Guillain-Barré syndrome: Could corticosteroids help or delay recovery?

Corticosteroids have not been shown to improve the long-term outcome of treatment for Guillain-Barré syndrome. Corticosteroid tablets might even delay recovery.

Guillain-Barré syndrome (GBS) only affects 1 or 2 out of 100,000 people, but it can be severe and frightening. Although it is more common in older people, it also happens to young people. At first, GBS causes tingling and numbness in the limbs. This can progress very quickly to extreme weakness, so that people are often no longer able to walk. It can affect the face and ability to swallow too, and up to a quarter of those affected will need a ventilator to help them breathe. For most people, though, GBS is much milder.

Many people recover fully within a few weeks or months, but it can be fatal. Although the syndrome will have got to its worst stage within four weeks, full recovery could take months. About 1 in 10 will have severe permanent disabilities (10%).

GBS is usually triggered by a viral infection, but sometimes it happens after vaccination or surgery. It is not known for certain why some people get GBS. It is thought to be an auto-immune response. That is, the body’s protection or immune system turns against the body’s own nervous system instead of against the virus or vaccine that has entered the body.

Treatment options for Guillain-Barré syndrome

There is no known cure for GBS, but several treatments are used to try to help people recover more quickly. The most common treatments are plasma exchange, immunoglobulin therapy and corticosteroids (such as prednisolone).

Immunoglobulins are antibodies (proteins) in the blood. Immunoglobulin therapy involves the use of a solution made out of the blood plasma of healthy people. The procedure is similar to a blood transfusion. This can help people to recover from GBS more quickly, although it is not known exactly why it helps.

Plasma is the fluid in the bloodstream. Plasma exchange involves removing fluid from the bloodstream and replacing it with other fluid. This aims to reduce the amount of abnormal antibodies that are circulating in the blood and damaging the nervous system.

Corticosteroids are medications that can reduce inflammation. When a person has GBS, their nerves have become inflamed. So theoretically, corticosteroids might reduce the nerve damage. However, corticosteroids can also have adverse effects. For example, having corticosteroids can increase the chances of getting an infection.

Research on corticosteroid therapy

To find out whether corticosteroids speed up recovery and reduce the effects of GBS, researchers from the Cochrane Collaboration analysed clinical trials of this treatment. The Cochrane Collaboration is an international network of researchers who systematically review trials that test the benefits of health care interventions. They found 8 trials. Only 6 of these trials measured disability in a way that could help answer important questions about the usefulness of corticosteroid therapy for patients. You can click here (URL: http://www.gesundheitsinformation.de/evidence-based-medicine.61.en.html) to read about why it is important to carry out trials in a particular way to find out whether a medical intervention helps. The 6 trials that were included in the analysis involved over 580 people with GBS.

After a year the people who had corticosteroids did not have less disability than people who took a dummy drug (placebo) or had immunoglobulin therapy only. Serious adverse effects from short courses of corticosteroids were not common, although people who had corticosteroids might have been a bit more likely to develop diabetes. There was some evidence that giving corticosteroids into the veins (intravenous therapy) along with immunoglobulin therapy in the early weeks might have a short-term benefit, but more research is needed to be sure.

The researchers found that corticosteroids might actually delay recovery when taken as tablets. More research is needed to be sure about this as well, though. One possible reason could be that, while early intravenous treatment might have some benefit in the acute phase of inflammation, tablets are usually taken over longer periods of time, and perhaps they start to do some unknown kind of harm after a while. It is theoretically possible, for example, that while the corticosteroids have a beneficial effect on the inflammation of the nerves, they could have a different effect on the muscles. The researchers concluded that immunoglobulin therapy can improve symptoms 4 weeks after GBS, but it is not certain that adding corticosteroids to the treatment will help.


Author: German Institute for Quality and Efficiency in Health Care (IQWiG)