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What Is Guillain-Barré Syndrome?

Guillain-Barré syndrome (GBS) is a rare neurological disease that affects the peripheral nerves
and causes muscle weakness.

Guillain-Barré syndrome is an autoimmune disease that affects the

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weakness, and death occurs in about 5% of patients. The most com- GBS symptoms develop over several days to weeks:
mon subtypes are acute inflammatory demyelinating polyradiculo- Feeding • Upward spread of limb
Peripheral tube weakness starting in the legs
neuropathy (AIDP) and acute motor axonal neuropathy (AMAN). (may cause paralysis)
nerves
Approximately 90% of people with GBS in North America and • Limb numbness and tingling
Europe have AIDP. • Difficulty swallowing and
breathing (may necessitate
Mechanical feeding tube or ventilator)
ventilator • Blood pressure fluctuation
Signs and Symptoms of GBS and irregular heart rhythm
Patients with the AIDP subtype of GBS typically have weakness that
starts in the legs and spreads to the arms, as well as decreased or
absent reflexes. In more than 50% of these patients, nerves that
Many patients gradually recover over 6 to 12 months
originate in the brain stem (cranial nerves) are affected, which may while some have residual symptoms.
cause facial weakness, difficulty swallowing, and eye muscle weak- Upward spread Treatment involves close monitoring of symptoms
ness or paralysis. Approximately 25% to 30% of patients develop of weakness whi
h le in the hospital, antibody infusions
severe weakness or paralysis of the muscles used to breathe. GBS or plasmaa exchangeg , and phy
h sical theerapy.

commonly causes symptoms of low back pain and limb numbness

and tingling, and fluctuations in blood pressure or an irregular heart
rhythm can also occur.
Risk Factors and Conditions Associated With GBS
GBS affects people worldwide, and the lifetime risk of GBS is esti-
mated at 1 in 1000. Although individuals of any age can develop GBS,
the incidence increases with age, and males are slightly more likely
to develop GBS than females.
Approximately two-thirds of patients have a diarrheal or respi-
ratory illness within 4 to 6 weeks prior to the onset of GBS symp-
toms. Other, less common events or conditions that may trigger GBS
include recent surgery, pregnancy, and immunosuppression. Al-
though rare sporadic cases of GBS have been reported after vacci-
nations, the risk of developing postvaccination GBS is much lower
than the risk of developing GBS after an infection.
Diagnosis and Treatment of GBS
Diagnosis of GBS is made based on symptoms and physical exami-
nation findings. Neurological testing often includes electromyog-
raphy and nerve conduction studies to assess nerve and muscle func-
tion. Results of a spinal tap (lumbar puncture) may support the
diagnosis of GBS and can rule out other neurological diseases.
Individuals with suspected GBS should be admitted to the hos-
pital. All patients with GBS need close monitoring of their breath-
ing, heart rate, and blood pressure. Individuals who develop se-
vere respiratory muscle weakness or paralysis are supported with
mechanical ventilation. Patients who have difficulty swallowing may
receive nutrition through a feeding tube.
Current recommended treatments for GBS are intravenous im-
mune globulin (IVIG), an infusion of antibodies, or plasma ex-
change, which involves removal and replacement of the liquid com-
ponent of blood. About 40% to 50% of patients with GBS do not
improve within 4 weeks after IVIG or plasma exchange and need pro-
longed supportive care. Physical, occupational, and speech therapy
are important to help patients regain strength and function.
What Is the Prognosis of GBS?
Most patients with GBS gradually improve and can have a com-
plete recovery over 6 to 12 months. However, some patients have
residual symptoms, including fatigue, pain, numbness, tingling, and
muscle weakness. Some factors associated with a higher risk of death
due to GBS include older age, more severe disease, and need for me-
chanical ventilation.
FOR MORE INFORMATION
National Institute of Neurological Disorders and Stroke

Author: Revital Marcus, MD
Published Online: February 2, 2023. doi:10.1001/jama.2022.24232
Author Affiliation: Fishbein Fellow, JAMA.
Conflict of Interest Disclosures: None reported.
Source: Sheikh KA. Guillain-Barré syndrome. Continuum (Minneap Minn). 2020;26(5):
1184-1204. doi:10.1212/CON.0000000000000929
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