Guillain-Barré Syndrome

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is Guillain-Barré syndrome?

Guillain-Barré syndrome (GBS) is an autoimmune disorder that affects the nerves. In autoimmune diseases, the immune system mistakenly attacks the body’s own cells and tissues as if they were foreign invaders. In GBS, the target of this erroneous attack is the peripheral nerves. Other names for GBS include Landry’s ascending paralysis and acute inflammatory demyelinating polyradiculoneuropathy (AIDP).

Peripheral nerves carry signals from the brain and spinal cord to the muscles and other tissues. These nerves are like electrical wiring. Nerve cells have a central portion—called the axon, or nerve fiber that transmits the signal. They also have a layer of insulation, called myelin, that surrounds the axon. The myelin layer helps the signal travel quickly to even the most distant body parts. GBS usually attacks the myelin layer, but can also affect the inner axon.

When GBS damages nerves, they can no longer transmit signals properly. This results in weakness and abnormal sensations, such as tingling. These symptoms typically start in the feet or hands and spread up the limbs. Symptoms begin and spread quickly, within hours or days, and affect both sides of the body.

Over the years, doctors and researchers have discovered that GBS has several forms and related conditions. Types of GBS include:

  • Acute inflammatory demyelinating polyradiculoneuropathy (AIDP), which is the most common type in the United States, attacks the myelin layer.

  • Acute motor axonal neuropathy (AMAN) and acute motor-sensory axonal neuropathy (AMSAN) attacks the central axon.

  • Miller-Fisher syndrome, which starts in the eyes, affects coordination and walking gait.

Anyone can get GBS, but it is a rare disorder in the United States. It strikes about 3,000 to 6,000 people in this country each year and is more common in adults older than 50. In most cases, it starts within a few days or weeks of a viral or bacterial infection. Experts believe the infection triggers GBS somehow, but they don’t understand exactly how or why. While GBS is not contagious; the infections that set it off are. 

There is no cure for GBS, so treatment is mainly supportive. Options include IVIG (intravenous immunoglobulin) therapy or a plasma exchange procedure. 

GBS can become life threatening quickly. It requires treatment in a hospital to monitor vital body functions. In severe cases, total paralysis can occur. This can affect the muscles that control breathing, making mechanical ventilation necessary. Fortunately, most people recover. However, recovery can be prolonged and take months or years.

Seek prompt medical care if you have mild weakness or tingling that is stable and isn’t spreading or getting worse. Seek immediate medical care if weakness or tingling is spreading or if you have trouble breathing or swallowing saliva.

What are the symptoms of Guillain-Barré syndrome?

The main Guillain-Barré syndrome symptoms are muscle weakness and unexplained sensations. This can include numbness, crawling, tingling, prickling or pain. Symptoms have a rapid onset, often within hours or days, and spread. The typical pattern starts in the feet or hands on both sides of the body and spreads upwards toward the body. However, it is possible for it to spread down from the body to the feet. The severity can range from mild and brief to dangerous and prolonged.

Common symptoms

Other symptoms of GBS may include: 

  • Difficulty moving the eyes or vision problems

  • Incoordination

  • Problems speaking, chewing or swallowing

  • Severe pain that may worsen at night

  • Unsteady gait or trouble walking

Serious symptoms that might indicate a life-threatening condition

GBS symptoms can progress quickly, sometimes in just a few hours. They typically reach maximum intensity and severity within 2 to 3 weeks. In some cases, GBS can cause life-threatening muscle paralysis. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

GBS almost always requires hospitalization in an ICU (intensive care unit). Do not wait to seek medical care if you have weakness or abnormal sensations that are spreading or getting worse. GBS can become fatal in a very short amount of time. Early treatment offers the best chance of a favorable outcome.

What causes Guillain-Barré syndrome?

Guillain-Barré syndrome (GBS) is an autoimmune disease. This means the immune system mistakes the body’s own tissues as foreign. It begins producing antibodies that attack the body’s tissues. In GBS, the immune system goes after the peripheral nerves. However, experts do not know how or why this happens. 

Researchers have identified several possible GBS triggers. About two-thirds of people with GBS had a recent respiratory or GI (gastrointestinal) infection. Up to 40% of GBS cases in the United States follow an infection with Campylobacter jejuni. This infection is usually a form of food poisoning from eating contaminated or undercooked food. Other infectious triggers can include the flu, cytomegalovirus, Epstein-Barr virus, and Zika virus. Less common triggers include recent surgery or vaccination.

What are the risk factors for Guillain-Barré syndrome?

In the United States, Guillain-Barré syndrome risk factors include:

  • Being an adult, especially an older adult over 50 years of age

  • Being male; while it can affect either sex, men have a slightly higher risk than women in this country

  • Having a recent infection with one of the possible triggering organisms

Reducing your risk of Guillain-Barré syndrome

It is not possible to predict who will develop GBS and who won’t. So, there is no definite way to prevent the disease. Early diagnosis and treatment is the best way to reduce the severity and length of GBS.

How is Guillain-Barré syndrome treated?

There is no curative Guillain-Barré syndrome treatment. Most people with GBS need care in an ICU. An ICU setting allows doctors to closely monitor the patient and intervene with supportive measures. This may include mechanical ventilation, heart and blood pressure support, blood clot prevention, and feeding tubes. 

Doctors have two treatment options that may help reduce the severity of GBS and speed recovery:

  • Immunotherapy with high-dose IVIG (intravenous immunoglobulin). Immunoglobulins are antibodies the immune system makes. IVIG contains antibodies from blood donors. Giving high doses to people with GBS may dilute their own abnormal antibodies. The normal antibodies in IVIG may also bind and block the abnormal ones in GBS. The overall result is to lessen the attack on the body’s nerves.

  • Plasma exchange or plasmapheresis. This procedure involves removing a portion of your blood to a machine that separates the liquid part—or plasma—from the blood cells. Then, your blood cells are returned to your body. Your body makes new plasma to replace what was lost. Plasma contains antibodies, among other proteins. Removing plasma will also remove abnormal antibodies.

These two treatments have about the same effectiveness. Using both together provides no additional benefit.

After the acute phase of GBS, most people need some level of rehabilitation. This may involve a stay in a rehab facility after discharge from the hospital. Physical, occupational and vocational therapy can help restore strength, function and independence. Speech and swallowing therapy may also be necessary.

What are the potential complications of Guillain-Barré syndrome?

Guillain-Barré is a very unpredictable condition. Most people—about 70%—will recover fully from Guillain-Barré syndrome, but it can take time. The usual disease course involves worsening symptoms for about two weeks, a plateau in symptoms within four weeks, and recovery in 6 to 12 months. However, recovery may only take a few weeks or it can be prolonged and last several years. During this time, fatigue, pain, and abnormal sensations are common. 

About 30% of people with GBS will still have some level of weakness three years after an episode. About 15% will have chronic weakness that may require a walker or wheelchair. Around 3% will have a relapse several years after the first episode.

GBS can be fatal, but this is rare when people seek proper medical care. GBS complications that can lead to death include pneumonia, respiratory failure, sepsis, pulmonary embolism, or heart attack.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Jan 15
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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