48
Treatment
Table 7. Nervous System Toxicities
7.2 Guillain-Barre Syndrome
Workup/Evaluation
• Neurologic consultation
• MRI spine w/wo contrast (rule out compressive lesion and evaluate for nerve root
enhancement/thickening )
• Lumbar puncture: CSF analysis for cell count and differential, cytolog y for malignant
cells, protein, glucose and viral/bacterial cultures. Note that CSF typically has
elevated protein and often elevated WBC as well even though this is not typically
seen in classical Guillain-Barre.
• Consider paraneoplastic workup — e.g., ANNA-1 antibody testing.
• Serum antiganglioside antibody tests for GBS and its subtypes — e.g., anti-GQ1b for
Miller Fisher variant associated with ataxia and ophthalmoplegia.
• Flow cytometry in patients with hematological malignancies
• Electrodiagnostic studies (NCS and EMG) to evaluate polyneuropathy
• Pulmonary function testing (NIF/VC)
• Frequent neuro checks.
Grading Management
All grades warrant workup and intervention given potential for progressive GBS to lead
to respiratory compromise.
Note: there is no G1 toxicity.
No G1 N/A
(cont'd)
