Research on Guillain-Barre Syndrome

Overview

Nerve and damaged myelin sheathOpen pop-up dialog box

Guillain-Barre (gee-YAH-buh-RAY) syndrome is a rare disorder in which your body's

immune system attacks your nerves. Weakness and tingling in your extremities are
usually the first symptoms.
These sensations can quickly spread, eventually paralyzing your whole body. In its most
severe form Guillain-Barre syndrome is a medical emergency. Most people with the
condition must be hospitalized to receive treatment.

The exact cause of Guillain-Barre syndrome is unknown. But two-thirds of patients

report symptoms of an infection in the six weeks preceding. These include respiratory or
a gastrointestinal infection or Zika virus.

There's no known cure for Guillain-Barre syndrome, but several treatments can ease
symptoms and reduce the duration of the illness. Although most people recover from
Guillain-Barre syndrome, the mortality rate is 4% to 7%. Between 60-80% of people are
able to walk at six months. Patients may experience lingering effects from it, such as
weakness, numbness or fatigue.

Symptoms

Guillain-Barre syndrome often begins with tingling and weakness starting in your feet
and legs and spreading to your upper body and arms. In about 10% of people with the
disorder, symptoms begin in the arms or face. As Guillain-Barre syndrome progresses,
muscle weakness can evolve into paralysis.

Signs and symptoms of Guillain-Barre syndrome may include:

 Prickling, pins and needles sensations in your fingers, toes, ankles or wrists

 Weakness in your legs that spreads to your upper body

 Unsteady walking or inability to walk or climb stairs

 Difficulty with facial movements, including speaking, chewing or swallowing

 Double vision or inability to move eyes

 Severe pain that may feel achy, shooting or cramplike and may be worse at night

 Difficulty with bladder control or bowel function

 Rapid heart rate

 Low or high blood pressure

  Difficulty breathing

People with Guillain-Barre syndrome usually experience their most significant weakness
within two weeks after symptoms begin.

Types

Once thought to be a single disorder, Guillain-Barre syndrome is now known to occur in

several forms. The main types are:

 Acute inflammatory demyelinating polyradiculoneuropathy (AIDP), the most

common form in North America and Europe. The most common sign of AIDP is
muscle weakness that starts in the lower part of your body and spreads upward.

 Miller Fisher syndrome (MFS), in which paralysis starts in the eyes. MFS is also
associated with unsteady gait. MFS is less common in the U.S. but more common
in Asia.

 Acute motor axonal neuropathy (AMAN) and acute motor-sensory axonal

neuropathy (AMSAN) are less common in the U.S. But AMAN and AMSAN are
more frequent in China, Japan and Mexico.

When to see a doctor

Call your doctor if you have mild tingling in your toes or fingers that doesn't seem to be
spreading or getting worse. Seek emergency medical help if you have any of these
severe signs or symptoms:

 Tingling that started in your feet or toes and is now moving up your body

 Tingling or weakness that's spreading rapidly

 Difficulty catching your breath or shortness of breath when lying flat

 Choking on saliva

Guillain-Barre syndrome is a serious condition that requires immediate hospitalization

because it can worsen rapidly. The sooner appropriate treatment is started, the better
the chance of a good outcome.

Causes
The exact cause of Guillain-Barre syndrome isn't known. The disorder usually appears
days or weeks after a respiratory or digestive tract infection. Rarely, recent surgery or
vaccination can trigger Guillain-Barre syndrome. Recently, there have been cases
reported following infection with the Zika virus. Guillain-Barre syndrome may also occur
after COVID-19 infection.

In Guillain-Barre syndrome, your immune system — which usually attacks only invading
organisms — begins attacking the nerves. In AIDP, the most common form of Guillain-
Barre syndrome in the U.S., the nerves' protective covering (myelin sheath) is damaged.
The damage prevents nerves from transmitting signals to your brain, causing weakness,
numbness or paralysis.

Risk factors

Guillain-Barre syndrome can affect all age groups. But your risk increases as you age.
It's also more common in males than females.

Guillain-Barre syndrome may be triggered by:

 Most commonly, 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's lymphoma
  Rarely, influenza vaccinations or childhood vaccinations

 COVID-19 infection

Complications

Guillain-Barre syndrome affects your nerves. Because nerves control your movements
and body functions, people with Guillain-Barre may experience:

 Breathing difficulties. The weakness or paralysis can spread to the

muscles that control your breathing, a potentially fatal complication. Up to
22% of people with Guillain-Barre syndrome need temporary help from a
machine to breathe within the first week when they're hospitalized for
treatment.

 Residual numbness or other sensations. Most people with Guillain-Barre

syndrome recover completely or have only minor, residual weakness,
numbness or tingling.

 Heart and blood pressure problems. Blood pressure fluctuations and

irregular heart rhythms (cardiac arrhythmias) are common side effects of
Guillain-Barre syndrome.

 Pain. One-third of people with Guillain-Barre syndrome experience severe

nerve pain, which may be eased with medication.

 Bowel and bladder function problems. Sluggish bowel function and urine

retention may result from Guillain-Barre syndrome.

 Blood clots. People who are immobile due to Guillain-Barre syndrome are

at risk of developing blood clots. Until you're able to walk independently,
taking blood thinners and wearing support stockings may be recommended.

 Pressure sores. Being immobile also puts you at risk of developing

bedsores (pressure sores). Frequent repositioning may help avoid this
problem.

 Relapse. From 2% to 5% of people with Guillain-Barre syndrome

experience a relapse.
Severe, early symptoms of Guillain-Barre syndrome significantly increase the risk of
serious long-term complications. Rarely, death may occur from complications such as
respiratory distress syndrome and heart attacks.

Sept. 17, 2020

https://www.mayoclinic.org/diseases-conditions/guillain-barre-syndrome/symptoms-causes/syc-
20362793#:~:text=Guillain%2DBarre%20(gee%2DYAH,eventually%20paralyzing%20your%20whole
%20body.

What is Guillain-Barré syndrome?

Guillain-Barré syndrome (GBS) is a rare neurological disorder in which the body's immune
system mistakenly attacks part of its peripheral nervous system—the network of nerves located
outside of the brain and spinal cord. GBS can range from a very mild case with brief weakness to
nearly devastating paralysis, leaving the person unable to breathe independently. Fortunately,
most people eventually recover from even the most severe cases of GBS.  After recovery, some
people will continue to have some degree of weakness.
Guillain-Barré syndrome can affect anyone. It can strike at any age (although it is more frequent
in adults and older people) and both sexes are equally prone to the disorder. GBS is estimated to
affect about one person in 100,000 each year.

What causes Guillain-Barré syndrome?

The exact cause of GBS is not known. Researchers don’t know why it strikes some people and
not others. It is not contagious or inherited.  
What they do know is that the affected person's immune system begins to attack the body itself.
It is thought that, at least in some cases, this immune attack is initiated to fight an infection and
that some chemicals on infecting bacteria and viruses resemble those on nerve cells, which, in
turn, also become targets of attack.  Since the body’s own immune system does the damage,
GBS is called an autoimmune disease (“auto” meaning “self”). Normally the immune system
uses antibodies (molecules produced in an immune response) and special white blood cells to
protect us by attacking infecting microorganisms (bacteria and viruses). In Guillain-Barré
syndrome, however, the immune system mistakenly attacks the healthy nerves.
Most cases usually start a few days or weeks following a respiratory or gastrointestinal viral
infection. Occasionally surgery will trigger the syndrome. In rare cases vaccinations may
increase the risk of GBS. Recently, some countries worldwide reported an increased incidence of
GBS following infection with the Zika virus.

What are the symptoms of GBS?

Unexplained sensations often occur first, such as tingling in the feet or hands, or even pain
(especially in children), often starting in the legs or back. Children will also show symptoms
with difficulty walking and may refuse to walk. These sensations tend to disappear before the
major, longer-term symptoms appear.  Weakness on both sides of the body is the major symptom
that prompts most people to seek medical attention. The weakness may first appear as difficulty
climbing stairs or with walking. Symptoms often affect the arms, breathing muscles, and even
the face, reflecting more widespread nerve damage. Occasionally symptoms start in the upper
body and move down to the legs and feet.
Most people reach the greatest stage of weakness within the first two weeks after symptoms
appear; by the third week 90 percent of affected individuals are at their weakest.
In addition to muscle weakness, symptoms may include:

 Difficulty with eye muscles and vision

 Difficulty swallowing, speaking, or chewing
 Pricking or pins and needles sensations in the hands and feet
 Pain that can be severe, particularly at night
 Coordination problems and unsteadiness
 Abnormal heart beat/rate or blood pressure
 Problems with digestion and/or bladder control.
These symptoms can increase in intensity over a period of hours, days, or weeks until certain
muscles cannot be used at all and, when severe, the person is almost totally paralyzed. In these
cases, the disorder is life-threatening—potentially interfering with breathing and, at times, with
blood pressure or heart rate.

What happens in GBS?

Many of the body’s nerves are like household wires. There is a central conducting core in the
nerves called the axon that carries an electric signal. The axon (an extension of a nerve cell) is
surrounded by a covering, like insulation, called myelin. The myelin sheath surrounding the axon
speeds up the transmission of nerve signals and allows the transmission of signals over long
distances.
Weakness
When we move, for example, an electric signal from the brain travels through and out of the
spinal cord to peripheral nerves along muscles of the legs, arms, and elsewhere—called motor
nerves. In most cases of GBS, the immune system damages the myelin sheath that surrounds the
axons of many peripheral nerves; however, it also may also damage the axons themselves.  As a
result, the nerves cannot transmit signals efficiently and the muscles begin to lose their ability to
respond to the brain's commands.  This causes weakness.
The weakness seen in GBS usually comes on quickly and worsens over hours or days. Symptoms
are usually equal on both sides of the body (called symmetric). In addition to weak limbs,
muscles controlling breathing can weaken to the point that the person must be attached to a
machine to help support breathing.
Sensation changes
Since nerves are damaged in GBS, the brain may receive abnormal sensory signals from the rest
of the body.  This results in unexplained, spontaneous sensations, called paresthesias, that may
be experienced as tingling, a sense of insects crawling under the skin (called formications), and
pain. Deep muscular pain may be experienced in the back and/or legs.

How does nerve damage occur?

Various ideas have been proposed to explain how GBS develops. One explanation is known as
the “molecular mimicry/innocent bystander” theory. According to this explanation, molecules on
some nerves are very similar to or mimic molecules on some microorganisms. When those
microbes infect someone, the immune system correctly attacks them. And if the microbe and
myelin look similar, the immune system makes a mistake and attacks the myelin.
Different mechanisms may explain how the molecular mimicry concept may work.  When
Guillain-Barré syndrome is preceded by a viral or bacterial infection, it is possible that the
infecting agent has changed the chemical structure of some nerves. The immune system treats
these nerves as foreign bodies and mistakenly attacks them. It is also possible that the virus
makes the immune system itself less discriminating and no longer able to recognize its own
nerves. Some parts of the immune system—special white blood cells called lymphocytes and
macrophages—perceive myelin as foreign and attack it. Specialized white blood cells called T
lymphocytes (from the thymus gland) cooperate with B lymphocytes (that originate in bone
marrow) to produce antibodies against the person’s own myelin and damage it.
In some forms of GBS, antibodies made by the person to fight a Campylobacter jejuni bacterial
infection attack axons in the motor nerves. This causes acute motor axonal neuropathy, which is
a variant of GBS that includes acute paralysis and a loss of reflexes without sensory
loss. Campylobacter infections can be caused by ingesting contaminated food or from other
exposures. The infected person’s body then makes antibodies against Campylobacter.
Some Campylobacter molecules resemble molecules in the person’s nerve axons, so when the
person’s antibodies fight the Campylobacter bacteria they also attack the look-alike axons. This
slows nerve conduction and causes paralysis. Scientists are investigating various GBS subtypes
to find why the immune system reacts abnormally in this syndrome and other autoimmune
diseases.

What disorders are related to GBS?

Guillain-Barré syndrome is one of several disorders involving weakness due to peripheral nerve
damage caused by the person’s immune system. While GBS comes on rapidly over days to
weeks, and the person usually recovers, other disorders develop slowly and can linger or recur.
The most common type of GBS seen in the United States is acute inflammatory demyelinating
polyneuropathy (AIDP). In AIDP, the immune response damages the myelin coating and
interferes with the transmission of nerve signals. In two other types of Guillain-Barré syndrome,
acute motor axonal neuropathy (AMAN) and acute motor-sensory axonal neuropathy (AMSAN),
the axons themselves are damaged by the immune response.
Miller-Fisher syndrome is a rare, acquired nerve disease that is a variant of Guillain-Barré
syndrome. It is characterized by abnormal muscle coordination with poor balance and clumsy
walking, weakness or paralysis of the eye muscles, and absence of the tendon reflexes. Like
GBS, symptoms may follow a viral illness. Additional symptoms include generalized muscle
weakness and respiratory failure. Most individuals with Miller Fisher syndrome have a unique
antibody that characterizes the disorder.
Related peripheral nerve disorders with slow onset and persisting or recurrent symptoms include
chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy.
CIDP features weakness that can recur, repeatedly, over the course of years. Multifocal motor
neuropathy typically affects many different muscles in a small part of a limb or limbs. Usually
the symptoms are more severe on one side of the body.

How is Guillain-Barré syndrome diagnosed?

The initial signs and symptoms of GBS are varied and there are several disorders with similar
symptoms.  Therefore, doctors may find it difficult to diagnose GBS in its earliest stages.
Physicians will note whether the symptoms appear on both sides of the body (the typical finding
in Guillain-Barré syndrome) and the speed with which the symptoms appear (in other disorders,
muscle weakness may progress over months rather than days or weeks). In GBS, deep tendon
reflexes in the legs, such as knee jerks, are usually lost. Reflexes may also be absent in the arms.
Because the signals traveling along the nerve are slow, a nerve conduction velocity test (NCV,
which measures the nerve’s ability to send a signal) can provide clues to aid the diagnosis. There
is a change in the cerebrospinal fluid that bathes the spinal cord and brain in people with GBS.
Researchers have found the fluid contains more protein than usual but very few immune cells
(measured by white blood cells). Therefore, a physician may decide to perform a spinal tap or
lumbar puncture to obtain a sample of spinal fluid to analyze. In this procedure, a needle is
inserted into the person’s lower back and a small amount of cerebrospinal fluid is withdrawn
from the spinal cord. This procedure is usually safe, with rare complications.
Key diagnostic findings include:

 Recent onset, within days to at most four weeks of symmetric weakness, usually
starting in the legs
 Abnormal sensations such as pain, numbness, and tingling in the feet that accompany
or even occur before weakness
 Absent or diminished deep tendon reflexes in weak limbs
 Elevated cerebrospinal fluid protein without elevated cell count.This may take up to
10 days from onset of symptoms to develop.
 Abnormal nerve conduction velocity findings, such as slow signal conduction
 Sometimes, a recent viral infection or diarrhea.
How is Guillain-Barré treated?
There is no known cure for Guillain-Barré syndrome. However, some therapies can lessen the
severity of the illness and shorten recovery time. There are also several ways to treat the
complications of the disease.
Because of possible complications of muscle weakness, problems that can affect any paralyzed
person (such as pneumonia or bed sores) and the need for sophisticated medical equipment,
individuals with Guillain-Barré syndrome are usually admitted and treated in a hospital’s
intensive care unit.
Acute care
There are currently two treatments commonly used to interrupt immune-related nerve damage.
One is plasma exchange (PE, also called plasmapheresis); the other is high-dose immunoglobulin
therapy (IVIg). Both treatments are equally effective if started within two weeks of onset of GBS
symptoms, but immunoglobulin is easier to administer. Using both treatments in the same person
has no proven benefit.
In the process of plasma exchange, a plastic tube called a catheter is inserted into the person’s
veins, through which some blood is removed. The blood cells from the liquid part of the blood
(plasma) are extracted and returned to the person. This technique seems to reduce the severity
and duration of the Guillain-Barré episode. Plasma contains antibodies and PE removes some
plasma; PE may work by removing the bad antibodies that have been damaging the nerves.
Immunoglobulins are proteins that the immune system naturally makes to attack infecting
organisms. IVIg therapy involves intravenous injections of these immunoglobulins. The
immunoglobulins are developed from a pool of thousands of normal donors. When IVIg is given
to people with GBS, the result can be a lessening of the immune attack on the nervous system.
The IVIg can also shorten recovery time. Investigators believe this treatment also lowers the
levels or effectiveness of antibodies that attack the nerves by both “diluting” them with non-
specific antibodies and providing antibodies that bind to the harmful antibodies and take them
out of commission.
Miller-Fisher syndrome is also treated with plasmapheresis and IVIg.
Anti-inflammatory steroid hormones called corticosteroids have also been tried to reduce the
severity of Guillain-Barré syndrome. However, controlled clinical trials have demonstrated that
this treatment is not effective.
Supportive care is very important to address the many complications of paralysis as the body
recovers and damaged nerves begin to heal. Respiratory failure can occur in GBS, so close
monitoring of a person’s breathing should be instituted initially. Sometimes a mechanical
ventilator is used to help support or control breathing. The autonomic nervous system (that
regulates the functions of internal organs and some of the muscles in the body) can also be
disturbed, causing changes in heart rate, blood pressure, toileting, or sweating. Therefore, the
person should be put on a heart monitor or equipment that measures and tracks body function.
Occasionally GBS-related nerve damage can lead to difficulty handling secretions in the mouth
and throat. In addition to the person choking and/or drooling, secretions can fall into the airway
and cause pneumonia.
Rehabilitative care
As individuals begin to improve, they are usually transferred from the acute care hospital to a
rehabilitation setting. Here, they can regain strength, receive physical rehabilitation and other
therapy to resume activities of daily living, and prepare to return to their pre-illness life. 
Complications in GBS can affect several parts of the body. Often, even before recovery begins,
caregivers may use several methods to prevent or treat complications. For example, a therapist
may be instructed to manually move and position the person’s limbs to help keep the muscles
flexible and prevent muscle shortening. Injections of blood thinners can help prevent dangerous
blood clots from forming in leg veins. Inflatable cuffs may also be placed around the legs to
provide intermittent compression. All or any of these methods helps prevent blood stagnation
and sludging (the buildup of red blood cells in veins, which could lead to reduced blood flow) in
the leg veins. Muscle strength may not return uniformly; some muscles that get stronger faster
may tend to take over a function that weaker muscles normally perform—called substitution. The
therapist should select specific exercises to improve the strength of the weaker muscles so their
original function can be regained.
Occupational and vocational therapy help individuals learn new ways to handle everyday
functions that may be affected by the disease, as well as work demands and the need for assistive
devices and other adaptive equipment and technology.

What is the long-term outlook for those with

Guillain-Barré syndrome?
Guillain-Barré syndrome can be a devastating disorder because of its sudden and rapid,
unexpected onset of weakness—and usually actual paralysis. Fortunately, 70% of people with
GBS eventually experience full recovery. With careful intensive care and successful treatment of
infection, autonomic dysfunction and other medical complications, even those individuals with
respiratory failure usually survive.
Typically, the point of greatest weakness occurs days to at most 4 weeks after the first symptoms
occur. Symptoms then stabilize at this level for a period of days, weeks, or, sometimes months.
Recovery, however, can be slow or incomplete. The recovery period may be as little as a few
weeks up to a few years. Some individuals still report ongoing improvement after 2 years. About
30 percent of those with Guillain-Barré have residual weakness after 3 years. About 3 percent
may suffer a relapse of muscle weakness and tingling sensations many years after the initial
attack. About 15 percent of individuals experience long-term weakness; some may require
ongoing use of a walker, wheelchair, or ankle support. Muscle strength may not return
uniformly.
Ongoing fatigue, pain, and other annoying sensations can sometimes be troublesome. Fatigue is
best handled by pacing activities and providing time for rest when fatigue sets in. Those with
Guillain-Barré syndrome face not only physical difficulties, but emotionally painful periods as
well. It is often extremely difficult for individuals to adjust to sudden paralysis and dependence
on others for help with routine daily activities. Individuals sometimes need psychological
counseling to help them adapt. Support groups can often ease emotional strain and provide
valuable information.

What research is being done?

The mission of the National Institute of Neurological Disorders and Stroke (NINDS) is to seek
fundamental knowledge of the brain and nervous system and to use that knowledge to reduce the
burden of neurological diseases. The NINDS conducts research on disorders including Guillain-
Barré syndrome and funds research at major institutions and universities. The NINDS is a
component of the National Institutes of Health (NIH), the leading supporter of biomedical
research in the world.
Neuroscientists, immunologists, virologists, and pharmacologists are working collaboratively to
learn how to prevent GBS and to make better therapies available when it strikes.
Scientists are concentrating on finding new treatments and refining existing ones. Scientists are
also looking at the workings of the immune system to find which cells are responsible for
beginning and carrying out the attack on the nervous system. The fact that many cases of
Guillain-Barré syndrome begin after a viral or bacterial infection suggests that certain
characteristics of some viruses and bacteria may activate the immune system inappropriately.
Investigators are searching for those characteristics. Certain proteins or peptides in viruses and
bacteria may be the same as those found in myelin, and the production of antibodies to neutralize
the invading viruses or bacteria could trigger the attack on the myelin sheath.
Some studies show that normal variations in certain genes could increase risk of developing
Guillain-Barré syndrome; however, more research is necessary to identify and confirm
associated genes. Since many of the genes that may increase the risk of Guillain-Barré syndrome
are involved in the immune system, their roles in fighting infection might contribute to the
development of the condition.           
NINDS-funded researchers have developed a mouse model with an altered autoimmune
regulator gene that generates autoimmunity against the peripheral nervous system (PNS). Using
this model, scientists hope to identify which PNS proteins are at greatest risk of autoimmune
attack and which components of the immune system contribute to the autoimmune response
against the PNS. A greater understanding of how the immune system damages the PNS could
lead to better treatments for autoimmune disorders such as GBS.    
Other NINDS-funded researchers are investigating the mechanisms by which IVIg treatment
lessens the symptoms of GBS. By understanding these mechanisms, it may be possible to
develop more effective treatments.
Prepared by:
Office of Communications and Public Liaison
National Institute of Neurological Disorders and Stroke
National Institutes of Health
Bethesda, MD 20892
Date last modified: Mon, 2020-03-16
https://www.ninds.nih.gov/disorders/patient-caregiver-education/fact-sheets/Guillain-barr%C3%A9-
syndrome-fact-sheet

What Is Guillain-Barre Syndrome?

Guillain-Barre Syndrome is a problem with your nervous system. It can
cause muscle weakness, reflex loss, and numbness or tingling in parts of
your body. It can lead to paralysis, which is usually temporary.
Most people recover, even those with severe cases. In fact, 85% of people
with GBS make a full recovery within 6 to 12 months. Once you get better,
the chance of it returning is very small.

Causes
Guillain-Barre syndrome (GBS) can happen to anyone, but it’s most common in people 50 years
old or older.
No one’s sure if a germ or virus, like the Zika virus, causes GBS . It could be that some illnesses
alter your nerve cells, so your immune system starts to view them as threats. Others think
your immune system forgets which cells it shouldn’t attack.
It usually shows up a few days or weeks after a cold, stomach virus, or the flu. In rare cases,
surgery or vaccinations can trigger it. You may hear your doctor mention “campylobacter.”
That’s a type of bacteria associated with GBS.
When you have it, your immune system begins attacking your nerve cells. That weakens their
ability to send signals to your brain. And your muscles then can’t respond to nerve signals. As a
result, your brain gets fewer messages to your body.

Symptoms
Guillain-Barre syndrome strikes quickly. You usually feel it first in your arms and legs. You may
notice muscle weakness or a “pins and needles” tingling in your hands and feet, which later
moves toward your midsection. You may also feel unusually tired. Your reflexes may slow.
Some people feel only a mild weakness. Others become almost entirely paralyzed and struggle to
swallow or breathe. If you feel anything more than mild weakness, you should call 911. Your
symptoms can get worse quickly.
Most people are at their weakest 3 weeks after symptoms appear.

Treatment
If your doctor thinks you have GBS, they will give you a test to measure how well your muscles
and nerves work. You may also get a spinal tap. A doctor inserts a needle into your lower back
and takes a small amount of spinal fluid. They’ll check the protein level; it’s high in people with
GBS.
If you’re diagnosed with GBS, you should begin treatment right away.
In some cases, in order to speed recovery, the doctor will take blood from your body, “clean” it,
and then return it to you. This process is called plasmapheresis.
Your doctor may give you immunoglobulin, or antibodies. You’ll get high doses of healthy cells
through an IV. These help lessen your immune system’s attack on your body.
Some people with GBS need to be hospitalized for a few days. Others stay for several weeks.
You’ll need support until you regain full control of your body. A nurse or loved one may need to
exercise your arms or legs for you.

What to Expect
It may take a while for you to feel like yourself again. After a hospital stay,
you may still feel weak and need a wheelchair or walker to get around.
You may have physical therapy to build up your strength . A small number
of people also have permanent nerve damage.
GBS usually lasts between 14 and 30 days. If your symptoms continue
longer, you may be suffering from a chronic form of GBS called chronic
inflammatory demyelinating polyneuropathy and will need more
aggressive treatment.
REVIEWED BY JENNIFER ROBINSON, MD ON JUNE 22,
https://www.webmd.com/brain/what-is-guillain-barre#2

What is Guillain-Barré syndrome?

Guillain-Barré syndrome is a rare but serious autoimmune disorder in which
the immune system attacks healthy nerve cells in your peripheral nervous
system (PNS).
This leads to weakness, numbness, and tingling, and can eventually cause
paralysis.

The cause of this condition is unknown, but it’s typically triggered by an

infectious illness, such as gastroenteritis (irritation of the stomach or
intestines) or a lung infection.

Guillain-Barré is rare, affecting only about 1 in 100,000 Americans, according

to the National Institute of Neurological Disorders and Stroke.

There’s no cure for the syndrome, but treatment can reduce the severity of
your symptoms and shorten the duration of the illness.

There are multiple types of Guillain-Barré, but the most common form is acute
inflammatory demyelinating polyradiculoneuropathy (CIDP). It results in
damage to myelin.

Other types include Miller Fisher syndrome, which affects the cranial nerves.

What causes Guillain-Barré

syndrome?
The precise cause of Guillain-Barré is unknown. According to the Centers for
Disease Control and Prevention (CDC)Trusted Source, about two-thirds of
people with Guillain-Barré develop it soon after they’ve been sick
with diarrhea or a respiratory infection.

This suggests that an improper immune response to the previous illness

triggers the disorder.
Campylobacter jejuni infection has been associated with Guillain-
Barré. Campylobacter is one of the most common bacterial causes of diarrhea
in the United States. It’s also the most common risk factor for Guillain-Barré.

Campylobacter is often found in undercooked food, especially poultry.

The following infections have also been associated with Guillain-Barré:

 influenza
 cytomegalovirus (CMV), which is a strain of the herpes virus
 Epstein-Barr virus (EBV) infection, or mononucleosis
 mycoplasma pneumonia, which is an atypical pneumonia caused by
bacteria-like organisms
 HIV or AIDS

Anyone can get Guillain-Barré, but it’s more common among older adults.

In extremely rare cases, people can develop the disorder days or weeks after
receiving a vaccinationTrusted Source.

The CDC and the Food and Drug Administration (FDA) have systems in place
to monitor the safety of vaccines, detect early symptoms of side effects, and
record any cases of Guillain-Barré that develop following a vaccination.

The CDC saysTrusted Source that research indicates you’re more likely to get

Guillain-Barré from the flu, rather than the vaccine.

What are the symptoms of

Guillain-Barré syndrome?
In Guillain-Barre syndrome, your immune system attacks your peripheral
nervous system.

The nerves in your peripheral nervous system connect your brain to the rest of
your body and transmit signals to your muscles.

The muscles won’t be able to respond to signals they receive from your brain
if these nerves are damaged.

The first symptom is usually a tingling sensation in your toes, feet, and legs.
The tingling spreads upward to your arms and fingers.

The symptoms can progress very rapidly. In some people, the disease can
become serious in just a few hours.

The symptoms of Guillain-Barré include:

 tingling or prickling sensations in your fingers and toes

 muscle weakness in your legs that travels to your upper body and gets
worse over time
 difficulty walking steadily
 difficulty moving your eyes or face, talking, chewing, or swallowing
 severe lower back pain
 loss of bladder control
 fast heart rate
 difficulty breathing
 paralysis
How is Guillain-Barré syndrome
diagnosed?
Guillain-Barré is difficult to diagnose at first. This is because the symptoms are very
similar to those of other neurological disorders or conditions that affect the nervous
system, such as botulism, meningitis, or heavy metal poisoning.

Heavy metal poisoning may be caused by substances such as lead, mercury,

and arsenic.

Your doctor will ask questions about specific symptoms and your medical history. Be
sure to tell your doctor about any unusual symptoms and if you’ve had any recent or
past illnesses or infections.

The following tests are used to help confirm a diagnosis:

Spinal tap

A spinal tap (lumbar puncture) involves taking a small amount of fluid from your
spine in your lower back. This fluid is called cerebrospinal fluid. Your cerebrospinal
fluid is then tested to detect protein levels.

People with Guillain-Barré typically have higher-than-normal levels of protein in their

cerebrospinal fluid.

Electromyography

An electromyography is a nerve function test. It reads electrical activity from the

muscles to help your doctor learn if your muscle weakness is caused by nerve damage
or muscle damage.
Nerve conduction tests

Nerve conduction studies may be used to test how well your nerves and muscles
respond to small electrical pulses.

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How is Guillain-Barré syndrome

treated?
Guillain-Barré is an autoimmune inflammatory process that’s self-limiting, meaning it
will resolve on its own. However, anyone with this condition should be admitted to a
hospital for close observation. The symptoms can quickly worsen and can be fatal if
untreated.

In severe cases, people with Guillain-Barré can develop full-body paralysis. Guillain-
Barré can be life-threatening if paralysis affects the diaphragm or chest muscles,
preventing proper breathing.

The goal of treatment is to lessen the severity of the immune attack and support your
body functions, such as lung function, while your nervous system recovers.

Treatments may include:

Plasmapheresis (plasma exchange)

The immune system produces proteins called antibodies that normally attack harmful
foreign substances, such as bacteria and viruses. Guillain-Barré occurs when your
immune system mistakenly makes antibodies that attack the healthy nerves of your
nervous system.
Plasmapheresis is intended to remove the antibodies attacking the nerves from your
blood.

During this procedure, blood is removed from your body by a machine. This machine
removes the antibodies from your blood and then returns the blood to your body.

Intravenous immunoglobulin

High doses of immunoglobulin can also help block the antibodies causing Guillain-
Barré. Immunoglobulin contains normal, healthy antibodies from donors.

Plasmapheresis and intravenous immunoglobulin are equally effective. It’s up to you

and your doctor to decide which treatment is best.

Other treatments

You may be given medication to relieve pain and prevent blood clots while you’re
immobile.

You’ll likely receive physical and occupational therapy. During the acute phase of the
illness, caregivers will manually move your arms and legs to keep them flexible.

Once you begin to recover, therapists will work with you on muscle strengthening and
a range of activities of daily living (ADLs). This can include personal care activities,
like getting dressed.

What are the potential

complications of Guillain-Barré
syndrome?
Guillain-Barré affects your nerves. The weakness and paralysis that occurs can affect
multiple parts of your body.

Complications may include difficulty breathing when the paralysis or weakness

spreads to muscles that control breathing. You may need a machine called a respirator
to help you breathe if this occurs.

Complications can also include:

 lingering weakness, numbness, or other odd sensations even after recovery

 heart or blood pressure problems
 pain
 slow bowel or bladder function
 blood clots and bedsores due to paralysis

What is the long-term outlook?

The recovery period for Guillain-Barré can be long, but most people recover.

In general, symptoms will get worse for two to four weeks before they
stabilize. Recovery can then take anywhere from a few weeks to a few years,
but most recover in 6 to 12 months.

About 80 percent of people affected by Guillain-Barré can walk independently

at six months, and 60 percent recover their regular muscle strength in one
year.

For some, recovery takes longer. Around 30 percent still experience some

weakness after three years.
About 3 percent of people affected by Guillain-Barré will experience a relapse
of their symptoms, like weakness and tingling, even years after the original
event.

In rare cases, the condition can be life-threatening, especially if you don’t get
treatment. Factors that may lead to a worse outcome include:

 advanced age
 severe or rapidly progressing illness
 delay of treatment, which can result in more nerve damage
 prolonged use of a respirator, which can predispose you to pneumonia

Blood clots and bedsores that result from being immobilized can be reduced.
Blood thinners and compression stockings may minimize clotting.

Frequent repositioning of your body relieves prolonged body pressure that

leads to tissue breakdown, or bedsores.

In addition to your physical symptoms, you may experience emotional

difficulties. It can be challenging to adjust to limited mobility and an increased
dependence on others. You may find it helpful to talk to a therapist.

Medically reviewed by Deborah Weatherspoon, Ph.D., R.N., CRNA — Written

by Jacquelyn Cafasso — Updated on February 27, 2019

https://www.healthline.com/health/guillain-barre-syndrome

Guillain-Barré (pronounced ghee-yan bar-ray) syndrome is a very rare and

serious condition that affects the nerves.

It mainly affects the feet, hands and limbs, causing problems such as numbness,
weakness and pain.

It can be treated and most people will eventually make a full recovery, although it can
occasionally be life-threatening and some people are left with long-term problems.
Guillain-Barré syndrome affects people of all ages but it is more common in adults and
males.

Symptoms of Guillain-Barré syndrome
Symptoms often start in your feet and hands before spreading to your arms and legs.

At first you may have:

 numbness
 pins and needles
 muscle weakness
 pain
 problems with balance and co-ordination
These symptoms may continue to get worse over the next few days or weeks before they start
to slowly improve. In severe cases, you may have difficulty moving, walking, breathing and/or
swallowing.

Read more about the symptoms of Guillain-Barré syndrome. 

When to get medical help

See a GP if you notice any of the early symptoms of Guillain-Barré syndrome, such as numbness
or weakness.

Call 999 for an ambulance or go to your nearest accident and emergency (A&E)
department immediately if someone:

 has difficulty breathing, swallowing or speaking

 cannot move their limbs or face
This is a medical emergency and the person needs to be seen in hospital as soon as possible.

Read more about how Guillain-Barré syndrome is diagnosed.

Causes of Guillain-Barré syndrome
Guillain-Barré syndrome is thought to be caused by a problem with the immune system, the
body's natural defence against illness and infection.
Normally the immune system attacks any germs that get into the body. But in people
with Guillain-Barré syndrome, something goes wrong and it mistakenly attacks and damages the
nerves.

It's not clear exactly why this happens, but the condition often happens after an infection;
especially an infection of the airways, such as flu, or an infection of the digestive system, such as
food poisoning or a stomach bug (gastroenteritis).

Read more about causes of Guillain-Barré syndrome.

Treatments for Guillain-Barré syndrome
Most people with Guillain-Barré syndrome are treated in hospital.

The main treatments are:

 intravenous immunoglobulin (IVIG) – a treatment made from donated blood that helps bring
your immune system under control
 plasma exchange (plasmapheresis) – an alternative to IVIG where a machine is used to filter
your blood to remove the harmful substances that are attacking your nerves
 treatments to reduce symptoms such as painkillers
 treatments to support body functions, such as a machine to help with breathing and/or a
feeding tube
Most people need to stay in hospital for a few weeks to a few months.

Read more about how Guillain-Barré syndrome is treated.

Recovering from Guillain-Barré syndrome
Most people with Guillain-Barré syndrome make a full recovery within a few weeks.

However, around 1 in 5 people are left with long-term problems such as:

 being unable to walk without assistance

 weakness in your arms, legs or face
 numbness, pain or a tingling or burning sensation
 balance and co-ordination problems
 extreme tiredness
Therapies such as physiotherapy, occupational therapy and speech and language therapy may
help you recover and cope with any lasting difficulties.

In a minority of cases, Guillain-Barré syndrome can cause life-threatening problems such as

severe breathing difficulties or blood clots. Overall, around 1 in 20 cases are fatal.

Read more about recovering from Guillain-Barré syndrome.

Guillain-Barré syndrome usually affects the feet or hands first, before spreading to other
parts of the body.

It often starts a few days or weeks after an infection, such as a stomach bug or flu.

Early symptoms
Symptoms of Guillain-Barré syndrome usually develop over hours or days and tend to start in
your feet and hands before spreading to your arms and legs.

At first you may have:

 numbness
 pins and needles
 muscle weakness
 pain
 problems with balance and co-ordination
These symptoms usually affect both sides of the body at the same time.

Later symptoms
The symptoms may continue to get worse over the next few days or weeks.

Some people are only mildly affected, but others may have:

 difficulty walking without assistance

 an inability to move the legs, arms and/or face (paralysis)
 difficulty breathing
 blurred or double vision
 difficulty speaking
  problems swallowing or chewing
 difficulty peeing, and constipation
 persistent and/or severe pain
Guillain-Barré syndrome usually reaches its most severe point within 4 weeks. It may
then remain stable for a few weeks or months before gradually improving.

Guillain-Barré syndrome is thought to be caused by a problem with the immune system,

the body's natural defence against illness and infection.

Normally the immune system attacks any germs that get into the body. But in people
with Guillain-Barré syndrome, something goes wrong and it mistakenly attacks the nerves.

This damages the nerves and stops signals from the brain travelling along them properly, which
can cause problems such as numbness, weakness and pain in the limbs.

It's not clear exactly why this happens. The condition is not passed from person to person and is
not inherited.

Possible triggers
Sometimes Guillain-Barré syndrome appears to have a particular trigger. These are some of the
main triggers.

Infections

In most cases, Guillain-Barré syndrome occurs a few days or weeks after an infection.

Infections that have been known to trigger the condition include:

 food poisoning – especially if caused by Campylobacter bacteria

 flu
 cytomegalovirus – a common virus that does not usually cause any symptoms
 glandular fever
 HIV
 some tropical diseases, including dengue and the Zika virus
Vaccinations

In the past, vaccinations (particularly the flu vaccine used in the US during a swine flu outbreak
in 1976) were linked to an increased risk of Guillain-Barré syndrome.
But research has since found the chances of developing the condition after having a vaccination
are extremely small.

For example, a study into the vaccine used during the 2009 swine flu outbreak found that for
every million people who had the vaccination, there were fewer than 2 extra cases of Guillain-
Barré syndrome.

And evidence suggests that you are far more likely to get Guillain-Barré syndrome from an
infection, such as the flu, than the vaccine designed to prevent the infection, such as the flu jab.

Guillain-Barré syndrome can be difficult to diagnose because several other conditions can
cause similar symptoms.

A GP will refer you to a hospital specialist if they think you might have it or they are not sure
what's causing your symptoms.

Examination
A GP or specialist may:

 ask about your symptoms, such as how long they've lasted and whether they're getting
worse – muscle weakness that's getting worse over time is a common sign of Guillain-Barré
syndrome
 examine your hands, feet or limbs to check for symptoms such as numbness
 ask if you've recently been ill – Guillain-Barré syndrome often follows an infection such as food
poisoning or flu
 check your reflexes, such as whether your leg twitches when your knee is tapped in a particular
place – people with Guillain-Barré syndrome usually have no or reduced reflexes
Nerve tests
In hospital, 2 tests may be carried out to see how well your nerves are working.

These are:

 electromyography (EMG) – tiny needles are inserted into your muscles and electrical recordings
are taken to see how they react when nearby nerves are activated
 nerve conduction studies – small discs (electrodes) are stuck on your skin and minor electric
shocks are used to activate the nerves and measure how quickly these signals travel along them
In people with Guillain-Barré syndrome, these tests will usually show that signals are not
travelling along the nerves properly.
Lumbar puncture
A lumbar puncture is a procedure to remove some fluid from around the spinal cord (the nerves
running up the spine) using a needle inserted into the lower part of the spine.

The sample of fluid will be checked for signs of problems that can cause similar symptoms
to Guillain-Barré syndrome, such as an infection.

Treatment for Guillain-Barré syndrome can help reduce the symptoms and speed up
recovery.

Most people are treated in hospital and usually need to stay in hospital for a few weeks to a few
months.

Intravenous immunoglobulin (IVIG)

The most commonly used treatment for Guillain-Barré syndrome is intravenous immunoglobulin
(IVIG).

When you have Guillain-Barré syndrome, the immune system (the body's natural defences)
produces harmful antibodies that attack the nerves.

IVIG is a treatment made from donated blood that contains healthy antibodies. These are given
to help stop the harmful antibodies damaging your nerves.

IVIG is given directly into a vein.

Plasma exchange (plasmapheresis)

A plasma exchange, also called plasmapheresis, is sometimes used instead of IVIG.

This involves being attached to a machine that removes blood from a vein and filters out the
harmful antibodies that are attacking your nerves before returning the blood to your body.

Most people need treatment over the course of around 5 days.

Other treatments
While in hospital, you'll be closely monitored to check for any problems with your lungs, heart
or other body functions.
You'll also be given treatment to relieve your symptoms and reduce the risk of further problems.
This may include:

 a breathing machine (ventilator) if you're having difficulty breathing

 a feeding tube if you have swallowing problems
 painkillers if you're in pain
 being gently moved around on a regular basis to avoid bed sores and keep your joints healthy
 a thin tube called a catheter in your urethra (the tube that carries urine out of the body) if you
have difficulty peeing
 laxatives if you have constipation
 medicine and/or special leg stockings to prevent blood clots
Once you start to improve, you may also need extra support to aid your recovery. Read more
about recovering from Guillain-Barré syndrome.

Most people eventually make a full recovery from Guillain-Barré syndrome, but this can
sometimes take a long time and around 1 in 5 people have long-term problems.

The vast majority of people recover within a year.

A few people may have symptoms again years later, but this is rare.

Possible long-term problems

These can include:

 being unable to walk without assistance – some people need to use a wheelchair

 weakness in your arms, legs or face
 numbness, pain or a tingling or burning sensation
 balance and co-ordination problems
 extreme tiredness
Support and rehabilitation
Specialised services are available to help you recover and adapt to any long-term problems.

This may involve support from:

 a physiotherapist – who can help with movement problems

  an occupational therapist – who can identify problem areas in the person's everyday life and
work out practical solutions
 a speech and language therapist – who can help with communication and swallowing problems
 a counsellor – who you can discuss your problems with and who can help you find ways to cope
emotionally
Your health and care needs will be assessed and an individual care plan drawn up to meet those
needs. This should involve a discussion with you and anyone likely to be involved in your care.

See the care and support section for information and advice about caring for someone, including
sections that may be useful if you're new to caring.

Support groups
If you have Guillain-Barré syndrome, or you're caring for someone who has, you may find it
useful to get in touch with a support group.

The main UK-based support group is GAIN (Guillain-Barré & Associated Inflammatory
Neuropathies). You can visit their website for information or contact their helpline on 0800
374803.

You can also ask the healthcare professionals caring for you about support groups in your area.

Page last reviewed: 6 February 2020

https://www.nhs.uk/conditions/guillain-barre-syndrome/

Pathophysiology
The pathophysiology of GBS is complex. GBS is considered to be an
autoimmune disease triggered by a preceding bacterial or viral infection.
Campylobacter jejuni, cytomegalovirus, Epstein-Barr virus and Mycoplasma
pneumoniae are commonly identified antecedent pathogens.

In the acute motor axonal neuropathy (AMAN) form of GBS, the infecting
organisms probably share homologous epitopes to a component of the
peripheral nerves (molecular mimicry) and, therefore, the immune responses
cross-react with the nerves causing axonal degeneration; the target molecules
in AMAN are likely to be gangliosides GM1, GM1b, GD1a and GalNAc-GD1a
expressed on the motor axolemma. In the acute inflammatory demyelinating
polyneuropathy (AIDP) form, immune system reactions against target
epitopes in Schwann cells or myelin result in demyelination; however, the
exact target molecules in the case of AIDP have not yet been identified [7]. 

The body's immune system begins to attack the body itself, [8] The immune
responses causes a cross-reaction with the neural tissue. When myelin is
destroyed, destruction is accompanied by inflammation. These acute
inflammatory lesions are present within several days of the onset of
symptoms. Nerve conduction is slowed and may be blocked completely. Even
though the Schwann cells that produce myelin in the peripheral nervous
system are destroyed, the axons are left intact in all but the most severe cases.
After 2-3 weeks of demyelination, the Schwann cells begin to proliferate,
inflammation subsides, and re-myelination begins.

While GBS is the most common cause of acute paralysis, the exact
pathogenesis is still unclear. The progression of demyelination appears
different in AMAN type of GBS versus AIDP type. Nadir is the point of
greatest severity and patients with AMAN type reach it earlier.

https://www.physio-pedia.com/Guillain-Barre_Syndrome