Weakness in the ICU: Guillain-Barré syndrome, myasthenia gravis, and critical illness polyneuropathy/myopathy

Abstract

Background: Weakness in the ICU may be caused by a number of disorders. Guillain-Barré syndrome (GBS) and myasthenia gravis (MG) are examples of conditions that might lead to an ICU admission. The most likely cause of weakness after ICU admission is critical illness polyneuropathy/myopathy (CIP/M).

Review summary: Studies have attempted to determine both clinical and pulmonary function criteria for the proper timing of intubation in severe GBS and MG. Optimizing medical management of patients with GBS, MG, and CIP/M is essential in reducing the high morbidity and mortality associated with these conditions. This includes measures to prevent deep venous thrombosis, gastric and decubitus ulcer prophylaxis, and chest physiotherapy. Both intravenous immunoglobulin (IVIG) and therapeutic plasma exchange (TPE) are probably equal in efficacy for the treatment of GBS, although relapse rates may differ. Treatment of MG crisis with TPE or IVIG must be followed by long-term immunosuppression. Studies suggest possible preventative measures for CIP/M such as tighter glycemic control but there are still no definitive treatments.

Conclusion: Research to advance our knowledge of the pathogenesis of GBS, MG, and CIP/M is clearly needed to develop more specific and more effective treatments in the future. In the meantime, measures that optimize medical management can be instituted to improve outcomes in patients with these conditions, preferably in a specialized neuroscience ICU setting.