Guillain Barre Syndrome (GBS)

Introduction

Guillain Barré Syndrome (GBS) is a rare but serious autoimmune disorder in which the body’s immune system attacks the peripheral nervous system. This condition can lead to muscle weakness, numbness, and even paralysis, which often starts in the limbs and can spread to other parts of the body.

Causes and Risk Factors

The exact cause of GBS is not fully understood, but it is often preceded by an infection. Many cases of GBS occur after a respiratory or gastrointestinal infection. Other triggers may include surgery, vaccinations, or certain chronic illnesses. It is believed that these events may trigger an inappropriate immune response that mistakenly attacks the body’s own nerve cells.

Guillain-Barre syndrome may be triggered by:

• Most commonly, an infection with campylobacter, a type of bacteria often found in undercooked poultry.
• Influenza virus.
• Cytomegalovirus.
• Epstein-Barr virus.
• Zika virus.
• Hepatitis A, B, C and E.
• HIV, the virus that causes AIDS.
• Mycoplasma pneumonia.
• Surgery.
• Trauma.
• Hodgkin lymphoma.
• Rarely, influenza vaccinations or childhood vaccinations.
• COVID-19 virus.

• Risk factors for Guillain-Barré Syndrome include recent infections, particularly respiratory or gastrointestinal infections, which are often reported in the weeks preceding the onset of symptoms.
• Additionally, individuals who have undergone recent surgical procedures, received specific vaccinations, or have certain chronic illnesses may also be at heightened risk.
• The precise mechanism remains unclear, but it is hypothesized that these factors may provoke an erroneous immune response that targets the peripheral nerves.
• Although Guillain-Barré Syndrome can affect individuals of any age, it is more commonly observed in adults and males are slightly more at risk compared to females.

Symptoms

The symptoms of Guillain-Barré Syndrome can vary widely but typically include:

• A pins and needles feeling in the fingers, toes, ankles or wrists.
• Weakness in the legs that spreads to the upper body.
• Unsteady walk or not being able to walk or climb stairs.
• Trouble with facial movements, including speaking, chewing or swallowing.
• Double vision or inability to move the eyes.
• Severe pain that may feel achy, shooting or cramplike and may be worse at night.
• Trouble with bladder control or bowel function.
• Rapid heart rate.
• Low or high blood pressure.
• Trouble breathing.

Symptoms of Guillain-Barré Syndrome can manifest abruptly and escalate rapidly, ranging from mild weakness to nearly complete paralysis. Initially, individuals may experience weakness and tingling sensations in the legs, often described as pins and needles. This weakness can progressively spread to the upper body and arms, sometimes leading to complete paralysis in severe cases.

Walking may become unsteady, or patients may find themselves unable to walk or climb stairs altogether. Facial and eye muscle control can be compromised, resulting in difficulty with eye or facial movements, speaking, chewing, or swallowing. Severe, cramp-like pain, particularly at night, is also a common complaint.

Autonomic functions can be affected, causing difficulty with bladder control or bowel movements, rapid heart rate, and in some cases, breathing difficulties, which may necessitate medical intervention.

Types

The symptoms of Guillain-Barre syndrome can vary based on the type. Guillain-Barre syndrome has several forms. The main types are:

• Acute inflammatory demyelinating polyneuropathy (AIDP): the most common variant of GBS in Western Europe and North America, primarily affecting the myelin sheath of affected nerves.
• Acute motor axonal neuropathy (AMAN): a form of GBS more common in Asian countries that primarily damages the axons of motor neurons specifically. This results in a purely motor presentation, as opposed to the more common sensorimotor neuropathy in AIDP.
• Acute motor sensory axonal neuropathy (AMSAN): affecting axons of both motor and sensory neurons. This variant is associated with a poorer rate of recovery.
• Miller-Fisher syndrome: a form of GBS defined by antibodies to the GQIb ganglioside, typically associated with a triad of ophthalmoplegia, ataxia, and areflexia. No treatment is required for Miller-Fisher Syndrome.
• A patient with GBS may exhibit characteristics of one or more variants. Identifying the subtype of GBS is important as they vary as to the degree of respiratory involvement, and therefore the indication for early pharmacological therapies or intensive care unit admission.

Diagnosis

Diagnosing GBS can be challenging due to its rarity and the variability of symptoms. Tests that may help in diagnosing GBS include:

History and physical exam: A doctor will perform a physical exam and review the person’s medical history. They will assess how the person’s muscles and nerves are working. The doctor will note whether symptoms appear on both sides of the body (which is typical in GBS) and how fast the symptoms appeared. This is helpful because in other disorders, muscle weakness may progress over months rather than days or weeks. They will also check the reflexes, as some reflexes are lost in people with GBS.

Nerve conduction velocity test (NCV): This test measures the nerve’s ability to send a signal. In GBS, the signals traveling along the damaged nerves are slowed because of damage to the myelin sheath.

Cerebrospinal fluid analysis: A doctor may also conduct an analysis of the cerebrospinal fluid that bathes the spinal cord. This fluid contains more protein and fewer immune cells in people with GBS.

Imaging: In some cases, an MRI (magnetic resonance imaging) of the spinal cord or even brain may help find any other potential causes of muscle weakness.

Differential diagnoses

Differential diagnoses to consider which also cause acute, potentially progressive paralysis include

• Stroke
• Encephalitis
• Myasthenia gravis
• Polymyositis
• Myelopathy
• Botulism

Treatment

There is no cure for Guillain-Barré Syndrome, but several treatments can help manage symptoms and improve outcomes:

• Guillain-Barré syndrome is potentially life-threatening. GBS patients should be hospitalized so that they can be monitored closely.
• Supportive care includes monitoring of breathing, heartbeat and blood pressure. In cases where a person’s ability to breathe is impaired, he or she is usually put on a ventilator. All GBS patients should be monitored for complications, which can include abnormal heart beat, infections, blood clots, and high or low blood pressure.
• There is no known cure for GBS, but treatments can help improve symptoms of GBS and shorten its duration.

General Management

General management of GBS includes:

• Serial lung function tests (FVC): every four hours to screen for respiratory compromise
• Supportive treatment: intravenous fluids, heart rate control (usually sufficient for mild-to-moderate cases)
• Venous thromboembolism (VTE) prophylaxis
• Eye care
• Pressure sore screening and management
• Pain relief: neuropathic pain medications such as amitriptyline or gabapentin. May require opiates for severe pain.
• Physiotherapy: to help regain motor function and avoid contractures
• Swallow assessment: patients may require nasogastric feeding if dysphagia is present

Corticosteroids, often used for other classical autoimmune conditions, have shown no clinical benefit in GBS.

Acute care for Guillain-Barré syndrome

Two treatments are commonly used to interrupt immune-related nerve damage. Both are equally effective if started within two weeks of GBS symptoms.

• Plasma exchange (PE), also called plasmapheresis, involves removing some blood through a catheter. Plasma (the liquid part of the blood) is separated from the blood cells. These cells, along with replacement fluid, are returned to the body. PE may work by removing the bad antibodies in the plasma that have been damaging the nerves.
• Intravenous immunoglobulin therapy (IVIg) involves injections of immunoglobulins—proteins that your immune system naturally makes to attack infecting organisms. The immunoglobulins are developed from a pool of thousands of healthy donors. IVIg can lessen the immune attack on the nervous system and shorten recovery time. Researchers believe this treatment also reduces the effectiveness of antibodies that attack the nerves by both “diluting” them with non-specific antibodies and reducing the number of harmful antibodies.

Prognosis

The prognosis for GBS varies. Most people recover fully, though some may experience lingering effects such as weakness, numbness, or fatigue. The recovery period can range from a few weeks to several years. Early and aggressive treatment can significantly improve the likelihood of a full recovery.

What to expect 

After your first symptoms, you are likely to get worse for about 2 weeks and reach your weakest point within 2 weeks.

Most people then start to recover but can still feel weak and need a wheelchair or walker for a while. Usually, recovery takes 6-12 months; though for some people, it can take 3 years.

Among adults with the condition:

• About 80% can walk without help after 6 months.
• About 60% fully recover muscle strength within 1 year.
• About 5%-10% have a very delayed and incomplete recovery.

Children rarely get GBS, but when they do, they usually recover more quickly than adults.

Guillain-Barré Syndrome Complications

During treatment for Guillain-Barré syndrome, you might get:

• Breathing problems
• Shortened tissues in your joints (contractures) or other deformities
• Blood clots that form when you’re inactive
• Infections
• Low or unstable blood pressure
• Paralysis
• Pneumonia
• Pressure sores, or bed sores (skin damage from lying in bed for a long time)
• Breathing food or fluids into your lungs (aspiration)

Living with Guillain-Barré Syndrome

Living with GBS can be challenging, but with the proper care and support, individuals can lead fulfilling lives. Support groups and counseling can provide emotional support, while ongoing medical care can help manage symptoms and monitor progress.

REFERENCES

1. Nguyen TP, Taylor RS. Guillain-Barre Syndrome. [Updated 2023 Feb 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532254/
2. Anastasia A. Kozyreva, Raisa Ts. Bembeeva, Guillain–Barré syndrome in children: clinical and diagnostic features, L.O. Badalyan Neurological Journal, 5, 4, (201-217), (2025). https://doi.org/10.46563/2686-8997-2024-5-4-201-217
3. BMJ Best Medical Practice. Guillain-Barre Syndrome. Last reviewed 19 Aug 2022.
4. Loffghan, R. Royal College of Emergency Medicine Learning. Guillain-Barre Syndrome. Published 27 Dec 2021.
5. National Institute of Neurological Disorders and Stroke. Guillain-Barré Syndrome Fact Sheet. Published June 2018.
6. Shaf, Suchita. Patient UK. Guillain-Barre Syndrome. Last edited 14 July 2022.
7. National Organization for Rare Diseases. Guillain-Barre Syndrome. Published 2020.
8. Walgaard, C., Lingsma, H.F., et al. Annals of Neurology 2010. Prediction of respiratory insufficiency in Guillain-Barré syndrome, Published 25 May 2010.

Stories are the threads that bind us; through them, we understand each other, grow, and heal.

JOHN NOORD

Connect with “Nurses Lab Editorial Team”

I hope you found this information helpful. Do you have any questions or comments? Kindly write in comments section. Subscribe the Blog with your email so you can stay updated on upcoming events and the latest articles.