Guillain–Barré Syndrome (GBS)

Overview

Guillain-Barré syndrome (GBS) is a rare neurological condition in which the body’s immune system mistakenly attacks the peripheral nerves, which are the nerves outside the brain and spinal cord. This network of nerves sends signals from the brain and spinal cord to the rest of the body. It helps control movement, sensation, and automatic body functions, like breathing and heart rate.

In simple terms, this connection between your brain and body becomes inflamed and damaged by your immune system, resulting in weak, numb, or difficult-to-control muscles.

Guillain-Barré syndrome usually develops quickly, often over days to weeks. Many people first notice tingling or weakness in their legs or feet, and the symptoms can gradually move upward into the arms and upper body until you can’t use certain muscles at all. In severe cases, it can affect breathing and swallowing muscles and require hospitalization in an intensive care unit (ICU).

The syndrome is a medical emergency when symptoms progress rapidly. Anyone with rapidly worsening weakness, trouble walking, or breathing difficulty should seek immediate medical care.

 Known triggers and associated causes of GBS include:

• Campylobacter infection: As one of the most common triggers, Campylobacter bacteria often cause symptoms of food poisoning, such as diarrhea, vomiting, stomach cramps, and fever. It’s commonly linked to undercooked poultry, contaminated water, or unpasteurized foods. After a Campylobacter infection has resolved, GBS can develop in the days or weeks afterward. 
• Respiratory infections: Many people report having a cold, flu-like illness, sinus infection, bronchitis, or another respiratory infection before being diagnosed with GBS. Infections such as influenza, COVID-19, RSV, rhinoviruses, among others, are thought to stimulate the immune system sufficiently to trigger an autoimmune attack on nerves.
• Surgery or major physical stress: Significant trauma, serious illness, major medical stress, or surgery can sometimes trigger GBS.
• Vaccines: On occasion, a vaccination can trigger the autoimmune disease. In general, the risk of contracting GBS from a vaccine is lower than the risk of contracting it from the infection that is prevented by the vaccine. 

Researchers still do not fully understand why some people develop Guillain-Barré syndrome while others do not.

You may experience a combination of the following symptoms as part of GBS:

• Tingling or “pins and needles” sensations: This is often one of the earliest symptoms of GBS, with tingling in your feet, toes, fingers, or hands being most common. Conversely, some people can develop reduced sensation in parts of their body.
• Muscle weakness: This symptom typically begins in the legs and gradually spreads to the arms and upper body equally on both sides. Muscle weakness often comes on quickly and worsens over hours or days, and standing, walking, or climbing stairs may become difficult. Muscle weakness may affect your ability to use your arms and legs, along with the ability to speak, swallow, and breathe. 
• Loss of reflexes: Reflexes in the arms and legs may be reduced or disappear completely. 
• Coordination problems: As GBS progresses, you may struggle with balance, coordination, and fine-motor skills that require precise movements.
• Muscle aches or cramping: As a result of the inflammation and muscle weakness, you may experience muscle aches and/or muscle cramping.
• Fatigue: Extreme exhaustion is extremely common in GBS, and tends to be one of the longest-lasting and most frustrating symptoms. When your nerves are injured and are slow to heal, your nervous system becomes less efficient, your muscles grow weak and deconditioned, and the widespread inflammation contributes to fatigue and poor stamina. 
• Nerve pain: As the condition worsens, pain can become severe. Aching, burning, stabbing, or shooting pain may occur, especially in the back, legs, or arms.
• Autonomic Symptoms: GBS can interfere with your autonomic nervous system, which manages involuntary bodily functions that occur without conscious effort. This involvement may result in an unstable heart rate, blood pressure fluctuations, and issues with digestive or bladder regulation.

If you experience any of the following symptoms, please call 9-1-1 immediately:

• Rapidly worsening weakness
• Trouble breathing
• Difficulty swallowing
• Inability to walk
• Chest tightness or fainting

In severe cases of GBS, muscles may become severely weak, leading to partial or complete paralysis. 

That said, people diagnosed with GBS usually recover well, especially with prompt treatment and the right supportive care.

Guillain–Barré Syndrome (GBS) Diagnosis

Doctors make a diagnosis of Guillain-Barré syndrome (GBS) based on a combination of clinical evaluations and testing, meaning there’s not one “perfect” test to confirm the condition. What’s more, diagnosis can sometimes be difficult, as early symptoms can resemble conditions like stroke, myasthenia gravis, multiple sclerosis (MS), other neurological disorders, pinched nerves, or severe electrolyte imbalance.

Your healthcare team might use the following exams, imaging studies, and blood tests if they suspect you have GBS:

• Physical and neurological exam: First, your provider will ask about your symptoms, when they began and how they have progressed, any recent illnesses or infections, and whether or not you have breathing or swallowing problems. Next, they’ll assess your neurological function, including muscle strength, sensation, reflexes, balance and coordination, and eye and facial movements. 
• Lumbar puncture: Also known as a spinal tap, this test is among the most important diagnostic tools for GBS. During this procedure, a needle is inserted into the lower back to collect a small sample of your cerebrospinal fluid (CSF). A pattern highly suggestive of GBS is elevated protein levels and normal or mildly increased white blood cells, reflecting nerve inflammation without a major infection in your spinal fluid. [Link: Lumbar Puncture video]
• Nerve Conduction Study and Electromyography (NCS/EMG): These tests measure how well electrical signals travel through your nerves as well as how muscles respond to nerve impulses. A nerve conduction study uses small electrical impulses to measure the signal speed and strength of your nerves, while EMG involves a small needle electrode being inserted into a few muscles to measure and record the electrical activity at rest and with contraction. 
• Magnetic Resonance Imaging (MRI): An MRI, while not able to directly diagnose GBS, can rule out conditions such as spinal cord compression, multiple sclerosis (MS), or other neurological diseases. In some people, GBS can cause the roots of some nerves near the spinal cord to light up brightly when an MRI is given with a contrast agent, providing an important diagnostic clue.
• Nerve ultrasound: Ultrasound of the nerves in the arms, legs, and shoulders may show that the nerves are enlarged and can be useful when the diagnosis of GBS is uncertain.
• Breathing and heart monitoring: Because automatic body functions can be affected by GBS, your breathing strength, oxygen levels, heart rhythm, and blood pressure stability are often monitored. Your care team may also monitor your lung function to determine if your breathing muscles are weakening.
• Blood tests: Bloodwork can help rule out other neurological disorders, identify recent infections, and assess for inflammation or immune abnormalities. Additionally, antibodies that bind to nerves can be identified to help diagnose GBS, although often these results do not come back until after GBS has begun resolving. Not all patients with GBS will have these antibodies.

Because GBS can rapidly worsen, early diagnosis is important. Health care professionals will pay especially close attention to warning signs like rapidly progressive weakness, difficulty walking, difficulty swallowing, or shortness of breath. These symptoms often require urgent hospitalization and monitoring.

 It’s generally divided into four categories: 

• Immune therapies
• Supportive medical care
• Rehabilitation therapies
• Occasionally, surgical procedures

In addition, new therapies are being researched and may result in more effective treatments.

Surgical procedures are typically reserved for cases with severe weakness to provide longer-term options for breathing and respiratory support (such as a tracheostomy) or for nutrition (such as a feeding tube) during the recovery and rehabilitation process. Surgery itself isn’t a standard treatment because GBS is an autoimmune nerve disorder, not a structural problem.

Nonsurgical Treatments

• Intravenous immunoglobulin (IVIG) therapy: IVIG therapy is one of the most common treatments for GBS. In this procedure, you receive antibodies through an IV infusion from donated plasma over several days, helping to reset or calm your immune system so it stops attacking your nerves. It also blocks harmful antibodies, reduces inflammation, and shortens the course of GBS while reducing its severity. Intravenous immunoglobulin tends to be the frontline treatment for GBS because it’s widely available, generally well tolerated, and considered less invasive than plasma exchange.
• Plasma exchange: This treatment physically removes antibodies that attack your nerves by removing your blood through a machine, separating the liquid plasma, removing the harmful immune antibodies, and returning the blood to your body with replacement fluids. It reduces the damage caused by your immune system, shortening the symptom duration while improving recovery outcomes. Plasma exchange is often most effective when started early.
• Respiratory support: In some patients—especially those with severe GBS—the diaphragm and breathing muscles can become temporarily paralyzed. These respiratory difficulties can require oxygen support, careful lung monitoring, and mechanical ventilation in severe cases. 
• Monitoring and supportive hospital care: Because GBS can affect the nerves that control automatic body functions, complications can turn serious quickly, necessitating close monitoring. A hospital care team will carefully monitor your heart rhythm, blood pressure, oxygen levels, bladder function, swallowing ability, blood clots, and infection risk to provide the most supportive level of care. 
• Pain management: Nerve inflammation and nerve damage can create burning, stabbing, or aching pain. While IVIG therapy and plasma exchange treatments help manage this inflammation, nerve pain medications and standard pain relievers are also frequently used.
• Physical therapy (PT): A major part of GBS recovery is physical therapy, as your muscles often become deconditioned. Physical therapy can involve strength exercises, stretching, balance work, and mobility retraining to help restore your strength, improve coordination, prevent stiffness and contractures, and rebuild your overall endurance.
• Occupational therapy (OT): If you struggle with dressing, bathing, cooking, or working as a result of GBS, occupational therapy can help you regain independence through daily activities training, adaptive equipment training, and hand and arm coordination training.
• Speech and swallowing therapy: If your face or throat muscles are affected by GBS, speech therapists can help you swallow safely, speak more clearly, and develop strategies for eating and drinking. This therapy is especially important, as weak swallowing muscles can increase your risk of choking or aspiration.
• Psychological and emotional support: Because GBS can appear suddenly and progress rapidly, and recovery can be long and emotionally exhausting, another essential therapeutic approach includes counseling, anxiety management, rehabilitation psychology, and support groups.
• Neuro-Rehabilitation: Often, as people recover from GBS, they will transition to a rehabilitation center for continued care and optimization of their recovery. In that setting, they continue to work with the supportive services mentioned above.

Surgical Treatments

Occasionally, surgical procedures may be necessary due to complications from severe GBS. These surgical procedures may include:

• Tracheostomy: Your doctors might recommend a tracheostomy if long-term ventilator support is required. In this procedure, a small surgical opening is created in the neck into the windpipe, and a breathing tube is placed directly into the airway to help a patient breathe more easily and comfortably. The tube allows air to enter the lungs directly, and it can be connected to oxygen or a ventilator when needed.
• Feeding tube placement: In some patients with severe swallowing difficulties, a feeding tube can ensure adequate nutrition and reduce the risk of choking.

One of the most hopeful aspects of Guillain-Barré syndrome is that once the immune system attack subsides, the nervous system often heals slowly but steadily over weeks or months. While recovery can feel frustratingly slow, meaningful improvement may continue for many months after the initial illness. Although most people eventually make a full recovery, older patients with more severe disease may have some permanent weakness from GBS.