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Serotonin Syndrome — SCE Neurology MCQ

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HardMovement DisordersSerotonin SyndromeSCE Neurology

A patient diagnosed with Guillain–Barré syndrome improves after IVIG, then deteriorates twice at weeks 5 and 10. Weakness remains demyelinating and there are no alternative systemic features. What diagnostic revision should now be considered?

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Correct answer: B — Reclassify as acute-onset CIDP and plan maintenance immunotherapy

Deterioration beyond eight weeks from onset or multiple treatment-related fluctuations should prompt reconsideration as acute-onset CIDP, which requires maintenance therapy rather than repeated acute GBS rescue alone. Miller Fisher syndrome is ophthalmoplegic-ataxic, MND does not improve with IVIG, multifocal motor neuropathy is asymmetric and steroid unresponsive, and reproducible demyelinating physiology argues against functional weakness.

Reference: EAN/PNS guideline on Guillain-Barré syndrome diagnosis and treatment (Published June 2023): https://onlinelibrary.wiley.com/doi/abs/10.1111/ene.16073; EAN/PNS guideline on chronic inflammatory demyelinating polyradiculoneuropathy (Published October 2021): https://onlinelibrary.wiley.com/doi/10.1111/jns.12455