992;326(17):1123-9.

Hughes RA, Swan AV, Van Doorn PA. Intravenous immunoglobulin for Guillain‐Barré syndrome. Cochrane Database of Systematic Reviews. 2014(9).

Kuitwaard K, de Gelder J, Tio-Gillen AP, Hop WC, van Gelder T, van Toorenenbergen AW, et al. Pharmacokinetics of intravenous immunoglobulin and outcome in Guillain-Barré syndrome. Ann Neurol. 2009;66(5):597-603.

Dalakas MC. Intravenous immunoglobulin in autoimmune neuromuscular diseases. JAMA. 2004;291(19):2367-75.

Zhang G, Lopez P, Li C, Mehta NR, Griffin JW, Schnaar RL, et al. Anti‐ganglioside antibody‐mediated neuronal cytotoxicity and its protection by intravenous immunoglobulin: implications for immune neuropathies. Brain. 2004;127(5):1085-100.

Buchwald B, Ahangari R, Weishaupt A, Toyka KV. Intravenous immunoglobulins neutralize blocking antibodies in Guillain‐Barré syndrome. Ann Neurol. 2002;51(6):673-80.

Dalakas MC. The use of intravenous immunoglobulin in the treatment of autoimmune neuromuscular diseases: evidence-based indications and safety profile. Pharmacol Therap. 2004;102(3):177-93.

Liu S, Dong C, Ubogu EE. Immunotherapy of Guillain-Barré syndrome. Human Vaccines Immunotherap. 2018;14(11):2568-79.

Davidson AI, Halstead SK, Goodfellow JA, Chavada G, Mallik A, Overell J, et al. Inhibition of complement in Guillain-Barré syndrome: the ICA-GBS study. J Peripher Nerv Syst. 2017;22(1):4-12.

Yamaguchi N, Misawa S, Sato Y. A prospective, multicenter, randomized phase II study to evaluate the efficacy and safety of eculizumab in patients with Guillain-Barré syndrome (GBS): protocol of Japanese eculizumab trial for GBS (JET-GBS). JMIR Res Protocols. 2016;5(4):e6610.

Motamed-Gorji N, Matin N, Tabatabaie O, Pavone P, Romano C, Falsaperla R, et al. Biological Drugs in Guillain-Barré Syndrome: An Update. Curr Neuropharmacol. 2017;15(7):938-50.

Meythaler JM. Rehabilitation of Guillain-Barré syndrome. Arch Phys Med Rehab. 1997;78(8):872-9.

Orsini M, de Freitas MR, Presto B, Mello MP, Reis CHM, Silveira V, et al. Guideline for neuromuscular rehabilitation in Guillain-Barre Syndrome: what can we do? Revista Neurociências. 2010;18(4):572-80.

Intan AD, Ratnawati A. Pulmonary Rehabilitation in Guillain-Barré Syndrome (GBS). Indonesian J Phys Med Rehab. 2015;4(01):52-62.

Hughes RA, Wijdicks EF, Benson E, Cornblath DR, Hahn AF, Meythaler JM, et al. Supportive care for patients with Guillain-Barré syndrome. Arch Neurol. 2005;62(8):1194-8.

Khan F, Ng L. Guillain-Barré syndrome: an update in rehabilitation. Int J Therap Rehab. 2009;16(8):451-60.

Shang P, Zhu M, Wang Y, Zheng X, Wu X, Zhu J, et al. Axonal variants of Guillain–Barré syndrome: an update. J Neurol. 2021;268(7):2402-19.

Leonhard SE, Mandarakas MR, Gondim FA, Bateman K, Ferreira MLB, Cornblath DR, et al. Diagnosis and management of Guillain–Barré syndrome in ten steps. Nat Rev Neurol. 2019;15(11):671-83.

Ko K-J, Ha G-C, Kang S-J. Effects of daily living occupational therapy and resistance exercise on the activities of daily living and muscular fitness in Guillain-Barré syndrome: a case study. J Phys Therap Sci. 2017;29(5):950-3.

Koeppen S, Kraywinkel K, Wessendorf TE, Ehrenfeld CE, Schürks M, Diener HC, et al. Long-term outcome of Guillain-Barré syndrome. Neurocrit Care. 2006;5(3):235-42.

Khan F, Pallant J, Ng L, Bhasker A. Factors associated with long-term functional outcomes and psychological sequelae in Guillain–Barre syndrome. J Neurol. 2010;257:2024-31.

Martín-Aguilar L, Camps-Renom P, Lleixà C, Pascual-Goñi E, Díaz-Manera J, Rojas-García R, et al. Serum neurofilament light chain predicts long-term prognosis in Guillain-Barré syndrome patients. J Neurol Neurosurg Psychiatry. 2020;jnnp-2020-323899.




How to Cite

Ali, B. M., Alghamdi, A. A., Alanazi, W. R., Alsamti, A. A., Allahyani, A. F., Altalhi, M. M., Alghamdi, A. A., Alareef, S. F., Alsedrah, A. H., Algarbo, M. S., & Alshehri, M. A. (2023). Guillain-Barré syndrome: a review of immunotherapy, rehabilitation, and long-term outcomes. International Journal Of Community Medicine And Public Health, 10(12), 5038–5043.



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