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Guillain-Barré syndrome — MCCQE Part 1 MCQ

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HardWeaknessGuillain-Barré syndromeMCCQE Part 1

A 64-year-old man develops symmetric ascending weakness and areflexia 10 days after gastroenteritis. Nerve-conduction studies support Guillain-Barré syndrome. He is now unable to walk 10 metres without assistance, although respiratory and autonomic monitoring are currently stable. Which disease-modifying treatment is most appropriate?

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Correct answer: E — Intravenous immunoglobulin 0.4 g/kg daily for five days

This patient has Guillain-Barré syndrome, is unable to walk unaided, and is within two weeks of weakness onset. The current EAN/PNS guideline recommends intravenous immunoglobulin at 0.4 g/kg daily for five days in this setting; a course of plasma exchange is an effective alternative when used as a stand-alone strategy. Corticosteroids do not improve GBS outcomes, and the guideline does not recommend plasma exchange followed immediately by IVIG. Cyclophosphamide is not standard treatment. Disease-modifying therapy does not replace close serial assessment for respiratory decline, bulbar dysfunction, dysautonomia, thrombosis, pain, and rehabilitation needs; airway decisions should use the overall trajectory and validated respiratory assessment rather than one isolated cutoff.

Reference: European Academy of Neurology and Peripheral Nerve Society. Guideline on diagnosis and treatment of Guillain-Barré syndrome. 2023. https://pubmed.ncbi.nlm.nih.gov/37814551/