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Guillain-Barré Syndrome (GBS)

(Acute Inflammatory Demyelinating Polyradiculoneuropathy; Acute Idiopathic Polyneuritis)


Michael Rubin

, MDCM, New York Presbyterian Hospital-Cornell Medical Center

Reviewed/Revised Apr 2022 | Modified Sep 2022
Topic Resources

Guillain-Barré syndrome is a form of polyneuropathy causing muscle weakness, which usually worsens over a few days to weeks, then slowly improves or returns to normal on its own. With treatment, people may improve more quickly.

  • Guillain-Barré syndrome is thought to be caused by an autoimmune reaction.

  • Usually, weakness begins in both legs and moves up the body.

  • Electromyography and nerve conduction studies can help confirm the diagnosis.

  • People with Guillain-Barré syndrome are hospitalized immediately because symptoms can worsen rapidly.

  • Immune globulin given intravenously or plasma exchange speeds recovery.

Nerve Cells and Fibers

Insulating a Nerve Fiber

Most nerve fibers inside and outside the brain are wrapped with many layers of tissue composed of a fat (lipoprotein) called myelin. These layers form the myelin sheath. Much like the insulation around an electrical wire, the myelin sheath enables nerve signals (electrical impulses) to be conducted along the nerve fiber with speed and accuracy. When the myelin sheath is damaged (called demyelination), nerves do not conduct electrical impulses normally.

Insulating a Nerve Fiber

Weakness caused by Guillain-Barré syndrome usually worsens over 3 or 4 weeks, then remains the same or starts to return to normal. If it worsens for more than 8 weeks, it is considered chronic inflammatory demyelinating polyneuropathy Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) Chronic inflammatory demyelinating polyneuropathy is a form of polyneuropathy that, like Guillain-Barré syndrome, causes increasing muscle weakness, but the weakness progresses for more than... read more (CIDP), not Guillain-Barré syndrome.

Symptoms of GBS

Symptoms of Guillain-Barré syndrome usually begin in both legs, then progress upward to the arms. Occasionally, symptoms begin in the arms or head and progress downward.

Symptoms include weakness and a pins-and-needles sensation or loss of sensation. Weakness is more prominent than abnormal sensation. Reflexes are decreased or absent. In 90% of people who have Guillain-Barré syndrome, weakness is most severe 3 to 4 weeks after symptoms start. In 5 to 10%, the muscles that control breathing become so weak that a mechanical ventilator is needed.

When the disorder is severe, the facial and swallowing muscles become weak in more than half of affected people. When these muscles are weak, people may choke when they are eating or become dehydrated and malnourished.

If the disorder is very severe, internal functions controlled by the autonomic nervous system Overview of the Autonomic Nervous System The autonomic nervous system regulates certain body processes, such as blood pressure and the rate of breathing. This system works automatically (autonomously), without a person’s conscious... read more Overview of the Autonomic Nervous System may be impaired. For example, blood pressure may fluctuate widely, heart rhythm may become abnormal, people may retain urine, and severe constipation may develop.

In a variant called Miller-Fisher syndrome, only a few symptoms develop: Eye movements become paralyzed, walking becomes unsteady, and normal reflexes disappear.

Diagnosis of GBS

  • A doctor's evaluation

  • Electromyography and nerve conduction studies, magnetic resonance imaging, blood tests, and a spinal tap

Doctors can usually diagnose Guillain-Barré syndrome based on the pattern of symptoms. However, tests are done to confirm the diagnosis. If doctors suspect Guillain-Barré syndrome, people are admitted to the hospital to have the tests because the syndrome can worsen rapidly and impair the muscles involved in breathing. Breathing is evaluated frequently.

Tests may include the following:

A combination of high protein levels and few or no white blood cells in the cerebrospinal fluid and characteristic results from electromyography strongly suggest Guillain-Barré syndrome.

Prognosis of GBS

Damage stops progressing within 8 weeks. Without treatment, most people with Guillain-Barré syndrome improve slowly over several months. However, with early treatment, people can improve very quickly—in days or weeks.

About 30% of adults and even more children with the disorder have residual weakness 3 years after the syndrome began. On average, fewer than 2% of people die.

Treatment of GBS

  • Hospitalization and supportive care

  • If needed, use of a ventilator to help with breathing

  • Immune globulin or plasma exchange

Guillain-Barré syndrome can worsen rapidly and is a medical emergency. People who develop this syndrome should be hospitalized immediately. The sooner appropriate treatment is started, the better the chance of a good outcome. If symptoms strongly suggest Guillain-Barré syndrome, treatment is usually started without waiting for test results.

Supportive care

In the hospital, people are closely monitored so that breathing can be assisted with a ventilator if necessary.

Being unable to move because muscles are weak can cause many problems, such as pressure sores Pressure Sores Pressure sores are areas of skin damage resulting from a lack of blood flow due to prolonged pressure. Pressure sores often result from pressure combined with pulling on the skin, friction,... read more Pressure Sores and stiff, permanently shortened muscles (contractures). So nurses take precautions to prevent pressure sores and injuries by providing soft mattresses and by turning the people with severe weakness every 2 hours.

Physical therapy is started to help prevent contractures and preserve joint and muscle function and the ability to walk. Heat therapy may be used to make physical therapy more comfortable. Physical therapy may begin with the therapist moving the limbs for people (passive exercise). As the weakness subsides, people should move their own limbs (active exercise).

Immune globulin or plasma exchange

Immune globulin (a solution containing many different antibodies collected from a group of donors), given early and by vein (intravenously) for 5 days, is the treatment of choice for Guillain-Barré syndrome.

These treatments shorten the hospital stay, speed recovery, and reduce the risk of death and permanent disability. Plasma exchange is usually done as soon as possible if people are worsening quickly. However, removing and replacing a lot of blood through a tube (catheter) inserted in a vein can cause low blood pressure and increase the risk of infection.

Because plasma exchange removes immune globulin from the blood, plasma exchange is not used at the same time as immune globulin. Plasma exchange is delayed for at least 2 to 3 days after immune globulin is given.

Other treatments

Corticosteroids do not help and may worsen Guillain-Barré syndrome.

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