Outcome of GBS after rehabilitation European Journal of Translational Myology pISSN: 2037-7452 eISSN: 2037-7460 https://www.pagepressjournals.org/index.php/bam/index Publisher's Disclaimer. E-publishing ahead of print is increasingly important for the rapid dissemination of science. The Early Access service lets users access peer-reviewed articles well before print / regular issue publication, significantly reducing the time it takes for critical findings to reach the research community. These articles are searchable and citable by their DOI (Digital Object Identifier). The European Journal of Translational Myology is, therefore, e-publishing PDF files of an early version of manuscripts that undergone a regular peer review and have been accepted for publication, but have not been through the typesetting, pagination and proofreading processes, which may lead to differences between this version and the final one. The final version of the manuscript will then appear on a regular issue of the journal. E-publishing of this PDF file has been approved by the authors. Eur J Transl Myol 2025 [Online ahead of print] To cite this Article: Finsterer J. The outcome of severe GBS after robotic or conventional rehabilitation also depends on the triggering agent and the electrophysiological subtype. Eur J Transl Myol doi: 10.4081/ejtm.2025.1237214516 ©The Author(s), 2025 Licensee PAGEPress, Italy Note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries should be directed to the corresponding author for the article. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. Submitted: 7 October 2025 Accepted: 8 October 2025 Early access: 19 December 2025 https://www.pagepressjournals.org/index.php/bam/index https://www.pagepress.org/site 2 The outcome of severe GBS after robotic or conventional rehabilitation also depends on the triggering agent and the electrophysiological subtype Josef Finsterer Neurology Department, Neurology & Neurophysiology Center, Vienna, Austria Key words: Guillain-Barré syndrome, axonal neuropathy, robotic rehabilitation, outcome, nerve conduction studies. Dear Editor, We read with interest the article by Tramonti et al. about a 54-year-old man with severe Guillain- Barré Syndrome (GBS) following a flu-like infection in April 2022, which required long-term intubation and mechanical ventilation.1 Despite immediate treatment with steroids, Intravenous Immunoglobulins (IVIG), and Plasma Exchange (PE), the patient was discharged to a rehabilitation facility after 9 months with severe quadruparesis and weakness of the axial, respiratory, and pharyngeal muscles.1 After intensive rehabilitation with conventional and robot-assisted approaches, the patient's condition improved significantly after another two months.1 The study is noteworthy, but some points require discussion. The first point is that no results of Nerve Conduction Studies (NCS) and needle Electromyography (EMG) were reported.1 We should know which type of GBS was diagnosed at disease onset in April 2022, as the disease course depends heavily on whether the patient was diagnosed with an axonal [acute motor (sensory) axonal neuropathy (AMAN, AMSAN)] or demyelinating form (acute inflammatory demyelinating polyneuropathy) of GBS. It should also be clarified whether the patient had cranial nerve involvement, as bulbar muscles were apparently also involved in GBS. Was there evidence of affection of the trigeminal, facial, glossopharyngeal, vagus, accessory, and hypoglossal nerves? The second point is that the trigger for GBS was not reported.1 Since the patient was admitted in April 2022, it is conceivable that the flu-like symptoms prior to the onset of GBS were actually a mild SARS-CoV-2 infection. Was the patient SARS-CoV-2 negative upon admission? SARS-CoV- 2 is known to cause GBS. Several cases of GBS due to SARS-CoV-2 infection have been reported,2 3 and until this trigger is definitively ruled out, it is the most plausible one. If the patient was SARS- CoV-2 negative, all other possible triggers that commonly cause GBS should be considered.3 The third point is that the patient was diagnosed with axonal Polyneuropathy (PNP) in addition to GBS.1 What was the cause of the axonal PNP? Did the patient have risk factors for PNP, such as diabetes, renal failure, vitamin deficiency, or a history of positive immunological disorders, cancer, or chemotherapy? We also need to know how long the patient was in the intensive care unit, how long they required mechanical ventilation, and whether he had a critically ill neuropathy/myopathy in addition to GBS. It should also be clarified whether the axonal polyneuropathy was actually the GBS or not. Fourth, it is unclear why the patient received steroids in addition to IVIG and PE.1 Steroids are known to have no beneficial effect in GBS.4 Steroids may cause more side effects than benefits. Did the patient show a positive effect from steroids? Fifth, the clinical improvement with rehabilitation was not documented by NCS. Since the patient was diagnosed with GBS or axonal PNP, clinical improvement should be confirmed by an improvement in electrophysiological parameters. Finally, the description of the clinical picture on admission is missing.1 To assess the benefit of treatment and rehabilitation, the degree of motor impairment and impairment of daily activities should be reported upon admission to the intensive care unit (ICU). In summary, the effect of rehabilitation in severe GBS depends on the causative agent and the electrophysiological subtype. GBS subtypes should be specified to guide treatment in the ICU and during rehabilitation. Corresponding author Josef Finsterer, Neurology Department, Neurology & Neurophysiology Center, Postfach 20, 1180 Vienna, Austria Tel. +43-1-5861075- Fax. +43-1-5861075 E-mail: fifigs1s@yahoo.de Ethical approval and consent to participate Not applicable. Funding None received. mailto:fifigs1s@yahoo.de 4 Availability of data and material All data are available from the corresponding author. Conflict of interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. References 1. Tramonti C, Gnetti B, Gemignani P, et al. Is a multidimensional robotic rehabilitation approach feasible in Guillain-Barrè syndrome? Report from a clinical case. Eur J Transl Myol 2025;35:12758. 2. Kilinc D, van de Pasch S, Doets AY, et al. Guillain-Barré syndrome after SARS-CoV-2 infection. Eur J Neurol 2020;27:1757-8. 3. Finsterer J. Triggers of Guillain-Barré Syndrome: Campylobacter jejuni Predominates. Int J Mol Sci 2022;23:14222. 4. Hughes RA, van Der Meché FG. Corticosteroids for treating Guillain-Barré syndrome. Cochrane Database Syst Rev 2000;3:CD001446. Update in: Cochrane Database Syst Rev 2006;2:CD001446.