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GBS – SID-GBS Trial — SCE Neurology MCQ

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HardPeripheral Neuropathy & NeuromuscularGBS – SID-GBS TrialSCE Neurology

A 46-year-old with Guillain–Barré syndrome completed IVIg 0.4 g/kg/day for 5 days. On day 7 the mEGOS predicts a poor walking outcome, but there has been no treatment-related fluctuation and respiratory and autonomic observations are stable. What is the most appropriate disease-modifying plan?

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Correct answer: C — Do not give routine second-course IVIg solely for the poor prognostic score

A poor prognostic score is not evidence of renewed immune activity. The EAN/PNS guideline recommends against a routine second IVIg course in GBS solely because prognosis is poor; the randomised evidence did not show worthwhile benefit and identified more serious adverse events. Continue meticulous supportive care, thromboprophylaxis, respiratory and autonomic surveillance, and rehabilitation. A genuine treatment-related fluctuation is a different clinical problem and should not be inferred from slow recovery alone. Sequential plasma exchange after adequate IVIg and corticosteroids are not routine rescue strategies.

Reference: EAN/PNS Guideline on diagnosis and treatment of Guillain–Barré syndrome. https://onlinelibrary.wiley.com/doi/10.1111/jns.12594