Guillain-Barré Syndrome (GBS): Everything You Need to Know
Also Known as Acute Inflammatory Demyelinating Polyneuropathy (AIDP)
Medically reviewed by David Ozeri, MD
Guillain-Barré syndrome is a neurological condition that causes rapidly worsening weakness, usually beginning in the legs and then traveling up the body. It is an autoimmune condition in which the immune system mistakenly attacks the body, specifically by damaging nerves in the legs, trunk, arms, and sometimes the face.
Severe weakness is the most prominent symptom, sometimes making it hard to breathe. Tingling sensations can be an early warning sign of Guillain-Barré syndrome. Guillain-Barré syndrome affects about 1 out of 100,000 people each year.
There is no cure for the condition, but treatment can help prevent complications and can help you recover. This article covers Guillain-Barré syndrome symptoms, causes, diagnosis, treatment, complications, and long-term outlook.
Guillain-Barré Syndrome Symptoms
The usual pattern of symptoms in Guillain-Barré syndrome begins with numbness of the feet and leg weakness, progressing to involve the trunk and arms within hours or days. This condition is symmetrical, affecting both sides of the body equally.
People who develop Guillain-Barré syndrome may experience unusual sensations, such as tingling in the legs, before the weakness begins. The syndrome has several variants, each with slightly different symptoms, and the variants are defined in a few different ways.
Some of the most commonly described variants of Guillain-Barré syndrome are:
Classical, generalized: This type causes severe weakness in both legs, both arms, and the respiratory muscles that control breathing.
Pure sensory variant: This type can cause severe loss of sensation without weakness.
Acute dysautonomia: This type can cause an irregular heart rate, disrupted blood pressure, and digestive symptoms.
Miller Fisher syndrome: This rare type causes ataxia (problems with coordination), areflexia (a lack of reflexes during a physical examination), and ophthalmoparesis (weak eye movements). Symptoms of weak eye movements can include blurred vision or double vision.
Localized: This type may involve only certain muscles, such as the muscles of the pharynx (affecting swallowing), face, or bladder.
In addition to these distinct types, some people may have Guillain-Barré syndrome with features of several types.
Acute Inflammatory Demyelinating Polyneuropathy (AIDP)
Guillain-Barré syndrome is sometimes referred to as AIDP because it occurs quickly and doesn't last long (being acute), is caused by inflammation, causes demyelination (loss of the protective coating) of the peripheral nerves, and affects many nerves.
Guillain-Barré Syndrome Causes and Risk Factors
Guillain-Barré syndrome is caused by inflammation that damages peripheral nerves. These are in your arms, legs, chest, abdomen, and face.
Generally, Guillain-Barré syndrome affects the motor nerves, which control movements. However, this condition can also sometimes affect the sensory nerves, which detect sensory information in your skin. It may affect autonomic nerves, which are the nerves that regulate digestion, heart function, and survival functions that you don’t consciously control.
Peripheral nerves contain long axonal extensions that transmit information. The axons are protected by a layer of insulation called myelin. The type of peripheral nerve damage found in Guillain-Barré can be axonal, demyelinating, or both.
Guillain-Barré is described as an autoimmune disorder because the inflammation is caused by the body’s own immune system attacking and damaging healthy nerves.
It’s not possible to predict whether someone will develop Guillain-Barré syndrome, but there are some risk factors and triggers. Most people who are exposed to these triggers do not develop Guillain-Barré syndrome.
Triggers and risk factors include:
Viral infections, including Epstein-Barr virus, varicella zoster (chickenpox), influenza, COVID-19, and others
Surgery
Cancer
Prolonged illness
These conditions are believed to trigger Guillain-Barré syndrome by activating the body’s immune response, which may erroneously attack healthy cells. It’s not known why some people develop Guillain-Barré syndrome while others who have these exposures don’t.
Is There a Vaccine Link?
There has been some concern about a potential association between Guillain-Barré and certain vaccines, including the flu vaccine and the COVID-19 vaccine.
Medical case reports describe some episodes of Guillain-Barré that appear to occur after people have received vaccines. The case reports include people who have received flu vaccines, varicella zoster vaccine, DTaP (diphtheria, tetanus, and acellular pertussis) vaccine, and the COVID-19 vaccine.
However, studies that have examined large populations have noted a decrease in Guillain-Barré in association with vaccines—which is believed to be due to the decrease in viral infections.
Related: Johnson & Johnson Vaccine to Include Warning About Guillain-Barré Syndrome
How Guillain-Barré Syndrome Is Diagnosed
The diagnosis of Guillain-Barré syndrome involves a history of symptoms, a physical exam, and possibly diagnostic tests. The condition can worsen rapidly, and it can be dangerous, so your healthcare team might begin treatment even before a firm diagnosis is established.
A neurologist will likely see you if you have signs and symptoms of this condition. During your physical exam, the neurologist will check your muscle strength, which would be weak if you have Guillain-Barré syndrome. Reflexes in your arms and legs would be diminished or completely absent.
Tests you might need include:
Pulse oximeter: This noninvasive test measures your oxygen level so that you can get an intervention as soon as your breathing becomes affected.
Electromyography (EMG) and nerve conduction study (NCV): This diagnostic procedure can measure the speed and intensity of nerve and muscle function. It can show a pattern that’s consistent with a diagnosis of Guillain-Barré.
Lumbar puncture (spinal tap): Sometimes, this invasive test may detect proteins in the spinal fluid with Guillain-Barré syndrome. A lumbar puncture is not diagnostic of the condition, but you might have this test if there’s a chance that you have meningitis (an infection of the spinal fluid).
Brain or spinal cord imaging: Guillain-Barré doesn’t usually cause changes that can be detected with imaging tests, but these tests might be needed if there’s a concern that damage in the brain or spinal cord could be causing your symptoms. Sometimes, nerve roots might appear inflamed with Guillain-Barré, but this is not always the case.
Blood tests: You might have blood tests if there’s concern that you could have an inflammatory disorder or an infection.
Guillain-Barré Syndrome Treatment
If you have Guillain-Barré syndrome, you will need prompt treatment, as well as close medical observation. Treatment is used to help lower the immune attack on the nerves. You might also need treatment for complications, such as blood clots or breathing difficulty. After recovery, you might need physical therapy to strengthen your muscles.
Plasmapheresis (Plasma Exchange)
Plasma exchange treatment is done in a hospital setting. You would have an intravenous line placed in a vein for the removal of your blood. Its aim is to reduce the harmful antibodies in your bloodstream that are attacking your nerves.
The blood runs through a machine that separates the liquid portion of the blood (plasma) from the blood cell components. The plasma is replaced with a plasma substitute and the cells and plasma substitute returned to you in an intravenous line.
The process can speed up the recovery, and it may reduce the severity of your condition.
Intravenous Immunoglobulin (IVIG)
This is an immune treatment that is given to provide normal immune proteins (antibodies). These inhibit or block the destructive immune response attacking the myelin in Guillain-Barré syndrome.
Other Treatments
Other treatments that can be used in this condition may be directed towards managing symptoms and complications.
Examples include:
Respiratory support, which may include intubation and mechanical respiration until the muscles regained strength
Blood thinners to treat a blood clot, which is at risk due to lack of physical movement
Antibiotics to treat pneumonia (lung infection), which may occur due to impaired swallowing
Antibiotics to treat a urinary tract infection, which may develop due to impaired physical movement
Pain medication, which may be needed if discomfort is significant
Learn More: How Guillain-Barré Is Treated
Potential Complications
During your treatment with plasmapheresis or IVIG, you would need to be monitored closely in case you start to develop any complications.
Complications may include:
Shortness of breath
Trouble swallowing
Choking
Pneumonia
Pressure sore
Urinary tract infection
Each of these complications could cause serious long-term problems and may be life-threatening. Your medical team would work to prevent these complications, monitor for any early signs of these complications, and treat them if they arise.
Long-Term Outlook for People With Guillain-Barré Syndrome
Most people have almost a full recovery after the acute stage of Guillain-Barré syndrome. You will likely need physical therapy after the acute phase to strengthen your muscles. After recovery, most people have some long-term residual weakness.
It's impossible to predict with certainty whether you will have a full recovery or whether you will have significant disability after a bout of Guillain-Barré syndrome. Some factors that are associated with better recovery include younger age, early treatment shortly after symptoms began, no face or neck weakness, not experiencing diarrhea, and no autonomic nerve involvement.
Coping With Guillain-Barré Syndrome
It can be stressful while you are in the acute phase of weakness from Guillain-Barré syndrome. It’s important that you tell your healthcare team about any changes in your symptoms—including unusual sensations, increased weakness, discomfort, or shortness of breath.
You can ask any questions about your treatment during this time so that you can understand your condition and know what to expect. But it’s important that you also rest while you are recovering.
If you have some weakness after the acute phase of the disease, you may need to make adjustments in your life. Adjustments might include using a cane or brace or getting help with your day-to-day tasks. You could benefit from working with an occupational therapist, who could advise you about your limitations and how to manage them.
When to See a Healthcare Provider
If you develop any symptoms of weakness, sensory changes, or shortness of breath, it’s crucial that you get medical attention right away. These symptoms could indicate Guillain-Barré syndrome or another serious medical condition.
Signs and symptoms include:
Tingling sensation, especially if it started in your feet or toes and is now moving up your body
Weakness of any part of your body
Double vision or blurred vision
Coordination problems
Trouble walking
Weakness of your face
Difficulty catching your breath
Shortness of breath when lying flat
Choking on food, drinks, or saliva
Summary
Guillain-Barré syndrome is a rapidly progressive and dangerous nerve disease. It causes severe weakness that begins in the feet and moves up the body, with a potentially life-threatening effect on breathing. This condition is caused by an autoimmune process, which a previous viral infection or illness might trigger.
While complications can potentially make it fatal, treatment can be lifesaving. The treatments include immune therapies to reduce the autoimmune process, as well as interventions to manage the symptoms and complications.
Most people experience almost a full recovery, often with mild to moderate residual weakness. You will likely need physical therapy after the acute phase, and you might need to make some adjustments if you have persistent weakness.
Read the original article on Verywell Health.
