- Also Known As:
- Infectious Polyneuritis
- Acute Inflammatory Demyelinating Polyneuropathy
- Landry's Ascending Paralysis
- Acute Idiopathic Polyneuritis
This page was fact checked by our expert Medical Review Board for accuracy and objectivity. Read more about our editorial policy and review process..
What is Guillain-Barré syndrome?
Guillain-Barré syndrome (GBS) is an acute condition associated with progressive muscle weakness and paralysis. It is an autoimmune disorder in which the body’s immune system attacks its own nervous system. This causes inflammation that damages or destroys the myelin sheaths covering and insulating nerve fibers (axons) and sometimes damages the fibers themselves. This demyelination process slows or stops the conduction of impulses…
Guillain-Barré syndrome (GBS) is an acute condition associated with progressive muscle weakness and paralysis. It is an autoimmune disorder in which the body’s immune system attacks its own nervous system. This causes inflammation that damages or destroys the myelin sheaths covering and insulating nerve fibers (axons) and sometimes damages the fibers themselves. This demyelination process slows or stops the conduction of impulses through the nerve, interfering with motor control and causing symptoms such as tingling or numbness that typically starts in the legs and moves to the arms, hands, and even the face. It often affects both sides of the body. GBS can be a medical emergency that must be closely monitored. Those affected may become so weak that they have trouble breathing and their heart rate may become abnormal.
Guillain-Barré syndrome is a relatively rare condition. According to the Centers for Disease Control and Prevention, an estimated 3,000 to 6,000 people develop GBS each year, affecting about 1 in 100,000 people. It can affect anyone at any age, although it is most common in older adults. It is an unusual neuropathy in that it spontaneously occurs, with recovery times varying from a few weeks to a few years.
The exact cause of GBS and why it affects one person and not another is not well understood. The autoimmune process may be spontaneous or may be triggered by some specific disease or exposure. About two-thirds of cases are linked with a viral or bacterial infection that causes diarrhea or a respiratory illness that occurs a week or two before GBS develops. One of the most common risk factors is an infection with the bacteria Campylobacter jejuni (about 40% of cases in the U.S. are thought to be triggered by this type of bacteria), but it may also be triggered by the flu or other viral infections such as cytomegalovirus, Epstein Barr virus, or Zika virus.
Cases have also been seen in people with HIV infection, in those with chronic diseases such as lupus (SLE), Hodgkin lymphoma (and some other malignancies), and rarely in those who have recently had a vaccination (such as for rabies or swine flu). Something in these circumstances leads to a change in the immune system’s ability to discriminate between “self” and “non-self.” Damage to the myelin sheath and nerve is thought to involve antibodies that mistakenly target these tissues.
According to the National Institute of Neurological Disorders and Stroke, some studies show there may be a genetic component to developing GBS, but more research is needed.
About Guillain-Barré Syndrome
Signs and Symptoms
Signs and symptoms of Guillain-Barré syndrome can progress relatively quickly once they appear. They typically start in the legs and spread upward to the arms and face. At first they may include:
- Tingling or pins-and-needle sensations
- Weakness, especially in the legs
- Muscle spasms
- Loss of coordination
- Loss of reflexes (e.g., loss of “knee jerk” reflex)
More serious symptoms, some of which may require emergency medical assistance, include:
- Difficulty breathing and/or swallowing
- Abnormal heart rate or blood pressure
In most cases, symptoms develop over hours to days and may continue to worsen for up to a month, after which they slowly resolve. Up to 30% of those affected may still have some lingering weakness after 3 years, and a small percentage (about 3%) may relapse years later. About 15% experience long-term weakness.
Your medical history is important in diagnosis of Guillain-Barré syndrome. The progression of ascending paralysis is a typical presentation. About 50% of cases also include a history of a recent infection or illness like a sore throat, a cold, the flu, or diarrhea. Several tests are commonly used to diagnose or confirm the disease and, sometimes, to monitor recovery.
- Cerebrospinal fluid (CSF) analysis – to identify the presence of increased protein and white blood cells. A healthcare practitioner performs a lumbar puncture (spinal tap) to collect a sample of CSF for this test. While some protein is normally present, an increased amount without an increase in the white blood cells in the CSF may indicate Guillain-Barré syndrome.
- Nerve conduction velocity – tests the speed at which impulses travel through a nerve. The nerve conduction velocity test uses electrodes placed on the skin over peripheral nerves and measures the amount of time it takes for an impulse to travel between electrodes.
- Electromyography (EMG) – measures the electrical activity of muscles fibers. The EMG test measures the electrical activity within muscle fibers by placing a needle electrode through the skin directly into the muscle and measuring the electrical activity of that muscle. It is usually done in conjunction with a nerve conduction velocity test.
There are various types of GBS that are associated with specific signs and symptoms and with the production of different types of antibodies directed against gangliosides. Rarely, ganglioside autoantibody tests may be ordered.
Other testing may be performed to help distinguish GBS from other causes of weakness, neuropathy, and immune dysfunction and to monitor your health status during illness and recovery.
There is no cure for Guillain-Barré syndrome. However, 70% of people with GBS experience full, functional recovery. Symptoms can be managed through various treatments stabilizing disease progression, which then begins to resolve within weeks or months. Death rarely occurs and is generally due to secondary lung (pulmonary) complications.
The goals of treatment are to try to help decrease the severity of symptoms, speed healing, and to prevent and/or minimize complications. You may require hospitalization for careful monitoring and supportive care. If the symptoms are severe, you may require breathing assistance.
Two approaches are sometimes used early in the disease to lessen the severity and hasten the recovery. Both are intended to decrease the effectiveness of the antibodies that attack the myelin sheath.
- Plasmapheresis is a process of removing blood, filtering out the liquid plasma that contains antibodies involved in the autoimmune disorder, and then returning the red and white blood cells to the circulation.
- High-dose immunoglobulin therapy has been used to diminish the activity of the damaging antibodies.
In the recovery phase, you will likely need to undergo physical therapy to help regain muscle strength.
Sources Used in Current Review
(June 2018) Guillain-Barre Syndrome Fact Sheet. National Institute of Neurological Disorders and Stroke. Available online at https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Guillain-Barr%C3%A9-Syndrome-Fact-Sheet. Accessed on 8/20/2019.
(October 16, 2015) Guillain-Barre Syndrome and Flu Vaccine. Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/flu/prevent/guillainbarre.htm. Accessed on 8/20/19.
(October 2, 2017) Guillain-Barre Syndrome. Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/campylobacter/guillain-barre.html. Accessed on 8/20/19.
Guillain-Barre Syndrome. Cleveland Clinic. Available online at https://my.clevelandclinic.org/health/diseases/15838-guillain-barr%C3%A9-syndrome. Accessed on 8/20/19.
(May 4, 2018) Guillain-Barre Syndrome. Medscape. Available online at https://emedicine.medscape.com/article/315632-overview. Accessed on 8/20/19.
Sources Used in Previous Reviews
(2006 July 12, Updated). Guillain-Barre Syndrome Fact Sheet. NINDS [On-line information]. Available online at http://www.ninds.nih.gov/disorders/gbs/detail_gbs.htm.
(2006 April 28). Guillain-Barre syndrome. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000684.htm.
(2005 May 31). Mayo Clinic. Guillian- Barre Syndrome. Available online at http://www.mayoclinic.com/health/guillain-barre-syndrome/D500413.
(Updated 2010 May 6). Guillain-Barré Syndrome Fact Sheet. National Institute of Neurological Disorders and Stroke [On-line information]. Available online at http://www.ninds.nih.gov/disorders/gbs/detail_gbs.htm. Accessed October 2010.
Mayo Clinic staff (2009 May 30). Guillain-Barre syndrome. MayoClinic.com [On-line information]. Available online at http://www.mayoclinic.com/print/guillain-barre-syndrome/DS00413/DSECTION=all&METHOD=print. Accessed October 2010.
Dowshen, S. (Reviewed 2009 October). Guillain-Barré syndrome. TeensHealth from Nemours [On-line information]. Available online at http://kidshealth.org/teen/diseases_conditions/bones/gbs.html. Accessed October 2010.
Davids, H. (Updated 2010 March 29). Guillain-Barre Syndrome. eMedicine [On-line information]. Available online at http://emedicine.medscape.com/article/315632-overview. Accessed October 2010.
Miller, A. et. al. (Updated 2010 April 23). Guillain-Barre Syndrome. eMedicine Emergency Medicine [On-line information]. Available online at http://emedicine.medscape.com/article/792008-overview. Accessed October 2010.
Rubin, M. (Revised 2008 February). Guillain-Barré Syndrome (GBS) Merck Manual for Healthcare Professionals [On-line information]. Available online at http://www.merck.com/mmpe/sec16/ch223/ch223c.html?qt=guillain-barre&alt=sh. Accessed October 2010.
(2010 June 4) Preliminary Results: Surveillance for Guillain-Barré Syndrome After Receipt of Influenza A (H1N1) 2009 Monovalent Vaccine — United States, 2009—2010. CDC Morbidity and Mortality Weekly Report (MMWR) 59(21);657-661 [On-line information]. Available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5921a3.htm. Accessed October 2010.
Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL eds, (2005) Harrison’s Principles of Internal Medicine, 16th Edition, McGraw Hill, Pp 2513-2516.
Van den Berg, Bianca, et. al. (2014, July 15). Guillain–Barré syndrome: pathogenesis, diagnosis, treatment and prognosis. Nature Reviews Neurology, vol 10. doi:10.1038/nrneurol.2014.121. Available online at http://www.nature.com/nrneurol/journal/v10/n8/full/nrneurol.2014.121.html. Accessed August 21, 2015.
Centers for Disease Control (2014, September 9, Updated). Guillain-Barré Syndrome (GBS). Available online at http://www.cdc.gov/flu/protect/vaccine/guillainbarre.htm#how1. Accessed August 20, 2015.
Mayo Clinic (2014, June 3, Updated). Guillain-Barré Syndrome. Available online at http://www.mayoclinic.org/diseases-conditions/guillain-barre-syndrome/basics/definition/con-20025832. Accessed August 21, 2015.
National Institute of Neurological Disorders and Stroke (2015, July 27, Updated). NINDS Guillain-Barré Syndrome Information Page. Available online at http://www.ninds.nih.gov/disorders/gbs/gbs.htm. Accessed August 21, 2015.
Hauser SL, Amato AA. Guillain-Barré Syndrome and Other Immune-Mediated Neuropathies. In: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. Harrison’s Principles of Internal Medicine, 19e. New York, NY: McGraw-Hill; 2015.