Russian Military Medical Academy ReportsRussian Military Medical Academy Reports2713-23152713-2323Eco-Vector8362210.17816/rmmar83622Research ArticleGuillain-Barré syndrome: diagnosis and treatment guidelinesEmelinAndrey Yu.<p>D.Sc. (Medicine), Professor</p>emelinand@rambler.ruhttps://orcid.org/0000-0002-4723-802XS.M. Kirov Military Medical Academy0612202140451582310202102112021Copyright © 2021, Emelin A.Y.2021<p>GuillainBarr syndrome is an acute, rapidly progressive immune-mediated disease of the peripheral nervous system, combining several variants and subtypes with various clinical, pathophysiological and electrophysiological signs. GuillainBarr syndrome usually develops 13 weeks after the viral or bacterial infection, which acts as the trigger triggering autoimmune mechanisms, leading to demyelination and axonal damage. The disease is getting more acute due to the emergence of a new coronavirus infection. Behind the diseases dipathophysiology there is the activation of cellular and humoral immunity with the production of autoantibodies to specific gangliosides and glycolipids and the formation of circulating immune complexes that attack peripheral nerves and roots (the phenomenon of molecular mimicry). The examination of patients requires an integrated approach, including, along with clinical and anamnestic data, the results of laboratory and neurophysiological examination. The treatment of patients with GuillainBarr syndrome is carried out in an intensive care unit and includes both pathogenetic therapy and nonspecific measures aimed to correct dysfunctions of vital organs, prevent complications and provide symptomatic therapy. Currently, the main direction of pathogenetic therapy of this disease is the use of high-dose intravenous immunotherapy with human normal immunoglobulin preparations or high-volume therapeutic plasmapheresis. Taking into account the absence of data about differences in the effectiveness of these methods, the choice of direction is determined taking into account the contraindications and possible development of adverse events, as well as the capabilities of the medical institution (2 tables, bibliography: 15 refs)</p>diagnosticelectroneuromyographyGuillain–Barré syndromehigh-dose intravenousimmunoglobulin treatmentsplasma exchangetreatmentвысокодозная внутривенная иммунотерапиядиагностикалечениеплазмафарезпрепараты иммуноглобулинасиндром Гийена–Барреэлектронейромиография[Piradov МА, Suponeva NА. Guillain–Barré syndrome: diagnosis and treatment: A Guide for Physicians. Мoscow: MedPress-inform Publisher; 2011. 200 p. (In Russ.)][Van den Berg B, Walgaard C, Drenthen J, et al. Guillain–Barré syndrome: pathogenesis, diagnosis, treatment and prognosis. Nat Rev Neurol. 2014;10(8):469–482. DOI: 10.1038/nrneurol.2014.121][Emelin AYu. Guillain–Barré syndrome as emergency: diagnosis and treatment. Bulletin of the Russian Military Medical Academy. 2019; S3.50–56. (In Russ.) DOI: 10/32863/1682-7392-2019-3-67-50-56][Zaytsev AA, Chernov SA, Kryukov EV, Goluchova EZ, Rybka MM. Practical experience of managing patients with new coronavirus infection COVID-19 in hospital (preliminary results and guidelines). Lechaschiy Vrach. 2020;6(19):12–20. (In Russ.) DOI: 10.26295/OS.2020.41.94.014][Leonhard SE, Mandarakas MR, Gondim FAA, et al. Diagnosis and management of Guillain–Barré syndrome in ten steps. Nat Rev Neurol. 2019;15(11):671–683. DOI: 10.1038/s41582-019-0250-9][Hughes RA. The concept and classification of Guillain–Barré syndrome and related disorders. Rev Neurol (Paris). 1995;151(5): 291–294.][Hadden RD, Cornblath DR, Hughes RA, et al. Electrophysiological classification of Guillain–Barré syndrome: clinical associations and outcome. Plasma Exchange/Sandoglobulin Guillain–Barré Syndrome Trial Group. Ann Neurol. 1998;44(5):780–788. DOI: 10.1002/ana.410440512][Fokke C, van den Berg B, Drenthen J, et al. Diagnosis of Guillain–Barré syndrome and validation of Brighton criteria. Brain. 2014;137(Pt 1):33–43. DOI: 10.1093/brain/awt285][Doets AY, Hughes RA, Brassington R, Hadden RD, Pritchard J. Pharmacological treatment other than corticosteroids, intravenous immunoglobulin and plasma exchange for Guillain-Barré syndrome. Cochrane Database Syst Rev. 2016;11(11):CD008630. DOI: 10.1002/14651858.CD008630.pub4][Chevret S, Hughes RA, Annane D. Plasma exchange for Guillain-Barré syndrome. Cochrane Database Syst Rev. 2017;27(2):CD001798. DOI: 10.1002/14651858.CD001798.pub3][Verboon С, Doets A, Galassi G, et al. Current treatment practice of Guillain–Barré syndrome. Neurology. 2019;93(1):e59–e76. DOI: 10.1212/WNL.0000000000007719][Hughes R, Brassington R, Gunn A, van Doorn P. Corticosteroids for Guillain–Barré syndrome. Cochrane Database Syst Rev. 2016;10(10): CD001446. DOI: 10.1002/14651858.CD001446.pub5][Verboon С, van Doorn P, Jacobs B. Treatment dilemmas in Guillain–Barré syndrome. J Neurol Neurosurg Psychiatry. 2017;88(4):346–352. DOI: 10.1136/jnnp-2016-314862][Kesici S, Tanyıldız M, Yetimakman F, Bayrakci B. A Novel Treatment Strategy for Severe Guillain–Barré Syndrome: Zipper Method. J Child Neurol. 2019;34(5):277–283. DOI: 10.1177/0883073819826225. Epub 2019][Trujillo Gittermann LM, Valenzuela Feris SN, von Oetinger Giacoman A. Relation between COVID-19 and Guillain–Barré syndrome in adults. Neurologia (Engl Ed). 2020;35(9):646–654. DOI: 10.1016/j.nrl.2020.07.004]