To treat or not to treat mild Guillain-Barre syndrome: limited evidence for but still none against

Both intravenous immunoglobulins and plasma exchange may shorten time to full recovery of muscle strength in patients with mild Guillain-Barré syndrome

There are several caveats to the use of terminology ‘mild Guillain-Barré syndrome (GBS)’ in clinical settings, as this is at present mainly based on motor function of legs and does not include weakness of arms nor other disabling dysfunctions such as ataxia. Moreover, some patients may progress beyond mild, but accurate biomarkers to timely identify this subset are lacking. Corroborating with the shift to less conservative ischaemic stroke treatment, where progression is no longer awaited and disabling symptoms such as exclusively aphasia may be considered appropriate thresholds for treatment with intravenous alteplase,1 the ‘inflammatory penumbra’ in GBS could be considered to benefit from timely and appropriate treatment (figure 1). In practice, treatment of GBS will often not be delayed when progression is suspected clinically, or…

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