Topic Overview

What is Guillain-Barré syndrome (GBS)?

Guillain-Barré syndrome (say "ghee-YAN bah-RAY") is a problem with your nervous system. It causes muscle weakness, loss of reflexes, and numbness or tingling in your arms, legs, face, and other parts of your body.

Guillain-Barré syndrome (GBS) can cause paralysis and lead to death. But most people get better and have few lasting problems.

GBS is rare.

What causes Guillain-Barré syndrome?

Experts don't know what causes GBS. They think that the nerves are attacked by your body’s own defense system (the immune system). This is called an autoimmune disease.

In GBS, the immune system attacks the covering (myelin sheath) of certain nerves. This causes nerve damage.

What infections may trigger Guillain-Barré syndrome?

GBS usually begins to affect the nerves after you've had a viral or bacterial infection. Often it is after an infection of the lungs or stomach and intestines.

Infections that may trigger GBS include:

• Campylobacter jejuni, which can cause a type of food poisoning.
• Mycoplasma , which can cause pneumonia.
• Cytomegalovirus (CMV) , which can cause fever, chills, sore throat, swollen glands, body aches, and fatigue.
• Epstein-Barr virus (EBV) , which can cause mononucleosis (mono).
• Varicella-zoster virus, which can cause chickenpox and shingles.

What are the symptoms?

Symptoms of GBS include:

• Numbness or tingling in your hands and feet and sometimes around the mouth and lips.
• Muscle weakness in your legs and arms and the sides of your face.
• Trouble speaking, chewing, and swallowing.
• Not being able to move your eyes.
• Back pain.

Symptoms usually start with numbness or tingling in the fingers and toes. Over days to weeks, muscle weakness in the legs and arms develops. After about 4 weeks, most people begin to get better.

You may need to be treated in the hospital for the first few weeks. This is because GBS can be deadly if weakness spreads to muscles that control breathing, heart rate, and blood pressure.

Call your doctor or get help right away if you think you might have GBS.

How is Guillain-Barré syndrome diagnosed?

Your doctor will ask when your symptoms started and how they have changed. He or she also may ask if you've had any recent infections.

Two signs are important in helping your doctor decide if you have GBS.

• Your arms and legs are getting weaker.
• You are losing your reflexes, which are automatic body movements that you can't control.

Your doctor also may do tests, such as a lumbar puncture and nerve conduction study.

If the diagnosis isn't clear, you may be referred to a doctor who specializes in the nervous system (neurologist).

How is it treated?

GBS usually is treated in the hospital. The hospital staff will watch you carefully to be sure you don't get worse or get an infection. Your breathing, heart rate, and blood pressure are carefully tracked. Some people need a ventilator to help them breathe.

In the hospital, you may get a plasma exchange or intravenous immune globulin (IVIG).

• In a plasma exchange, blood is taken out of your body. The harmful antibodies are removed from the blood, and then the blood is returned to your body.
• In IVIG, helpful antibodies are added to your blood.

These treatments may help your body fight the disease and may speed your recovery if they are used when you first get GBS.

You may need 3 to 6 months or longer to recover from GBS. And sometimes GBS can come back.

If you had severe muscle weakness, you may need physical or occupational therapy. You will also need exercise to help you regain muscle strength and movement. You may need help with daily tasks for a while.

Frequently Asked Questions

Learning about Guillain-Barré syndrome:	What is Guillain-Barré syndrome? What are the symptoms?
Being diagnosed:	How is Guillain-Barré syndrome diagnosed?
Getting treatment:	How is Guillain-Barré syndrome treated? What is immunotherapy for GBS?
Living with Guillain-Barré syndrome:	What can I do at home to get stronger after GBS?

Symptoms

Symptoms of Guillain-Barré syndrome (GBS) include:

• Numbness or tingling in the hands and feet and occasionally around the mouth and lips.
• Muscle weakness on both sides of the body in the legs, arms, and face.
• Difficulty speaking, chewing, and swallowing.
• Inability to move the eyes.
• Back pain.

The first symptoms of Guillain-Barré syndrome include tingling in the fingers and toes and weakness in the arms and legs that may appear several days or weeks after a respiratory or gastrointestinal infection. Tingling is a very common symptom that may be caused by a wide variety of medical problems. But after muscle weakness develops in addition to tingling, GBS becomes a more likely cause of these symptoms. Tingling and weakness may spread to the arms and upper body. GBS can become life-threatening if weakness spreads to muscles that control breathing, heart rate, and blood pressure.

Muscle weakness caused by GBS often gets worse over 1 to 4 weeks before it stabilizes and then gradually improves. In some people, symptoms continue to get worse for up to 3 months. In children, persistent symptoms of GBS may include tiring easily and having muscle pain during exercise.¹

There are different forms of GBS, but symptoms are often a lot alike. Most GBS symptoms are caused by damage to nerve coverings (demyelination). This causes problems with how messages travel between the brain and the rest of the body.

Exams and Tests

Guillain-Barré syndrome (GBS) may be difficult to diagnose in the early stages of the disease. A detailed examination of your nervous system is needed to diagnose the condition. Your doctor will ask questions about your symptoms, including when they started and how they have changed over time. A history of recent infection (especially respiratory or gastrointestinal illness) may also be an important clue in the diagnosis.

The two signs that must be present to diagnose GBS are:

• Progressive weakness in both arms and both legs.
• Loss of reflexes.

When these two signs are present, a diagnosis of GBS may be more likely if:

• The symptoms developed over a period of days to several weeks.
• The symptoms affect both sides of your body equally.
• Mild sensory symptoms are present, such as numbness and tingling.
• The muscles on each side of your face are affected.
• You begin to recover 2 to 4 weeks after symptoms have stabilized.
• You did not have a fever when symptoms first started.

Some tests may be necessary to rule out other conditions, such as electrolyte imbalances and certain types of poisoning, that could also be causing the symptoms and to help confirm the diagnosis of GBS. These tests include:

• A lumbar puncture, which is an analysis of the fluid around the spine. If you have GBS, this test may show increased amounts of protein in your spinal fluid without other signs of infection.
• Nerve conduction studies, which use electrical impulses to indicate how well the nerves are working. If you have GBS, the results may show a slowing of nerve function, which usually suggests that damage to the covering (myelin sheath) of the peripheral nerves has occurred.

In the very early stages of GBS, the results of these tests may be normal. Abnormal results may not show up for a week or more after symptoms begin.

If the diagnosis is unclear, you may be referred to a doctor who specializes in brain and nervous system disorders (neurologist).

Treatment Overview

The main treatment for GBS is preventing and managing complications (such as breathing problems or infections) and providing supportive care until symptoms begin to improve. This may include:

• Easing your breathing problems, sometimes through the use of a breathing machine (ventilator).
• Monitoring your blood pressure and heart rate.
• Providing adequate nutrition if you have problems chewing and swallowing.
• Managing bladder and bowel problems.
• Using physical therapy to help maintain muscle strength and flexibility.
• Preventing and treating complications such as pneumonia, blood clots in the legs, or urinary tract infections.

Other treatment of Guillain-Barré syndrome (GBS) depends on how severe your symptoms are. More severe cases of GBS are treated with immunotherapy, which includes plasma exchange or intravenous immune globulin (IVIG). Treatment is given in a hospital. It starts immediately after you have been diagnosed with GBS that is getting worse. Early intervention with either of these treatments appears to be effective and may reduce recovery time. Neither treatment is better than the other, and there is no benefit to combining these treatments.²

Careful monitoring is very important during the early stages of GBS because breathing problems and other life-threatening complications can occur within 24 hours after symptoms first start.

• Admission to a hospital or intensive care unit is often needed when muscle weakness progresses quickly. Muscle weakness may rapidly affect the muscles that control breathing. In such cases, temporary use of a mechanical ventilator may be necessary to help you breathe until you can breathe on your own again.
• Careful outpatient monitoring may be enough in cases where significant muscle weakness has not developed. It is important to continue to watch closely for any signs that the condition is getting worse so that you can contact your doctor or hospital immediately.

You probably will need to be hospitalized if you:

• Are unable to move around on your own.
• Have significant paralysis.
• Have breathing problems.
• Have blood pressure problems or an abnormal, very fast, or very slow heart rate.

If possible, you will be referred to a medical center that has experience treating the illness.

Recovery

Recovery may take 3 to 6 months, sometimes longer—in some cases, up to 18 months. People who have severe muscle weakness may need to stay at a rehabilitation hospital to receive ongoing physical therapy and occupational therapy as their motor function returns. For those who stay at home, devices that help perform certain daily activities can be used until motor function and muscle strength return.

Physical therapy and regular exercise are needed throughout the recovery period to strengthen the weakened muscles. The therapy program can be made to fit your specific needs.

Although recovery can be slow, most people who have GBS eventually recover.

• Many people have some minor long-term effects, such as numbness in the toes and fingers. In most cases, these problems will not significantly interfere with your lifestyle.
• About 20% of people have permanent problems that tend to be more disabling, such as weakness or balance problems. These problems may interfere with daily activities.³
• About 3% to 8% of people who develop GBS die from complications of the illness, such as respiratory failure, infection (often pneumonia), or heart attack.³
• Up to 67% of people who get GBS have some problems with persistent fatigue.²

Relapses

Relapses or repeated episodes of GBS happen in about 5% to 10% of cases, and they may be very serious.⁴ If you have a relapse, aggressive treatment with plasma exchange or IV immune globulin may reduce the severity of the attack and prevent further relapses. If you have more than one relapse, treatment with other drugs may be needed.

Home Treatment

If you think you might have Guillain-Barré syndrome (GBS), call your doctor or seek immediate medical attention.

After having Guillain-Barré syndrome, you may have to wait several months before you can return to your regular daily activities. Support at home is important during this time. You may need temporary help with some of your activities and chores. Also, you can strengthen your weakened muscles by exercising regularly. Talk to your doctor about exercising during your recovery.

Other Places To Get Help

Organizations

National Institute of Neurological Disorders and Stroke
P.O. Box 5801
Bethesda, MD  20824
Phone:	1-800-352-9424 (301) 496-5751
TDD:	(301) 468-5981
Web Address:	www.ninds.nih.gov
The National Institute of Neurological Disorders and Stroke (NINDS), a part of the National Institutes of Health, is the leading U.S. federal government agency supporting research on brain and nervous system disorders. It provides the public with educational materials and information about these disorders.
American Autoimmune Related Diseases Association (AARDA)
22100 Gratiot Avenue
East Detroit, MI  48021
Phone:	(586) 776-3900
E-mail:	aarda@aol.com
Web Address:	www.aarda.org
This national nonprofit health agency is dedicated to curing autoimmune diseases and relieving the suffering and the economic and social impact of autoimmune diseases. AARDA brings professionals together in the areas of education, research, and patient services, and sponsors physicians' conferences, research, legislative advocacy, and a national awareness campaign.
Guillain-Barré Syndrome/Chronic Inflammatory Demyelinating Polyneuropathy Foundation International (GBS/CIDP)
104½ Forrest Avenue
Narbeth, PA  19072
Phone:	1-866-224-3301 toll-free (610) 667-0131
Fax:	(610) 667-7036
E-mail:	info@gbs-cidp.org
Web Address:	http://gbs-cidp.org
This organization is a good source of information and support for people affected by Guillain-Barré syndrome (GBS) or Chronic Inflammatory Demyelinating Polyneuropathy (CIDP). It can direct people who have long-term disability caused by GBS or CIDP to support groups and resources that provide vocational, financial, and other assistance.

References

Citations

1. Vajsar J, et al. (2003). Long-term outcome in children with Guillain-Barré syndrome. Journal of Pediatrics, 142: 305–309.
2. Hughes RAC, et al. (2003). Practice parameter: Immunotherapy for Guillain-Barré syndrome. Neurology, 61: 736–740.
3. Chiò A, et al. (2003). Guillain-Barré syndrome: A prospective, population-based incidence and outcome survey. Neurology, 60(7): 1146–1150.
4. Ropper AH, Brown RH (2005). Guillain-Barré syndrome (Landry-Guillain-Barré-Strohl syndrome, acute inflammatory polyneuropathy, AIDP) section of Diseases of the peripheral nerves. In Adams and Victor's Principles of Neurology, 8th ed., pp. 1110–1177. New York: McGraw-Hill.

Other Works Consulted

• Hughes RAC, et al. (2006). Intravenous immunoglobulin for Guillain-Barré syndrome. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.
• Lovitt S, Harati Y (2003). Guillaine-Barré syndrome. In RW Evans, ed., Saunders Manual of Neurologic Practice, chap. 2, pp. 572–575. Philadelphia: Saunders.
• Raphaël JC, et al. (2002). Plasma exchange for Guillain-Barré syndrome. Cochrane Database of Systematic Reviews (2). Oxford: Update Software.

Credits

Author	Monica Rhodes
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer	Colin Chalk, MD, CM, FRCPC - Neurology
Last Updated	July 31, 2008