A rare autoimmune condition where the immune system attacks the nerves, causing weakness that can spread quickly.

Overview of Guillain-Barré syndrome

Guillain-Barré syndrome (GBS) is a condition in which the immune system mistakenly attacks the body's nerves, leading to symptoms such as weakness, numbness or paralysis. It typically begins with tingling and weakness in the hands and feet, which can rapidly spread and progress to paralysis. In severe cases, GBS is a medical emergency and most patients require hospital care.

Causes of GBS

The exact cause of GBS is not fully understood. It often develops days or weeks after a respiratory or gastrointestinal infection and in rare cases, it may follow recent surgery or vaccination.

GBS can be triggered by several factors, most commonly infections such as

• Campylobacter (often linked to undercooked poultry)
• Influenza virus
• Cytomegalovirus
• Epstein-Barr virus
• Zika virus
• Hepatitis A, B, C, and E
• Human immunodeficiency virus (HIV)
• Mycoplasma pneumoniae

Other possible triggers include surgery, trauma, Hodgkin lymphoma and, very rarely, influenza or childhood vaccinations, as well as COVID-19 infection.

Symptoms

GBS can affect your senses, movement and even vital functions like breathing and heart rate. It most often starts in the legs and arms before spreading to other parts of the body. Symptoms typically worsen over the first 2 to 4 weeks. Early signs may include tingling, numbness, or a “pins and needles” feeling in the hands and feet. This is usually followed by muscle weakness and difficulty in moving joints.

Other possible symptoms include:

• Sharp or shooting nerve pain, commonly in the legs or back
• Breathing difficulties
• Facial weakness, such as drooping muscles or trouble speaking or swallowing
• Eye problems, including double vision

In severe cases, symptoms can progress to significant paralysis, affecting the ability to move the arms, legs, and face.

Complications of GBS

GBS affects the nerves, which control movement and many vital body functions. Because of this, people may experience a range of complications:

• Breathing problems: Weakness or paralysis can affect the muscles used for breathing, which can become life-threatening
• Lingering symptoms: Most people recover fully or are left with only mild weakness, numbness, or tingling
• Heart and blood pressure issues: Fluctuations in blood pressure and abnormal heart rhythms can occur
• Pain: Around one-third of patients experience nerve pain, which can often be managed with medication
• Bowel and bladder problems: Some people may have constipation or difficulty emptying the bladder
• Blood clots: Reduced mobility increases the risk of clots, so blood thinners or compression stockings may be needed until walking improves
• Pressure sores: Being immobile can lead to bedsores, which can be prevented by frequently changing position
• Relapse: In rare cases, symptoms may return, even years after recovery, leading to renewed muscle weakness

The severity of early symptoms can influence the risk of long-term complications. In rare and severe cases, complications such as respiratory failure or heart problems may be fatal.

Diagnosis

Doctors usually diagnose GBS based on symptoms and medical history. They will ask when your symptoms began and whether you had any recent illness. A physical and neurological examination is also done to check for muscle weakness and reduced or absent reflexes (hyporeflexia or areflexia).

Since several neurological conditions can have similar symptoms, additional tests are often needed to confirm the diagnosis and rule out other causes. These may include:

• Electromyography (EMG) and nerve conduction studies: These tests assess how well your nerves and muscles are functioning
• Spinal tap (lumbar puncture): A small sample of cerebrospinal fluid (CSF) is collected from the lower back and analysed in a laboratory. In about 80% of cases, CSF shows increased protein levels with a normal white blood cell count, which supports the diagnosis of GBS. Other patterns may suggest different conditions.
• Imaging tests: A magnetic resonance imaging (MRI) scan of the spine may be recommended to exclude other neurological problems.

Treatment

There is currently no cure for GBS, but treatment can help reduce symptoms and speed up recovery.

Most people with GBS are admitted to the hospital, often in the intensive care unit (ICU), because muscle weakness can affect breathing and other vital functions.

Main treatments for GBS

Two main treatments help stop further nerve damage caused by the immune system. Both work best if started within the first two weeks of symptoms:

Plasma exchange (plasmapheresis): Blood is taken out of the body, and the liquid part (plasma) is separated from the blood cells. The plasma, which may contain harmful antibodies, is removed and replaced with a substitute fluid and the blood cells are returned to the body. This helps remove the substances attacking the nerves.

Intravenous immunoglobulin (IVIg): This treatment uses healthy antibodies collected from many donors. These are given through a vein and help block the harmful antibodies that are damaging the nerves, reducing their effect and helping speed up recovery.

Rehabilitation treatment

As people with GBS start to recover, they may be moved from acute hospital care to a rehabilitation centre. There, they receive physiotherapy and other therapies to help rebuild strength and return to normal daily activities.

Since GBS can affect many parts of the body, different types of care may be needed to prevent or manage complications. For example, a physiotherapist may gently move and position the limbs to keep muscles flexible and prevent stiffness or shortening. Recovery of muscle strength may not be identical to before illness—sometimes stronger muscles compensate for weaker ones, a process called substitution. Targeted exercises are used to help strengthen weaker muscles so they can regain their original function.

Occupational and vocational therapy can also help patients relearn everyday tasks that may be affected. These therapies support returning to work and daily life and may include guidance on using assistive devices or adaptive equipment and technology when needed.

Recovery

GBS can be very serious because it often begins suddenly and quickly leads to weakness and sometimes paralysis. However, most people eventually recover completely. With proper intensive care and treatment of infections, breathing problems and other complications, even those with severe breathing difficulty usually survive. Recovery may take time, ranging from a few weeks to several years. Some people may not recover fully and can continue to have weakness, numbness, fatigue or pain. The recovery period can also be emotionally challenging, especially when there is a sudden loss of movement and dependence on others for daily activities. Some patients may benefit from counselling to cope with these changes. Support groups can also help by providing emotional support and useful information.

Prevention

In most cases, GBS cannot be prevented and it is not clear why some people develop it after an illness while others do not. However, you may help reduce your risk by maintaining good overall health.

Helpful steps include:

• Washing your hands regularly
• Avoiding close contact with people who have stomach flu or other infections
• Eating a balanced diet and exercising regularly to support immune health
• Cleaning and disinfecting frequently touched surfaces such as tables, door handles, toys, phones and bathroom fixtures
• Keeping your vaccinations up to date

Frequently Asked Questions