Guillain-Barré Syndrome

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Topic Overview

What is Guillain-Barré syndrome (GBS)?

Guillain-Barré syndrome (GBS) (say "ghee-YAN bah-RAY") is a rare nervous system disorder that results from nerve damage caused by the body's own defenses (immune system), usually in response to an infection or other illness. GBS causes muscle weakness, loss of reflexes, and numbness or tingling in the arms, legs, face, and other parts of the body. It may progress to complete paralysis.

About 1 or 2 people out of 100,000 develop GBS each year.¹ Although GBS can be life-threatening, most people recover with few lasting problems.

What causes Guillain-Barré syndrome?

The exact cause of GBS is not known. But it is believed that the disorder is an autoimmune disease, a condition in which the immune system attacks its own tissues as though they were foreign substances. Nerves are damaged by the immune system, usually in response to a viral or bacterial infection or other illness. As the immune system produces antibodies to fight the infection or illness, it may also produce antibodies that attack the covering (myelin sheath ) of the peripheral nerves and sometimes the nerve fibers (axons). The resulting nerve damage leads to tingling and numbing sensations, muscle weakness, and paralysis.

Although it is not known exactly what triggers the body's response, GBS most often develops after a respiratory or gastrointestinal infection. A variety of infections may be associated with GBS. Those that have been most commonly linked to the disease are Campylobacter jejuni (a bacterial infection that affects the intestinal tract), mycoplasma (a type of bacteria that can cause pneumonia), cytomegalovirus (CMV), Epstein-Barr virus (EBV), and varicella-zoster virus, the virus that causes chickenpox and shingles.

The 1976 swine flu vaccine was linked to GBS. Since then, researchers have studied the link between any flu vaccine and GBS. Some studies show a very small increase in the risk of GBS after having the flu vaccine. But getting the flu is much more of a health risk than is the chance that you could get GBS after having the flu vaccine.^{2 3}

What are the symptoms?

Generally, symptoms of 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.

Symptoms usually start with numbness or tingling in the fingers and toes, followed by weakness in the leg and arm muscles that develops over a period of days to weeks. Hospital treatment is often needed during this time. The progression of weakness usually does not last longer than about 4 weeks. The weakness then stabilizes and gradually improves within the following few months.

How is Guillain-Barré syndrome diagnosed?

GBS may be difficult to diagnose in its early stages and requires a detailed examination of the nervous system. Your doctor will ask 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. Two important signs must be present for your doctor to diagnose GBS: progressive weakness in both arms and both legs and the loss of reflexes.

Early on, your doctor may do a lumbar puncture to check your spinal fluid for proteins and other markers that can help make the diagnosis.

How is it treated?

Treatment of GBS depends on how severe your symptoms are and whether complications start. 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. For many people who have GBS, immunotherapy is also given in the hospital. This treatment includes plasma exchange or intravenous immune globulin (IVIG). In many people, immunotherapy may speed recovery when used early in the course of the disease.

Physical therapy and exercise are used throughout recovery to help restore muscle strength and movement.

Frequently Asked Questions

Last updated:	July 31, 2008
Author:	Monica Rhodes
Reviewed By:	Anne C. Poinier, MD - Internal Medicine, Colin Chalk, MD, CM, FRCPC - Neurology
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC