GBS scores
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GBS Guillain-Barre syndrome scoring systems Hughes disability scale Brighton criteria EGOS mEGOS EGRIS
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Guillain-Barré Syndrome (GBS) Scoring Systems
There are several distinct scoring tools used in GBS, each serving a different clinical purpose: diagnosis, disability assessment, outcome prediction, and respiratory risk stratification.
1. Brighton Collaboration Criteria (Diagnostic)
Developed in 2011, these case definitions provide levels of diagnostic certainty, useful particularly in epidemiologic studies and vaccine safety surveillance. They have since been validated in clinical cohorts. - Harrison's Principles of Internal Medicine, 22E
| Level | Criteria |
|---|---|
| Level 1 (Highest certainty) | Bilateral flaccid limb weakness + decreased/absent DTRs in weak limbs + monophasic illness with nadir 12h-28 days + CSF cell count <50/uL + CSF protein above normal + EDx features of neuropathy + no alternative diagnosis |
| Level 2 | Same as Level 1 but without EDx confirmation (clinical + CSF only) |
| Level 3 | Clinical only: bilateral flaccid limb weakness + decreased/absent DTRs in weak limbs + monophasic illness with nadir 12h-28 days + no alternative diagnosis (CSF and EDx not available/done) |
| Level 4 | Does not meet levels 1-3, but diagnosis reported by a physician |
Required features for any level:
- Progressive weakness of both legs and arms
- Areflexia or hyporeflexia
Supportive features: progression over days to 4 weeks, relative symmetry, bifacial palsies, autonomic dysfunction, absence of fever at onset, CSF albuminocytological dissociation - Bradley and Daroff's Neurology in Clinical Practice
2. GBS Disability Scale (Hughes Scale)
Originally described by Hughes et al. (1978), this is the standard functional outcome scale for GBS. It ranges from 0 (normal) to 6 (death) and is used to track progression and determine treatment eligibility.
| Score | Description |
|---|---|
| 0 | Healthy state |
| 1 | Minor symptoms; capable of running |
| 2 | Able to walk 10m or more unaided, but unable to run |
| 3 | Able to walk 10m across open space with help |
| 4 | Bedridden or chairbound |
| 5 | Requiring assisted ventilation for at least part of the day |
| 6 | Dead |
Treatment is generally indicated when score is ≥3 (unable to walk unaided). This scale is a key component of the prognostic EGOS score.
3. MRC Sum Score (Severity of Weakness)
The Medical Research Council (MRC) sum score quantifies limb muscle strength by testing 6 bilateral muscle groups (shoulder abductors, elbow flexors, wrist extensors, hip flexors, knee extensors, ankle dorsiflexors), each graded 0-5.
- Total score: 0 (complete paralysis) to 60 (normal strength)
- Used as an input in both mEGOS and EGRIS
- Higher score = less weakness
4. EGOS - Erasmus GBS Outcome Score (Prognostic)
Used at 14 days after hospital admission to predict the probability of inability to walk independently at 6 months. - Rosen's Emergency Medicine
| Variable | Points |
|---|---|
| Age at onset | <40 yrs = 0; 41-60 yrs = 0.5; >60 yrs = 1 |
| Preceding diarrhea | No = 0; Yes = 1 |
| GBS disability score at day 14 | 0-2 = 1; 3 = 2; 4 = 3; 5 = 4 |
- Total score: 1-7
- Higher score = worse prognosis (less likely to walk independently at 6 months)
5. mEGOS - Modified Erasmus GBS Outcome Score (Prognostic)
A modification of EGOS that can be applied earlier, at day 7 of admission, and substitutes the GBS disability score with the MRC sum score (easier to measure early in the course).
| Variable | Points |
|---|---|
| Age at onset | <40 yrs = 0; 41-60 yrs = 0.5; >60 yrs = 1 |
| Preceding diarrhea | No = 0; Yes = 1 |
| MRC sum score at day 7 | 51-60 = 0; 41-50 = 1; 31-40 = 2; 0-30 = 3 |
- Total score: 0-5; validated in Dutch and Japanese GBS cohorts
- Higher score = higher probability of being unable to walk during 6-month follow-up
6. EGRIS - Erasmus GBS Respiratory Insufficiency Score (ICU/Ventilation Risk)
Predicts risk of respiratory failure requiring mechanical ventilation within the first week of hospitalization. Particularly useful for ICU triage decisions.
| Variable | Points |
|---|---|
| Days from weakness onset to admission | >7 days = 0; 4-7 days = 1; ≤3 days = 2 |
| Facial and/or bulbar weakness at admission | Absent = 0; Present = 1 |
| MRC sum score at admission | 60 = 0; 51-60 = 1; 41-50 = 2; 31-40 = 3; 21-30 = 4; ≤20 = 5 |
| EGRIS Total | Risk of Intubation |
|---|---|
| 0-2 | Low (~1%) |
| 3-4 | Intermediate (~12-24%) |
| 5-7 | High (~65%) |
Additional predictors of respiratory failure (not in EGRIS): peroneal nerve conduction block, forced vital capacity (FVC) <20 mL/kg indicates impending failure; FVC >40 mL/kg usually does not require ventilation. - Rosen's Emergency Medicine
Quick Reference Summary
| Score | Timing | Purpose |
|---|---|---|
| Brighton criteria | At diagnosis | Confirms diagnostic certainty (Levels 1-4) |
| Hughes disability scale | Anytime | Tracks functional status; guides treatment |
| MRC sum score | Anytime | Quantifies weakness; input for EGRIS/mEGOS |
| EGRIS | At admission | Predicts respiratory failure risk |
| EGOS | Day 14 | Predicts walking ability at 6 months |
| mEGOS | Day 7 | Earlier version of EGOS using MRC score |
Key clinical points:
- Treatment (IVIg or plasmapheresis) is indicated for patients who cannot walk unaided (Hughes score ≥3); these are equivalent in efficacy and combination is not superior to either alone - Harrison's Principles of Internal Medicine, 22E
- ~30% of GBS patients require mechanical ventilation; EGRIS helps identify them early
- ~85% of patients achieve full functional recovery within months to a year; mortality is <5% in optimal settings
- Poor prognostic factors: advanced age, severe proximal motor/sensory axonal damage, fulminant onset, delay in treatment
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