Analysis of Research Trends in Korean Medicine Treatment for Guillain-Barre Syndrome in Korea

Article information

J Acupunct Res. 2022;39(3):190-201
Publication date (electronic) : 2022 August 24
doi : https://doi.org/10.13045/jar.2022.00171
Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University, Daejeon, Korea
*Corresponding author. Yong Il Kim, Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University, 75, Daedeok-daero 176 beon-gil, Seogu, Daejeon, Korea, E-mail: omdkim01@dju.kr
Received 2022 July 6; Revised 2022 August 1; Accepted 2022 August 10.

Abstract

This review aimed to analyze Korean medicine treatment (KMT) methods used for Guillain-Barre syndrome (GBS) in studies from January 1, 2010, to December 21, 2021. Five online databases (KISS, SCIENCEON, DBpia, RISS, KMbase) were searched for GBS-related studies. A total of 14 case reports were selected. Various treatment methods for GBS such as acupuncture, herbal medicine, moxibustion, and cupping have been reported, and some included Western medication. Herbal medicine and acupuncture were the most frequently used treatment methods. The most common prescription for GBS was Shipjeondaebotang Gami, the most common herb used was Glycyrrhizae radix et rhizome, and the most common acupoints were ST36, LI11, TE5, and LI4. In moxibustion treatment for GBS, CV4 was commonly used, and in cupping treatment the low back and back-shu points and were mostly used. Further studies on Korean medicine treatment of GBS are necessary for standardization of treatment.

Introduction

Guillain-Barre syndrome (GBS) causes inflammatory demyelination and axonal degeneration, which is an autoimmune peripheral polyneuropathy characterized by elevated protein levels and normal cell counts in the cerebrospinal fluid [1]. The incidence of GBS has been reported to be 0.6–4 per 100,000 people worldwide [2], and the incidence in women is reported to be 1.5 times higher than in men [3]. The GBS is commonly preceded by a viral infection before symptoms begin, and it has been reported that various other factors including surgery, vaccination or bacterial infections precede GBS [4]. Symptoms of GBS occur in one or more limbs and are characterized by upward paralysis and a decrease in deep tendon reflex (DTR). Most of the paralysis is symmetrical. In addition, there are typically complaints of numbness, abnormal sensation, facial paralysis, difficulty breathing, and autonomic nervous system symptoms such as tachycardia, arrhythmia, high blood pressure, and low blood pressure [4]. Generally, symptoms peak within 2–4 weeks of onset, then recovery begins [4]. Recovery may progress slowly over several months, and most patients fully recover functionally [4]. However, 5–8% of patients with GBS die from complications such as respiratory failure, and 15–25% have sequelae such as the need for assisted walking a year after the first symptoms [1,5]. The typical Western medical treatment for GBS is the administration of intravenous high-dose immune globulins (IVIG) and plasmapheresis, and other treatments are performed according to the symptoms [6]. Despite administration of IVIG and plasmapheresis, nearly 20% of patients have sequelae [5], and there are no clear treatment method other than physiotherapy, occupational therapy, and speech and language therapy. In addition, IVIG and plasmapheresis can cause headaches, nausea, and vomiting [7]. Therefore, it is necessary to study treatment methods other than IVIG and plasmapheresis.

In Korea, the incidence of GBS increased by 45.2% from 648 to 941 between 2010 and 2016, and the incidence significantly increased in most age groups with the exception of those under the age of 20 [8]. There have been several reports of Korean medicine treatment (KMT) being administered to patients with GBS in Korea [9], but most are almost limited to case reports. A study on the latest trends in KMT for GBS has not yet been conducted. Therefore, in this study, we report on the efficacy and safety and various KMTs for GBS by analyzing publications from 2010 to 2021.

Materials and Methods

Search strategy

A comprehensive literature search was conducted for studies that applied KMT to treat GBS from January 1, 2010, to December 31, 2021, using five Korean databases [Korean studies Information Service System (KISS), SCIENCEON, Data Base Periodical Information Academic (DBpia), Research Information Sharing Service (RISS), Korean Medical Database (KMbase)]. The search terms used were “Guillain-Barre Syndrome” or “GBS,” and “Acupuncture” or “Korean Medicine.” Similar words, such as “Korean medicine treatment” and “Oriental Medicine” were also searched. Search terms and formulas were modified and combined according to the characteristics of the database.

Search methods

This review included all studies that used KMT for patients with GBS regardless of the patient’s gender/sex, age, or race. Patients who had been clinically diagnosed with GBS or received treatment for GBS by doctors were selected, and patients suspected of having GBS were excluded. Only randomized controlled clinical studies and studies with case reports were included. Relevant literature published from January 1, 2010, to December 31, 2021 were retrieved. The title and abstract were used to screen the studies that contained information on GBS treatment. There were 116 duplicate studies which were excluded from a total of 332 retrieved articles. Of the 216 remaining studies, 201 were not related to KMT and one did not include information on GBS. Finally, 14 studies were selected for this review. Among the 14 selected studies, treatments performed to treat the patient’s underlying diseases, such as hypertension, or diabetes i.e., symptoms other than those caused by GBS, were excluded from the analysis (Fig. 1).

Fig. 1

Flow chart of the study selection process.

Data analysis

The year of publication, complaints and symptoms, treatment, and evaluation for each study were summarized.

Results

Publication trends

A total of 14 studies were selected, all of which were case reports [1023]. The studies were published in the Journal of Korean Oriental Internal Medicine (n = 7); Journal of Korean Acupuncture and Moxibustion Society (n = 1); Journal of Korean Medicine Rehabilitation (n = 2); Journal of Korea CHUNA Manual Medicine for Spine & Nerves (n = 1); Research Institute of Korean Medicine, Taejon University (n = 1); Journal of the Society of Stroke on Korean Medicine (n = 1), and the Journal Sasang Constitutional Medicine (n = 1).

Year of publication

Studies on KMT for GBS were reported annually since 2011, except for 2012–2013 (Fig. 2).

Fig. 2

Analysis of publication year.

Analysis of sample data

A total of 14 studies reported one case each: eight males and six females (Fig. 3). Patient complaints were extracted in duplicate based on the chief complaint as described in the study. Symptoms were compiled in the order of weakness of extremities (n = 12), numbness or paresthesia (n = 10), facial paralysis (n = 4), and pain (n = 4; Fig. 4; Table 1).

Fig. 3

Age and sex distribution.

Fig. 4

Analysis of chief complaint.

Symptoms, Treatment, and Evaluation Summary of the 14 Case Reports Included in this Review.

Acupuncture

In the 14 studies reviewed, acupuncture treatment was performed once or twice a day. There were 13 studies using a single size needle, four studies using 0.20 × 30 mm [12,16,17,22], three studies using 0.25 × 40 mm [10,18,19], four studies using 0.25 × 30 mm [13,15,21,23], one study using 0.30 × 30 mm [14], and one study using 0.30 × 40 mm [20]. In one study [11], two different sizes of needles, 0.20 × 30 mm and 0.25 × 30 mm, were used. Acupuncture treatment time was 15–20 minutes in all studies, except in two studies [15,18], where the treatment time was not specified. The period of acupuncture treatment ranged from a minimum of 14 days to a maximum of 118 days. The most frequently used acupoints were ST36 (n = 10), LI11 (n = 9), TE5 (n = 8), LI4 (n = 7). The most frequently used meridian systems were the large intestine meridian (n = 27) and stomach meridian (n = 27). The frequency of acupuncture treatment was not counted in duplicate in the same case regardless of the type of acupuncture (manual acupuncture, electroacupuncture, or pharmacopuncture). Pharmacopuncture was used in five studies [10,12,15,17,18]. Hominis placenta pharmacopuncture was used in three studies [10,15,16], jungsongouhyul pharmacopuncture was used in two studies [10,12], and Shinbaro pharmacopuncture [18], snake venom toxin pharmacopuncture [17], and sweet bee venom (BV) [12] were used in one study each. The acupoints most frequently used were in areas with complaints of weakness and pain.

Herbal medicine

Complex herbal medicine treatment was used in all 14 studies. Medical decoction was used in 13 studies, and in one study [11], extract product (squeeze-type insurance product) was used. A total of 21 complex herbal medicines were used in the 14 studies. Both decoctions and extract products were administered three times a day. Shipjeondaebotang Gami (n = 4) was used in four studies [10,12,16,22] and Bojungikgitang Gami was used in two studies [13,21]. Herbal medicine complex prescriptions and herbal medicines that were used to treat symptoms other than GBS symptoms were excluded. Similarly, when herbal medicines were added based on the same prescription and subsequently administered, the prescription was not calculated as a duplicate.

Herbs used in complex prescription

A total of 85 herbal medicines were used for the prescription: Glycyrrhizae radix et rhizoma (n = 16), Angelicae gigantis radix (n = 14), Paeoniae radix alba (n = 12), Ligustici rhizoma (n = 11), and Poria sclerotium (n = 10).

Western medicine treatment

All 14 patients were diagnosed and underwent Western medical treatment before receiving KMT, of which 2 studies [14,21] did not describe the types of Western medicine. The most frequently performed Western medical treatment was IVIG (n = 11) [1013,1520,22]. In four studies [11,18,19,23], steroids were taken orally, and patients in one study each received rehabilitation treatment [10], plasmapheresis [15], and manual treatment [15].

In four studies [11,13,14,21], Western medicine was used to control the symptoms of GBS. In one study [23], Western medicine was stopped prior to KMT. Ibuprofen 400 mg [11], piroxicam 48 mg [11], pregabalin 75 mg [13], aceclofenac 100 mg [14], and gabapentin 300 mg [14] were the most commonly used analgesics. Western medicine to treat underlying diseases such as hypertension, and diabetes were not included in the analysis.

Moxibustion, cupping, and other Korean treatment

Moxibustion treatment was used in 10 studies [1015,17,19,21,22], all of which used indirect moxibustion. Moxibustion treatment was performed 6–7 times a week. The most frequently used acupoint in moxibustion treatment was CV4 (n = 8), followed by CV12 (n = 3) and LI4 (n = 2). The most frequently used meridian system was the conception vessel (n = 8). Cupping was used in seven studies [1115,17,22]. In all seven studies, dry cupping was performed, and in one study [15], wet cupping was performed when necessary. Cupping was performed 6–7 times a week. The most frequently used acupoint was the back-shu points (n = 4), followed by the ashi-point of the neck and waist (n = 2). There were 4 studies [11,15,16,18] that performed other KMT; in three studies [11,15,18] a steam bath was used, and in one study Chuna treatment was used [16].

Physical therapy

Physical therapy was used in nine studies [1114,1722]: interferential current therapy [11,12,17], electrical stimulation therapy [12,21,22], transdermal electric stimulation therapy (Silver Spike Point) [11,19,22], and transcutaneous electrical nerve stimulation [11,18,20]. Microwave [12,17] and electrotherapy [13,14] were used in 3 studies each. Functional electrical stimulation [19], air massage [19], and massage [20] were each used in one study each. Physical therapy was most frequently performed when there were complaints of paralysis and weakness of the extremities (n = 5). In the same case, if another form of physical therapy was received in the same area, it was counted as a duplicate.

Exercise therapy

Exercise therapy was used in nine studies [10,11,1317,19,22]. Manual therapy was performed in five studies [10,11,15,17,22], and occupational therapy was performed in three studies [13,14,19]. Manual therapy was applied to the whole body including the face.

Assessment tools and analysis of the effect

In 12 studies [10,11,1316,1823], weakness due to GBS was evaluated using manual muscle testing (MMT) which identified one case of in the upper extremities [15], two cases in the lower extremities [20,23], and nine cases in the extremities. The MMT showed improvement in all 12 studies. The study that showed the most improvement as measured by MMT was reported Huh et al [21], which showed that the MMT of the extremities changed from 4/4 or 5/5 to 5/5 (Table 2).

Assessment Tool Summary of 14 Patients.

In 11 studies [1115,1719,2123], pain, numbness, and paresthesia were evaluated using the Numeric Rating Scale (NRS). Pain and paresthesia were evaluated in two studies [11,17], pain in two studies [18,23], and paresthesia in four studies [12,14,15,22]. Complaints of numbness were recorded in three studies [13,19,21], but were not included in the evaluation tools. On average, the pain improved by 76.4% and numbness was improved by 69.1%. The most effective treatment was reported in the study by Cha et al [12], where the patient’s NRS score of 6 for numbness in both fingers and 7 for numbness in toes before treatment improved to 0 after treatment.

In six studies [10,13,14,16,20,22], the state of ambulation evaluation method was used. There were five studies [10,13,14,16,20] which reported that patients with GBS, initially using a wheelchair, improved allowing walking with a cane [10,14], and improved with self-gait [13,16,20]. In the remaining one study [22], improvement was from a state of being able to walk with help to self-gait.

In five studies [15,18,19,21,23], the GBS disability scale evaluation method was used, and improvement by 3 points was observed in two studies [18,23], improvement by 2 points in one study [19], and improvement by 1 point in two studies [15,21]. In three studies [11,12,22], the Yanagihara grading score evaluation method was used for facial paralysis caused by GBS. All three studies showed improvement, and among them, Cha et al [12] reported that the patient had a complete recovery. In six studies, the Korean version of the Modified Barthel index [11,16] and Modified Barthel index [13,14,18,21] evaluation methods were used. The study that reported the most improvement was by Ahn et al [13], which showed an 81-point improvement, and the study that reported the least improvement was Won et al [11], which showed a 6-point improvement. On average, this was a 38.5-point improvement over the six studies.

In addition, independent walking speed [10], the Korean-Mini-Mental Status Examination (K-MMSE) [13], Functional Independence Measure [13,14], Euro-quality of life-5 dimension 5-level instrument [13], DTR [16], fatigue severity scale [17], degree of satisfaction [20], shoulder joint active range of movement [21], grip strength [21], and complete blood count [22] were the evaluation methods used. Among them, the K-MMSE [13] was used only at the first evaluation and was not used thereafter, so improvement could not be evaluated. The DTR was reported to be maintained, and the remaining evaluation methods showed improvement [16]. Bladder disorders, respiratory disorders, dysarthria, anorexia, and edema were not evaluated. There were no side effects reported in the 14 studies.

Discussion

This study analyzed 14 studies on GBS published in Korea between January 1, 2010, and December 31, 2021 retrieved from five Korean databases. In 14 studies, 14 cases were reported. In 14 studies, acupuncture and herbal medicine were used, and in 10 studies electroacupuncture was used. A review of overseas research trends in the effects of acupuncture treatment to promote nerve regeneration and recovery by Yang et al [24] analyzed 24 studies and reported that acupuncture and electroacupuncture had a positive effect in 23 studies. In a study by Wangatel et al [25], there were 49 patients with GBS who were randomly divided into an immunotherapy group or acupuncture treatment group, and the patients were observed for 6 months. It was reported that the group receiving acupuncture treatment had less motor function than the group receiving immunotherapy. In this current review, it seems that acupuncture and electroacupuncture had a positive effect on nerve regeneration and motor function recovery in GBS. The most frequently used acupoints for GBS were ST36 (n = 10) and LI11 (n = 9). The most frequently used meridian systems were the intestine meridian and stomach meridian. These are the acupoints and meridian systems located above the radial brachioradialis, carpal extensor, and tibialis anterior muscles, which are muscles affected by paralysis. Huangjenaegyeong considered it important to use intestine meridian and stomach meridian for wi syndrome [26]. Hong et al [27] reported that the acupuncture treatment for GBS was mainly performed on the intestine meridian and stomach meridian, but was modified according to the symptoms. The use of these acupoints and meridian systems are used to treat paralysis, numbness, and paresthesia in the extremities caused by GBS.

In 6 studies, pharmacopuncture was used. In three studies, hominis placenta pharmacopuncture was used, showing the highest frequency of use. Pharmacopuncture is a type of KMT in which various components extracted from herbal medicines are injected into the body. It is a treatment that combines acupuncture and herbal medicine [28]. The study by Kim et al [29] reported that hominis placenta pharmacopuncture restores motor function by reducing neuronecrosis by promoting the expression of NGF. In this current review, Shinbaro pharmacopuncture, snake venom toxin pharmacopuncture, and sweet BV were used in each study. Shinbaro pharmacopuncture is pharmacopuncture using GCSB-5 (Acanthopanacis Cortex, Achyranthis Radix, Saposhnikoviae Radix, Cibotii Rhizoma, Glycine Semen Nigra, Eucommiae Cortex) as the main component [30], which has anti-inflammatory effects (lowering iNOS, COX-2, TNF-α, and mRNA expression), and has a pain relieving effect by increasing the pain threshold [31]. Shinbaro pharmacopuncture also has a nerve regeneration effect [32]. Snake venom toxin for pharmacopuncture is made by refining and diluting the venom of a viper. It is a neurotoxin mainly used for its analgesic effect on pain and nervous system conditions/diseases [33]. Melittin and apamin, which are components of sweet BV, have local analgesic and anti-inflammatory effects such as increasing the concentration of cortisol in the blood and inhibiting the biosynthesis of prostaglandin [34]. This may help control the nerve damage and pain caused by GBS.

In the 14 studies in this current review, herbal treatment was used, and among them, the most frequently prescribed was Sipjeondaebotang Gami, which was used in four studies. Sipjeondaebotang participates in T helper 1 and T helper 2 immune response in the bone marrow, spleen, thymus, liver, Peyer’s patch, which are immune organs, increases the functions of bone marrow, spleen, and thymus, and also affects T-cell and B-cell immunity through Ig regulation, thereby enhancing immune activity [35]. In a study by Lee et al, Sipjeondaebotang was reported to have the potential to prevent damage to the brain and nerve cells through its antioxidant effect [36]. It appears that Sipjeondaebotang treatment for GBS caused immunomodulation to protect the nerve cells.

A total of 85 herbal medicines were used in the prescription, and the highest frequency of use was for Glycyrrhizae radix et rhizoma (n = 16), Angelicae gigantis radix (n = 14), Paeoniae radix alba (n = 12), Ligustici rhizoma (n = 11), and Poria sclerotium (n = 10). Glycyrrhizae radix et rhizoma has been reported to inhibit hyaluronidase activity to reduce hypersensitivity [37] and have anti-inflammatory effects by inhibiting immune signal transduction in phagocytes [38]. Angelicae gigantis radix helps to maintain normal blood pressure by inducing vasodilation [39] and acts on the central nervous system to relieve pain [40]. Angelicae gigantis radix may be effective in reducing pain and controlling hypertension of the autonomic nervous system symptom. Paeoniflorin, a monoterpene glycoside in peony, is a key component of Paeoniae radix alba [41]. Paeoniflorin has an anti-inflammatory effect by inhibiting inflammatory substances such as nitric oxide, reactive oxygen species, and prostaglandin E2 generated from lipopolysaccharide-activated macrophages [42]. Paeoniflorin may be effective in treating GBS.

Moxibustion treatment was used in 10 studies. The most frequently used acupoint was CV4 (n = 8). The CV4 was used to treat and prevent conditions/diseases by regulating Qi and the blood, regulating water metabolism, and improving systemic function [43]. Hu et al [44] reported that moxibustion treatment significantly induced, stimulated, and controlled axonal regeneration and myelin formation during the recovery phase of the damaged peripheral nerves. In addition, proliferation of Schwann cells can be promoted when serum from moxibustion-treated mice is injected into damaged nerves in vitro. Moxibustion may be helpful in the recovery of patients with GBS.

Cupping was used in 7 studies. The most frequently used acupoint was back-shu points (n = 4), followed by the neck and waist ashi-points (n = 2). Back-shu points are the acupoints located on the back, and activation of these points stimulates the sympathetic and parasympathetic nervous systems that flow out through the thoracolumbar spine [45]. Whang et al [46] reported that cupping on back-shu points in patients with autonomic nervous system dysfunction had a positive effect (immediately after the cupping treatment) on autonomic nervous system stability through the stabilization of heart rate variability. Cupping treatment for GBS may alleviate autonomic symptoms.

In 12 studies [10,11,1316,1823], weakness was evaluated using the MMT. The MMT is a commonly used clinical measure of changes in muscle strength of a patient’s body in a way that can be simply measured [47]. In 11 studies [1115,1723], pain and paresthesia were evaluated using the NRS. The NRS is a very simple and convenient scale for patients to express their level of pain using numbers from 0 to 10, and the concept of the NRS can be easily understood, so that it can be applied to patients with low educational levels [48,49]. In five studies [15,18,19,21,23], the GBS disability scale was used as a specialized evaluation index for GBS. It is a disability scale developed by the GBS study group, consisting of points from 0 to 6, ranging from “Normal” (0 points), “Able to walk 5 m or more without assistance but unable to run” (2 points) to “Death” (6 points) [50]. However, since the evaluation method is focused on the patient’s walking and muscle strength, other symptoms, such as fatigue and edema derived from GBS, may be overlooked. In addition, independent walking speed [10], K-MMSE [13], Euro-quality of life-5 dimension 5-level instrument [13], DTR [16], fatigue severity scale [17], degree of satisfaction [20], and shoulder joint active range of movement used in one study each [21], and grip strength [21], complete blood count [22], and Functional Independence Measure [13,14] used in two studies each were used as evaluation methods. Thus, standardization of the evaluation method for GBS would be helpful in the future.

This study is significant in that it comprehensively analyzed relatively recent case studies in Korea that applied KMT to GBS. In addition, in the 14 studies analyzed in this review, it was reported that all 14 patients who received KMT showed improvement, suggesting the possibility that KMT could be effective in GBS. KMT may shorten the recovery period for Guillain-Barre syndrome and minimize the sequelae. Various KMT methods were analyzed and presented as a method that can be used in the treatment of GBS in clinical practice. However, this study has some limitations. None of the 14 studies reported adverse reactions or side effects. However, it is unclear whether the researcher overlooked the adverse reactions and side effects of KMT or whether adverse reactions and side effects did not occur. In addition, all 14 studies were reported as cases, and there were no controls. By evaluating the various KMTs combined, the effect of an individual treatment cannot be assessed. Therefore, this study suggests that KMT may be used for GBS, although there is risk of bias in the case studies used in this review.

Since GBS is an intractable condition/disease and it is difficult to conduct large-scale studies due to the small number of patients, case accumulation is required, and thus there is a need to establish a consistent treatment and evaluation method for GBS. In addition, further studies are needed to determine the effectiveness of individual KMTs. It is believed that large-scale clinical studies, and KMT-only randomized controlled studies are needed in the future to ascertain the efficacy of KMT for GBS.

Conclusion

  1. There were complaints of weakness of the extremities in 12 cases, and paresthesia and numbness in nine cases in that order.

  2. The most frequently used treatments in GBS were acupuncture and herbal medicine.

  3. A total of 60 acupoints were used for GBS treatment, the most used acupoints were ST36, and the most used meridian systems were the intestine meridian and the stomach meridian.

  4. A prescription for herbal medicine was used in all 14 cases, and Sipjeondaebotang Gami was the most used in four cases.

  5. A total of 85 herbal medicines were used in 21 prescriptions, followed by Glycyrrhizae radix et Rhizoma in 16 cases, Angelicae gigantis radix in 14 cases, and Paeoniae radix alba in 12 cases.

  6. Moxibustion was used in 10 cases, and the most used acupoints were CV4.

  7. Cupping was used in 7 cases, and the most used acupoints were back-shu points.

  8. Treatment evaluation mainly consisted of MMT and NRS. The MMT was used to evaluate weakness, and NRS was used to evaluate pain and paresthesia.

Notes

Author Contributions

Conceptualization: HJJ. Methodology: HJJ. Formal investigation: HJJ. Data analysis: HJJ. Writing original draft: HJJ. Writing - review and editing: HJJ, SJK, MJK, HKC, YRL, HJC, JKJ, JHJ and YIK.

Conflicts of Interest

The authors declare that they have no competing interests.

Ethical Statement

This research did not involve any human or animal experiment.

Data Availability

All relevant data are included in this manuscript.

Funding

None.

References

1. Pritchard J, Hughes RA. Guillain-Barré syndrome. Lancet 2004;363:2186–2188.
2. Hughes RAC, Rees JH. Clinical and epidemiological features of Guillain-Barré syndrome. J Infect Dis 1997;176:92–98.
3. Bogliun G, Beghi E. Incidence and clinical features of acute inflammatory polyradiculoneuropathy in Lombardy, Italy, 1996. Acta Neurol Scand 2004;110:100–106.
4. Asbury AK, Cornblath DR. Assessment of current diagnostic criteria for Guillain-Barré syndrome. Ann Neurol 1990;27:21–24.
5. Rees JH, Thompson RD, Smeeton NC, Hughes RA. Epidemiological study of Guillain-Barre syndrome in south east England. J Neurol Neurosurg Psychiatry 1998;64:74–77.
6. The Guillain-Barre Syndrome Study Group. Plasmapheresis and acute Guillain-Barré syndrome. Neurology 1985;35:1096–1104.
7. Jain RS, Kumar S, Aggarwal R, Kookna JC. Acute aseptic meningitis due to intravenous immunoglobulin therapy in Guillain-Barre syndrome. Oxf Med Case Rep 2014;7:132–134.
8. Kim AY, Lee H, Lee YM, Kang HY. Epidemiological features and economic burden of Guillain-Barré syndrome in South Korea: A nationwide population-based study. J Clin Neurol 2021;17:257–264. [in Korean].
9. Kim HJ, Lee EJ, Lee SH, Chang GT. A literature study on treatment of Guillain-Barre syndrome based on traditional Chinese medicine journals. J Pediatr Korean Med 2015;29:21–31. [in Korean].
10. Heo GY, Lee C, Cho IH, Kang HK, Kim MH, Kim SY, et al. A case report of a patient with Guillain-Barre syndrome who complained of quadriplegia. J Int Korean Med 2021;42:1009–1019. [in Korean].
11. Won SY, Kim HY, Kim JH, Ryu JY, Jung ES, Yoo HR, et al. A case report of a patient with Guillain-Barre syndrome complaining of limb weakness and facial paralysis that improved after Korean medicine treatment. J Int Korean Med 2021;42:695–706. [in Korean].
12. Cha HJ, Kim BS, Lee YJ, Kim HB, Sung KJ, Lee YR, et al. A patient with Guillain-Barre syndrome treated with combined Korean medicine treatments. J Acupunct Res 2021;38:245–256.
13. Ahn JY, Sim SS, Jeong S, Shin YJ, Moon BS, Yun JM. A case report of a patient with Guillain-Barre syndrome complaining of quadriplegia and anorexia improved by Korean medicine treatment. J Int Korean Med 2020;41:769–776. [in Korean].
14. Lee HS, Kim DR, Shim SS, Baek DG, Yun JM, Moon BS. A case report on a patient with Guillain-Barre syndrome complaining of quadriplegia and paresthesia, which improved after Korean medicine treatment. J Int Korean Med 2019;40:1210–1218. [in Korean].
15. Roh JY, Jang JW, Lee GE, Hong JS, Kim DJ. A clinical case study of Guillain-Barre syndrome with chronic progression. J Int Korean Med 2018;38:76–83. [in Korean].
16. Park SM, Cho SW. A case of combined Korean medicine treatment for recurrent limb weakness after Guillain-Barre syndrome improvement: Case report. J Korean Med Rehabil 2019;29:135–142. [in Korean].
17. Lee YR, Kim KS, Choi HS, Kim SM. A case report of patient with Guillain-Barre syndrome complaining of fatigue and tingling improved by Korean medicine treatment. J Int Korean Med 2017;38:719–726. [in Korean].
18. Hwang DG, Park SM, Kim EJ, Kim JY. Case report of patients diagnosed with Guillain-Barre syndrome improved by traditional Korean medical treatment. J Int Korean Med 2016;37:305–314. [in Korean].
19. Heo I, Heo KH, Hwang EH. A case report on patient with Guillain-Barre syndrome improved by Korean medical combined treatment. J Korean Med Rehabilitation 2015;25:95–101. [in Korean].
20. Kim KW, Kim SS, Lee JS, Chung SH. A clinical case study on Guillain-Barre syndrome complaining both lower extremity weakness with oriental medical treatment. J Korea Chuna Man Med Spine Nerves 2011;6:27–33. [in Korean].
21. Huh G, Lee YC, Lee JM, Oh MS. A case report of Guillain-Barre syndrome. J Haehwa Med 2014;23:137–148. [in Korean].
22. Jung ES, Yoo HR, Kim WS, Seol IC. A case report of Guillain-Barré syndrome with neutropenia improved by combined Korean medicine treatment. J of the Society of Stroke on Korean Medicine 2020;21:57–66. [in Korean].
23. Oh JY, Kim YW, Lim EC. A case-report of a Taeyangin patient with acute motor axonal neuropathy using ogapijangchuk-tang. J Sasang Constitut Med 2021;33:171–180. [in Korean].
24. Yang MS, Jong KS, Choi JB. Current research trend on acupuncture treatment for nerve regeneration and recovery: Based on the data of Pub. Med J Acupunct Res 2014;31:147–157. [in Korean].
25. Wang HF, Wang FC, Wang J, Zhang EL, Dong GR. Clinical observation on electroacupuncture at shu-points of the five zang-organs for treatment of acute Guillain-Barre syndrome. Chin Acupunct Moxibustion 2004;24:823–824. [in Chinese].
26. Korean Acupuncture & Moxibustion Medicine Society Textbook Compilation Committee. Acupuncture Medicine Seoul (Korea): Hanmi medical; 2016. p. 623.
27. Hong YS, Hwang YJ. The Oriental Medicine Study on G-B Syndrome. Centering around the etiological factors pathological mechanism and diagnosis and treatment. J Korean Med 1995;16:118–131.
28. Shin MS, Choi SW. Pharmacopuncturology in Musculoskeletal Disease Goyang (Korea): Gaonhae Media; 2015. p. 3.
29. Kim JE, Kim GY. Effects of hominis placenta pharmacopuncture and electroacupuncture neuroprotection in contused spinal cord of rats. J Physiol Pathol Korean Med 2011;25:257–263.
30. Kim WH, Lee CH, Lee JS, Cho KH, Kim SO, Cho SH, et al. Anti-inflammatory activities of a herbal preparation GCSB-5 on acute and chronic inflammation. Korean J Pharmacognosy 2005;36:311–317.
31. Lee SY, Kwon HK, Lee SM. SHINBARO, a new herbal medicine with multifunctional mechanism for joint disease: First therapeutic application for the treatment of osteoarthritis. Arch Pharm Res 2011;34:1773–1777.
32. Kim TH, Yoon SJ, Lee WC, Kim JK, Shin JS, Lee SH, et al. Protective effect of GCSB-5, an herbal preparation, against peripheral nerve injury in rats. J Ethnopharmacol 2011;136:297–304.
33. Marsh N, Williams V. Practical applications of snake venom toxins in hemostasis. Toxicon 2005;45:1171–1181.
34. Kocyigit A, Guler EM, Kaleli S. Anti-inflammatory and antioxidative properties of honey bee venom on Freund’s Complete Adjuvant-induced arthritis model in rats. Toxicon 2019;161:4–11.
35. Kim JH, Shin HG. Analysis of biological experiment on immunoactivity of Sipjeondabo-tang. J Physiol Pathol Korean Med 2012;26:641–649. [in Korean].
36. Lee MY, Ma JY, Choo YK, Jung KY. Protection of spontaneous and glutamate-induced neuronal damages by soeumin sibjeundaibo-tang and soyangin sibimijihwang-tang in cultured mice cerebrocortical cells. Orient Pharm Exp Med 2000;1:55–63.
37. Kakegawa H, Matsumoto H, Satoh T. Inhibitory effects of some natural products on the activation of hyaluronidase and their anti-allergic actions. Chem Pharm Bull 1992;40:1439–1442.
38. Yokota T, Hishio H, Kubota Y, Mizoguchi M. The inhibitory of glabridin from licorice extracts on melanogenesis and inflammation. Pigment Cell Res 1998;11:355–361.
39. Rhyu MR, Kim JH, Kim EY. Radix Angelica elicits both nitric oxide-dependent and calcium influx-mediated relaxation in rat aorta. J Cardiovasc Pharmacol 2005;46:99–104.
40. Choi SS, Han KJ, Lee HK, Han EJ, Suh HW. Antinociceptive profiles of crude extract from roots of Angelica gigas Nakai in various pain models. Biol Pharm Bull 2003;26:1283–1288.
41. He DY, Dai SM. Anti-inflammatory and immunomodulatory effects of paeonia lactiflora pall., a traditional chinese herbal medicine. Front Pharmacol 2011;25:10.
42. Chen G, Guo LX, Deng XH, Yin ZY, Jing JJ. Effects of total glucosides of paeony on nitric oxide and inducible nitric oxide synthase production in macrophages and its mechanism. Zhongguo Mian Yi Xue Za Zhi 2008;24:345. [in Chinese].
43. Byun JY, Son YC, Um TS. A literature review on the hyeolseong of Zusanli and Chung-wan. J Acupunct Res 1992;9:173–178.
44. Hu LN, Tian JX, Gao W, Zhu J, Mou FF, Ye XC, et al. Electroacupuncture and moxibustion promote regeneration of injured sciatic nerve through Schwann cell proliferation and nerve growth factor secretion. Neural Regen Res 2018;13:477–483.
45. da Silva MA. A neurosegmental perspective of the classical back shu points. Med Acupuncture 2010;22:257–264.
46. Hwang EM, Wang KH, Bae JI, Keum DH. The effect of dry cupping treatment applied to back-shu points on the autonomic nervous system through HRV. J Orient Rehabil Med 2013;23:51–64.
47. Lee YS, Lee YB, Kim CH. The preferred method for evaluation of lower extremity functional status in patients with stroke. J Korean Geriatr Soc 2006;10:192–196.
48. Shim SY, Park HJ, Lee JM, Lee HS. An overview of pain measurements. J Meridian Acupoint 2007;24:77–97.
49. White A. Measuring pain. Acupunct Med 1998;16:83–87.
50. van Doorn PA, Kuitwaard K, Walgaard C, van Koningsveld R, Ruts L, Jacobs BC. IVIG Treatment and Prognosis in Guillain-Barre Syndrome. J Clinical Immunol 2010;30:74–78.

Article information Continued

Fig. 1

Flow chart of the study selection process.

Fig. 2

Analysis of publication year.

Fig. 3

Age and sex distribution.

Fig. 4

Analysis of chief complaint.

Table 1

Symptoms, Treatment, and Evaluation Summary of the 14 Case Reports Included in this Review.

Author (y) [ref] Gender/Sex Treatment period (d) Symptoms Treatment Treatment site Evaluation Result/Score
Heo (2021) [10] M/52 118 Quadriplegia Manual acupuncture GV20, GB20, TE5, GB34, SP9, ST38, GB39, SP6, EX-UE9, EX-LE10, EX-UE11, EC-LE12 MMT Shoulder (elevation) 4/4 → 4+/4, (abduction, adduction) 3+/3+ → 4/4
Elbow (flexion) 3/3 → 4/4
Wrist (extension) 3/3 → 3+/3+
Finger (flexion) 3/3 → 3+/4
Hip (flexion) 2−/2− → 3+/4, (abduction, adduction) 2−/2− → 3+/3+
Knee (extension) 1/1 → 3−/3
Ankle (dorsiflexion, Planta flexion) 0/0 → 2−/2−
Toe (extension) 0/0 → 1/1
Electroacupuncture LI4, LI11, ST36, LR3 Ambulation state Wheelchair → can walk with a cane
Pharmacopuncture
  • - hominis placenta pharmacopuncture/2–4 cc

  • - jungsongouhyul pharmacopuncture/2–4 cc

  • - LI11, LI4, TE5, GB34, ST36, SP9, ST38, GB39, SP6, LR3, EX-B

  • - Back-shu points, hyeop check points

Independent walking speed 0.23 m/s (no loading) → 0.51 m/s (with 3 kg loading)
Moxibustion (indirect) CV4, CV1, BL64
Rehabilitation bicycle, standing balance training, quadruped walking, strength training, ambulation exercise, manual therapy
Herbal Medicine ― GamiShipjeontang, GamiSamultang, GamiSamultang + Sosikcheongwooltang
Won (2021) [11] F/25 20 Quadriplegia, facial paralysis, numbness of the extremities, headache, pantalgia Manual acupuncture BL2, TE23, ST3, CV24, LI20, GV20, TE5, LI4, HT7, Neck and lumbar ashi-points MMT Shoulder, elbow, finger, ankle 4/4 → 4+/4+
Hip, knee 4+/4+ → 4+/4+
Electroacupuncture Right ST4, ST06, LI10, GB39 K-MBI 92 → 98
Moxibustion (indirect) Both ST6, ST3, TE5, LI4, LI10, and HT7 Y-score 31 → 36
Cupping (not bleeding) Neck and lumbar ashi-point, back-shu points NRS Headache 6 → 2
Neck and back pain 6 → 1
Steam bath Face
Physical therapy
  • - ICT, TENS

  • - SSP

  • - Neck and lumbar ashi-points

  • - Face

Facial manual therapy
Herbal medicine-banha-sasim-tang soft extract
Western medicine-prednisolone 5 mg, ibuprofen 400 mg, acetaminophen 650 mg, nortriptyline HCl 11.4 mg, ursodeoxycholic acid 100 mg, dexlansoprazole 30 mg, piroxicam 48 mg, sodium hyaluronate 1 mg
Cha (2021) [12] F/37 51 Facial paralysis, numbness of bilateral fingers and toes, backache, paresthesia of the sphincter Manual acupuncture GV20, BL2, EX-HN4, TE23, EX-HN5, TE17, ST4,ST6, LI4, PC6, EX-LE10, EX-UE9, SP6, ST36, ST40, GB41 Y-score 22 → 40
Pharmacopuncture
  • - sweet BV (1:10,000)/1 cc

  • - jungsongouhyul pharmacopuncture/0.6 cc

  • - left EX-HN4, EX-HN5, ST4, ST2, and both TE5, ST36, SP6

  • - TE5, ST36, ST41

NRS Numbness in fingers 6 → 0
Numbness in toes 7 → 0
Moxibustion (indirect) CV4
Cupping (not bleeding) Back
Physical therapy
  • - ICT, MW

  • - EST

Back
Both sides of the forearms and lower limbs
Herbal medicine-gamishipjeondaebotang, hyangbujasunkipalmultang
Ahn (2020) [13] F/79 64 Quadriplegia, numbness of upper and lower limbs, cognitive disorder, anorexia Manual acupuncture GV20, CV24, LI4, TE5, LI11, GB34, SP9, SP6, HT7 MMT Shoulder, hip, knee, Ankle 2+/2+ → 4+/4+
Elbow, wrist, finger 3/3 → 4+/4+
Electroacupuncture LI10, GB39 K-MMSE 11 → unknown
Moxibustion (indirect) CV4 MBI 14 → 95
Cupping (not bleeding) Back-shu points FIM 42 → 101
Physical therapy-electrotherapy Unknown Ambulation state Wheelchair → can walk without assistance
Tilt training, mat training, occupational therapy, ADL therapy EQ-5D-5L 24 → 7
Herbal medicine-gamibojungikgitang
Western medicine-rivaroxaban micronized 20 mg, tamsulosin hydrochloride 0.2 mg, cholecalciferol concentrated gr. 56 mg, risedronate sodium 2.5 mg, hydrate 40.162 mg, acebrophylline 100 mg, dimenhydrinate 50 mg, pregabalin 75 mg, mosapride citrate hydrate 5.29 mg
Lee (2019) [14] F/71 51 Quadriplegia, numbness of upper and lower limbs, dysuria, respiratory disturbance, edema of both hands and foots Manual acupuncture GV20, CV24, LI4, TE3, TE5, ST36, LI11, GB34, SP9, SP6, HT7 MMT Shoulder 3−/3− → 4/4
Elbow 3/3 → 4/4
Finger 2+/2+ → 3+/3+
Hip 2/2 → 4/4
Knee 1/1 → 4/4
Ankle 1/1 → 2/2
Electroacupuncture Both sides of LI10, GB39 MBI 11 → 56
Moxibustion (indirect) CV4 FIM 37 → 70
Cupping (not bleeding) Back-shu points Ambulation state Wheelchair → can walk 30 m with a cane
Physical therapy-electrotherapy Unknown NRS Numbness in upper and lower limbs 8 → 3
Mat training, occupational therapy
Herbal medicine-gamisambitang
Western medicine-levothyroxine sodium hydrate 0.1 mg, atorvastatin calcium trihydrate 10 mg, tamsulosin hydrochloride 0.2 mg, vitis vinifera seed dried ext. 150 mg, acebrtophylline 100 mg, amitriptyline hydrochloride 10 mg, polaprezinx 75 mg, bethanechol chloride 25 mg, aceclofenac 100 mg, gabapentin 300 mg, citrulline malate 1 g
Roh (2018) [15] M/43 24 Weakness of right upper limb, numbness of both lower limbs Manual acupuncture Lumbar and lower limbs ashi-point, both sides of brachioradialis m., hand extensors MMT Rt. elbow 4 → 4
Rt. wrist 3 → 3
Rt. 2nd finger 2− → 2+
Rt 3rd finger 2+ → 3
Electroacupuncture Lumbar and lower limbs ashi-point, both sides of brachioradialis m., hand extensors GBS disability scale 2 → 1
Pharmacopuncture-hominis placenta pharmacopuncture/0.4 cc Both LI11, ST36 NRS Numbness in both calf 2 → 1
Numbness in both toes and plantar 8 → 7
Moxibustion (indirect) CV4
Cupping (not bleeding or bleeding) BL50
Steam bath Both upper and lower limbs
Manual therapy
Herbal medicine-gamiyoungseonjaetongeum, gamitaglisodogeum
Park (2019) [16] M/16 26 Quadriplegia Manual acupuncture ST34, SP10, LI11, TE5, ST38, LR3, KI3, Ashi-point of peroneus longus m. and extensor digitorum longus m. MMT Hip, knee −3/−3 → 5/5
Wrist 5−/5− → 5/5
Pharmacopuncture-hominis placenta Pharmacopuncture/0.4 cc Both LR3, KI3 K-MBI 71 → 86
Chuna manual therapy Unknown Ambulation state Wheelchair → can walk 5 m without assistance
Tilt training DTR Biceps, triceps, Achilles tendon reflex ++/++ → ++/++
patella tendon +++/+++ → +++/+++
Herbal medicine-shipjeondaebotang
Lee (2017) [17] M/39 14 Fatigue, numbness, pantalgia Manual acupuncture SI5, ST41, GB41, ST43, LI11, ST36, neck and lumbar ashi-point FSS 8 → 2
Pharmacopuncture-snake venom Toxin pharmacopuncture/0.5 cc LI11, ST36 NRS Numbness 8 → 0
Pain 8 → 3
Moxibustion (indirect) CV4, CV12
Cupping (not bleeding) Neck and lumbar ashi-point
Physical therapy-ICT, MW Both sides of upper and lower limbs
Manual therapy, simple therapeutic exercise
Herbal medicine-gami-hyangsayangwitang
Hwang (2016) [18] M/22 48 Quadriplegia, low back pain Manual acupuncture Back-shu points both sides of brachioradialis m., hand extensors, quadriceps femoris m., tibialis anterior m. MMT Elbow (flexion), wrist (extension), finger (flexion) 4/4 → 5/5
Hip (ab, adduction, Flexion, extension) 3−/3 → 4+/4+
Knee (flexion, extension) 3−/3− → 5/5
ankle (flexion, extension), 1st toe (flexion, extension) 3+/3− → 5/5
Electroacupuncture Ashi-point of lumbus, both sides of quadriceps femoris m. and tibialis anterior m. GBS disability scale 3 → 0
Pharmacopuncture-shinbaro Pharmacopuncture/unknown Back-shu points, both sides of brachioradialis m., hand extensors, Quadriceps femoris m., tibialis anterior m. MBI 52 → 100
Steam bath Low back NRS low back pain 4 → 0
Physical therapy-TENS Low back
Herbal medicine-sukjiyanggeuntang
Heo (2015) [19] F/71 59 Paraplegia, paresthesia of extremities Manual acupuncture Both sides of brachioradialis m., hand extensors, quadriceps femoris m., tibialis anterior m. MMT Neck (flexion, extension) 3/4 → 5/5, (rotation) 4/4 → 5/5
shoulder (elevation) 4−/4− → 4+/4+ (abduction) 4−/4− → 5/5 (adduction) 3/3 → 5/5
Elbow (flexion) 4−/4− → 5/5
wrist (extension), finger (flexion) 4−/4− → 4+/4+
hip (flexion) 3−/3− → 4/4 (abduction, adduction) 3/3 → 4/4
knee (extension) 3−/3− → 3+/3+
ankle (dorsi flexion, planta flexion), toe (extension) 3−/3− → 3/3
Electroacupuncture Both sides of brachioradialis m., hand extensors, quadriceps femoris m., tibialis anterior m. GBS disability scale 4 → 2
Moxibustion (indirect) CV4, CV12
Physical therapy
  • - FES, SSP

  • - Air massage

  • - Both sides of tibialis anterior m. both sides of quadriceps femoris m., tibialis anterior m.

  • - Both lower limbs

Ambulation exercise, occupational therapy
Herbal medicine-chungjogupyetang
Kim (2011) [20] M/36 35 Weakness of extremities, edema, and pain in both hand and foot Manual acupuncture TE10, TE6, SP29 Saam’s acupuncture (SI5, LI5, BL66, LI2) MMT Hip, knee, ankle 4/4 → 4+/4+
1st toe 3/3 → 4+/4+
Electroacupuncture Both sides of ST36,ST37,SP39,LR3 Ambulation state Wheelchair → can walk without Assistance
Physical therapy
  • - TENS

  • - Massage

  • - Ashi-point

  • - Back-shu points

Satisfaction degree Poor → good
Herbal medicine-gunbitang
Huh (2014) [21] M/46 147 Weakness of both upper limbs, numbness of both upper limbs, facial paralysis, both shoulder pain, dysarthria, asthenia, residual Urine Manual acupuncture LI14, TE14, GB21, LI11, KI3, LR3, ST36 Shoulder joint aROM Abduction, flexion 0/0 → 180/180
Adduction, extension 0/0 → 45/45
Internal rotation 0/0 → 90/90
External rotation 0/0 → 90/85
Electroacupuncture LU9, LI4 MMT Both legs 4/4 → 5/5
Both arms 2/2 → 5/5
Moxibustion (indirect) GB21, LI11, LI4, LU9 MBI 53 → 89
Physical therapy-EST Both sides of the shoulder GBS disability scale 3 → 2
Herbal medicine-gamiyugmijihwangtang, yukwooltang, bojungikgijeon, palmultang Grip strength (kg) Rt. 7.3 → 11.6
Lt. 0 → 5.5
Western medicine-warfarin sodium 2 mg, warfarin sodium 5 mg
Jung (2019) [22] F/75 22 Paresthesia of extremities, quadriplegia, facial paralysis Manual acupuncture Both LI10, TE5, ST38, ST7, ST4, ST6, LI20 MMT Elbow (flexion), wrist (extension) 3+/3+ → 4+/4+
hip (flexion), knee (flexion, extension), ankle (dorsi flexion, planta flexion) 3+/3 → 4+/4+
Electroacupuncture Both LI11, ST36, LI14, LR3 Y-score 36/21 → 40/26
Moxibustion (indirect) CV12 NRS Numbness in hand and foot 5 → 3
Cupping (not bleeding) Back-shu points CBC WBC (103/μL; 4.5–11) 2.30 → 5.10
ANC (cells/mm3; > 2,000) 1,122 → 3,070
Physical therapy
  • - SSP

  • - EST

  • - Face

  • - Both sides of tibialis anterior m.

Ambulation state Walk with assistance → can walk without assistance
Manual therapy, simple therapeutic exercise
Herbal medicine-gamishipjeondaebotang
Oh (2021) [23] M/50 73 Weakness of both lower limbs, sign of itching Manual acupuncture GV20,LI4,TE5,ST36,LI11,GB34,LI10,SP9,GB39,HT7,GB41, Saam’s acupuncture (KI10, LR8, LU8) MMT 4/4 → 5/5
Herbal medicine-ogapijangchuktang LR4, HT8, LU10, LU5, ST36 GBS disability scale 3 → 0
Western medicine-prednisolone 5 mg NRS Pain of thigh and calf 6 → 2

MMT, manual muscle test; K-MBI, Korean version of modified Barthel index; Y-score, Yanagihara grading score; NRS, numeric rating scale; K-MMSE, Korean-mini mental status examination; MBI, modified Barthel index; FIM, functional independence measure; EQ-5D-5L, Euro-quality of life-5 dimension 5-level instrument; GBS disability scale, Guillain-Barre syndrome disability scale; DTR, deep tendon reflex; FSS, fatigue severity scale; Shoulder aROM, shoulder active range of motion; CBC, complete blood count.

Table 2

Assessment Tool Summary of 14 Patients.

Assessment tool Author (y) [ref] Result/score
MMT Heo (2021) [10] Shoulder (Elevation) 4/4 –> 4+/4, (abduction, adduction) 3+/3+ –>4/4
Elbow (Flexion) 3/3 –>4/4, wrist (extension) 3/3–>3+/3+, finger (flexion) 3/3 –>3+/4
Hip (Flexion) 2−/2− –>3+/4, (abduction, adduction) 2−/2− –>3+/3+
Knee (Extension) 1/1–>3−/3, ankle (dorsiflexion, planta flexion) 0/0 –>2−/2−, toe (extension) 0/0 –>1/1
Won (2021) [11] Shoulder, elbow, finger, ankle 4/4 –> 4+/4+, hip, knee 4+/4+ –> 4+/4+
Ahn (2020) [13] Shoulder, hip, knee, ankle 2+/2+ –> 4+/4+, elbow, wrist, finger 3/3 –> 4+/4+
Lee (2019) [14] Shoulder 3−/3− –> 4/4, elbow 3/3 –> 4/4, finger 2+/2+ –> 3+/3+
Hip 2/2 –> 4/4, knee 1/1 –> 4/4, ankle 1/1 –> 2/2
Roh (2018) [15] Rt. elbow 4 –>4, Rt. wrist 3 –> 3, Rt. 2nd finger 2− –> 2+, Rt 3rd finger 2+ –> 3
Park (2019) [16] Hip, knee −3/−3 –> 5/5, wrist 5−/5− –> 5/5
Hwang (2016) [18] Elbow (flexion), wrist (extension), finger (flexion) 4/4 –> 5/5, hip (ab, adduction, flexion, extension) 3−/3− –> 4+/4+
Heo (2015) [19] Knee (flexion, extension) 3−/3− –> 5/5, ankle (flexion, extension), 1st toe (flexion, extension) 3+/3− –> 5/5
Neck (flexion, extension) 3/4 –> 5/5, (rotation) 4/4 –> 5/5
Shoulder (elevation) 4−/4− –> 4+/4+ (abduction) 4−/4− –> 5/5 adduction 3/3 –> 5/5
Elbow (flexion) 4−/4− –> 5/5
Wrist (extension), finger (flexion) 4−/4− –> 4+/4+
Hip (flexion) 3−/3− –> 4/4 (abduction, adduction) 3/3 –> 4/4
Kim (2011) [20] Knee (extension) 3−/3− –>3+/3+
Ankle (dorsi flexion, planta flexion), toe (extension) 3−/3− –> 3/3
Huh (2014) [21] Hip, knee, ankle 4/4 –> 4+/4+, 1st toe 3/3 –> 4+/4+
Jung (1029) [22] Both legs 4/4 –> 5/5, both arms 2/2 –> 5/5
Oh (2021) [23] Elbow (flexion), wrist (extension) 3+/3+ –> 4+/4+
Hip (flexion), knee (flexion, extension), ankle (dorsiflexion, planta flexion) 3+/3 –> 4+/4+ 4/4 –> 5/5

NRS Won (2021) [11]
Cha (2021) [12]
Lee (2019) [14]
Roh (2018) [15]
Lee (2017) [17]
Hwang (2016) [18]
Jung (1029) [22]
Oh (2021) [23]
Headache 6 –> 2, neck and back pain 6 –> 1
Numbness in fingers 6 –> 0, numbness in toes 7 –> 0
Numbness in upper and lower limbs 8 –> 3
Numbness in both calf 2 –>1, numbness in both toe and plantar 8 –> 7
Numbness 8 –> 0, pain 8 –> 3
Low back pain 4 –> 0
Numbness in hand and foot 5 –> 3
Pain of thigh and calf 6 –> 2

Ambulation state Heo (2021) [10]
Ahn (2020) [13]
Lee (2019) [14]
Park (2019) [16]
Kim (2011) [20]
Jung (1029) [22]
Wheelchair –> can walk with a cane
Wheelchair –> can walk without assistance
Wheelchair –> can walk 30 m with a cane
Wheelchair –> can walk 5 m without assistance
Wheelchair –> can walk without assistance
Walk with assistance –> can walk without assistance

GBS disability scale Roh (2018) [15]
Hwang (2016) [18]
Heo (2015) [19]
Huh (2014) [21]
Oh (2021) [23]
2 –> 1
3 –> 0
4 –> 2
3 –> 2
3 –> 0

Y-score Won (2021) [11]
Cha (2021) [12]
Jung (1029) [22]
31 –> 36
22 –> 40
36/21 –> 40/26

K-MBI Won (2021) [11]
Park (2019) [16]
Ahn (2020) [13]
Lee (2019) [14]
92 –> 98
71 –> 86
14 –> 95
11 –> 56
MBI Hwang (2016) [18]
Huh (2014) [21]
52 –> 100
53 –> 89

Independent walking speed Heo (2021) [10] 0.23 m/s (no loading) –> 0.51 m/s (with 3 kg loading)

K-MMSE Ahn (2020) [13] 11 –> unknown

FIM Ahn (2020) [13]
Lee (2019) [14]
42 –> 101
37 –> 70

EQ-5D-5L Ahn (2020) [13] 24 –> 7

DTR Park (2019) [16] Biceps, triceps, Achilles tendon reflex ++/++ –> ++/++
Patella tendon +++/+++ –> +++/+++

FSS Lee (2017) [17] 8 –> 2

Degree of satisfaction Kim (2011) [20] Poor –> good

Shoulder joint aROM Huh (2014) [21] Abduction, flexion 0/0 –> 180/180
Adduction, extension 0/0 –> 45/45
Internal rotation 0/0 –> 90/90
External rotation 0/0 –> 90/85

Grip strength (kg) Huh (2014) [21] Rt. 7.3 –> 11.6
Lt. 0 –> 5.5

CBC Jung (1029) [22] WBC (103/μL; 4.5–11) 2.30 –> 5.10
ANC (cells/mm3; > 2,000) 1,122 –> 3,070

MMT, manual muscle test; NRS, numeric rating scale; GBS disability scale, Guillain-Barre Syndrome disability scale; Y-score, Yanagihara grading score; K-MBI, Korean version of modified Barthel index; MBI, modified Barthel index; K-MMSE, Korean-mini mental status examination; FIM, functional independence measure; EQ-5D-5L, Euro-quality of life-5 dimension 5-level instrument; DTR, deep tendon reflex; FSS, fatigue severity scale; Shoulder aROM, shoulder active range of motion; CBC, complete blood count.