Assessment of current diagnostic criteria for Guillain-Barre syndrome [77]

Required features

  • Progressive weakness in both arms and legs

  • Areflexia (or hyporeflexia).

Features supportive of diagnosis

  • Progression of symptoms over days to 4 weeks

  • Relative symmetry

  • Mild sensory signs or symptoms

  • Cranial nerve involvement, especially bilateral facial weakness

  • Recovery beginning 2 to 4 weeks after progression ceases

  • Autonomic dysfunction

  • Absence of fever at onset

  • Typical CSF and EMG/nerve conduction studies features.

Features casting doubt on the diagnosis

  • Asymmetrical weakness

  • Persistent bladder and bowel dysfunction

  • Bladder or bowel dysfunction at onset

  • >50 mononuclear leukocytes/mm^3 or presence of polymorphonuclear leukocytes in CSF

  • Distinct sensory level.

Features that rule out the diagnosis

  • Hexacarbon abuse

  • Abnormal porphyrin metabolism

  • Recent diphtheria infection

  • Lead intoxication

  • Other similar conditions: poliomyelitis, botulism, hysterical paralysis, toxic neuropathy.

Electrophysiological classification of Guillain-Barre syndrome [99]

Neurophysiological criteria for acute inflammatory demyelinating polyradiculoneuropathy (AIDP), acute motor-sensory axonal neuropathy (AMSAN), and acute motor axonal neuropathy (AMAN). [83] [99]

At least 3 sensory nerves and 3 motor nerves with multi-site stimulation F waves, and bilateral tibial H reflexes, need to be evaluated. [83]


At least 1 of the following in each of at least 2 nerves, or at least 2 of the following in 1 nerve if all others inexcitable and distal compound muscle action potential (dCMAP) >10% lower limit of normal (LLN):

  • Motor conduction velocity <90% LLN (85% if dCMAP <50% LLN)

  • Distal motor latency >110% upper limit of normal (ULN) (>120% if dCMAP <100% LLN)

  • pCMAP/dCMAP ratio <0.5 and dCMAP >20% LLN

  • F-response latency >120% ULN.


  • None of the features of AIDP except 1 demyelinating feature allowed in 1 nerve if dCMAP <10% LLN

  • Sensory action potential amplitudes less than LLN.


  • None of the features of AIDP except 1 demyelinating feature allowed in 1 nerve if dCMAP <10% LLN

  • Sensory action potential amplitudes normal.


  • dCMAP absent in all nerves or present in only 1 nerve with dCMAP <10%.

Electrodiagnostic criteria for acute and chronic inflammatory demyelinating polyradiculoneuropathy [100]

Different sets of criteria have been published, including the following (sensitivity 64% to 72%):

  • 150% prolongation of motor distal latency above ULN

  • 70% slowing of motor conduction velocity below LLN

  • 125% (150% if the distal negative-peak CMAP amplitude was 80% of LLN) prolongation of F wave latency above ULN

  • Abnormal temporal dispersion (peak CMAP duration increase) in ≥2 nerves.

Diagnostic and classification criteria for the Guillain-Barre syndrome [78]

Necessary criteria for clinical diagnosis: [78]

  • Sub-acutely developing flaccid paralysis over <4 weeks

  • Symmetrical weakness from the onset of the symptoms

  • Diminished or absent reflexes

  • No other aetiology for flaccid weakness identified.

Hughes Scale [131]

0 - healthy

1 - minor symptoms or signs of neuropathy but capable of manual work

2 - able to walk without support of a stick but incapable of manual work

3 - able to walk with a stick, appliance, or support

4 - confined to bed or chair-bound

5 - requiring assisted ventilation

6 - dead

Identification of patients with GBS at risk of respiratory failure using the 20/30/40 rule [108]

In patients with no bulbar dysfunction, or with mild bulbar dysfunction without aspiration risk, the 20/30/40 rule should be used.

ICU monitoring and elective intubation should be considered if: [108]

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