49
Table 7. Nervous System Toxicities
G2: Moderate: some interference
with ADLs, symptoms
concerning to patient.
• Discontinue ICPi.
• Admission to inpatient unit with capability of
rapid transfer to ICU-level monitoring.
• Start IVIG (0.4 G/kg/day for 5 days for a total
dose of 2 G/kg ) or plasmapheresis.
Note: plasmapheresis immediately after IVIG will
remove immunoglobulin.
• Corticosteroids are usually not recommended
for idiopathic GBS, however in ICPi-related
forms, a trial is reasonable (methylprednisolone
2–4 mg/kg/day), followed by slow steroid taper.
Pulse steroid dosing (methylprednisolone 1
gram daily for 5 days) may also be considered for
G3–4 along with IVIG or plasmapheresis. After
pulse steroids, taper steroids over 4–6 weeks.
• Frequent neuro checks and pulmonary function
monitoring.
• Monitor for concurrent autonomic dysfunction.
• Non-opioid management of neuropathic
pain, for example, pregabalin, gabapentin, or
duloxetine.
• Treatment of constipation/ileus.
G3–4: Severe: limiting self-care
and aids warranted, weakness
limiting walking, ANY
dysphagia, facial weakness,
respiratory muscle weakness, or
rapidly progressive symptoms.
Additional considerations:
• Extreme caution with rechallenging for severe cases after complete resolution of
symptoms and tapered off immunosuppression.
(cont'd)
