- Guillain-Barré syndrome (GBS) is a rare condition in which a person’s immune system attacks the peripheral nerves.
- People of all ages can be affected, but it is more common in adults and in males.
- Most people recover fully from even the most severe cases of Guillain-Barré syndrome.
- Severe cases of Guillain-Barré syndrome are rare, but can result in near-total paralysis.
- Guillain-Barré syndrome is potentially life-threatening. People with Guillain-Barré syndrome should be treated and monitored; some may need intensive care. Treatment includes supportive care and some immunological therapies.
In Guillain-Barré syndrome, the body's immune system attacks part of the peripheral nervous system. The syndrome can affect the nerves that control muscle movement as well as those that transmit pain, temperature and touch sensations. This can result in muscle weakness and loss of sensation in the legs and/or arms.
It is a rare condition, and while it is more common in adults and in males, people of all ages can be affected.
Symptoms typically last a few weeks, with most individuals recovering without long-term, severe neurological complications.
- The first symptoms of Guillain-Barré syndrome include weakness or tingling sensations. They usually start in the legs, and can spread to the arms and face.
- For some people, these symptoms can lead to paralysis of the legs, arms, or muscles in the face. In 20%–30 % of people, the chest muscles are affected, making it hard to breathe.
- The ability to speak and swallow may become affected in severe cases of Guillain-Barré syndrome. These cases are considered life-threatening, and affected individuals should be treated in intensive-care units.
- Most people recover fully from even the most severe cases of Guillain-Barré syndrome, although some continue to experience weakness.
- Even in the best of settings, 3%–5% of Guillain-Barré syndrome patients die from complications, which can include paralysis of the muscles that control breathing, blood infection, lung clots, or cardiac arrest.
Guillain-Barré syndrome is often preceded by an infection. This could be a bacterial or viral infection. Guillain-Barré syndrome may also be triggered by vaccine administration or surgery.
In the context of Zika virus infection, unexpected increase in cases of Guillain-Barré syndrome has been described in affected countries. The most ly explanation of available evidence from outbreaks of Zika virus infection and Guillain-Barré syndrome is that Zika virus infection is a trigger of Guillain-Barré syndrome.
Diagnosis is symptoms and findings on neurological examination including diminished or loss of deep-tendon reflexes. A lumbar puncture may be done for supportive information, though should not delay treatment. Other tests, such as blood tests, to identify the underlying trigger are not required to make the diagnosis of GBS and should not delay treatment.
The following are recommendations for treatment and care of people with Guillain-Barré syndrome:
- Guillain-Barré syndrome is potentially life-threatening. GBS patients should be hospitalized so that they can be monitored closely.
- Supportive care includes monitoring of breathing, heartbeat and blood pressure. In cases where a patient's ability to breathe is impaired, he or she is usually put on a ventilator. All GBS patients should be monitored for complications, which can include abnormal heart beat, infections, blood clots, and high or low blood pressure.
- There is no known cure for GBS. But treatments can help improve symptoms of GBS and shorten its duration.
- Given the autoimmune nature of the disease, its acute phase is typically treated with immunotherapy, such as plasma exchange to remove antibodies from the blood or intravenous immunoglobulin. It is most often beneficial when initiated 7 to 14 days after symptoms appear.
- In cases where muscle weakness persists after the acute phase of the illness, patients may require rehabilitation services to strengthen their muscles and restore movement.
WHO is supporting countries to manage GBS in context of Zika virus infection by:
- Enhancing surveillance of GBS in Zika affected countries.
- Providing guidelines for the assessment and management of GBS.
- Supporting countries to implement guidelines and strengthen health systems to improve the management of GBS cases.
- Defining the research agenda for GBS.
Guillain-Barré syndrome is a rare nerve disorder.
Guillain-Barré syndrome (GBS) is an illness that can result in muscle weakness or loss of muscle function in parts of the body.
In people with Guillain-Barré syndrome (pronounced GHEE-yan ba-RAY), the body's own immune system attacks the peripheral nervous system.
The peripheral nervous system includes the nerves that connect the brain and spinal cord to the limbs. These nerves help control muscle movement.
Guillain-Barré syndrome is a rare disease.
The Centers for Disease Control and Prevention (CDC) estimates that about 1 or 2 every 100,000 people develop GBS each year in the United States.
Anyone can get GBS, but the condition is more common in adults than in children, and more men than women are diagnosed with GBS each year.
Causes and Risk Factors
Doctors don't know what causes Guillain-Barré syndrome.
Many people with GBS report a bacterial or viral infection (such as the flu) days or weeks before GBS symptoms start.
Less common triggers for GBS may include:
Guillain-Barré syndrome is not contagious — it cannot spread from one person to another.
Types of GBS
There are several types of Guillain-Barré syndrome, which are characterized by what part of the nerve cell is damaged.
The most common type of GBS is called acute inflammatory demyelinating polyradiculoneuropathy (AIDP).
In AIDP, the immune system mistakenly attacks the protective nerve covering that helps transmit nerve signals from the brain to other parts of the body.
Guillain-Barré Syndrome Symptoms
The first symptoms of Guillain-Barré syndrome often include feelings of tingling or weakness in the feet and legs. These feelings may spread to the arms and face.
The chest muscles can also be affected. Up to a quarter of people with GBS experience problems breathing.
In very severe cases, people with GBS may lose all muscle function and movement, becoming temporarily paralyzed.
Signs and symptoms of Guillain-Barré syndrome may include:
- Pricking or tingling “pins and needles” sensations in the fingers, toes, ankles, or wrists
- Muscle weakness that starts in the legs and spreads to the upper body
- Unsteady walking
- Difficulty with eye or facial movements (blinking, chewing, speaking)
- Difficulty controlling the bowels or bladder
- Rapid heart rate
- Difficulty breathing
Before diagnosing Guillain-Barré syndrome, your doctor will perform a complete physical and neurological exam to rule out other illnesses that could be causing your symptoms.
Your doctor may then recommend additional tests that can help detect and measure changes in nerve function.
These tests may include:
Spinal tap: Your doctor will insert a needle into your lower back and remove a small amount of spinal fluid for testing.
Electromyography: Thin needles are inserted into certain muscles to measure nerve activity in the muscles.
Nerve conduction: You'll receive small shocks from electrodes taped to your skin, allowing your doctor to measure nerve function.
In very severe cases of Guillain-Barré syndrome, muscle weakness may impair your ability to breathe. Some people with GBS need a breathing tube and machine to help them breathe.
Most people make a full recovery from GBS, but some people experience lingering problems, including:
- Minor weakness, numbness, or tingling
- Recurring nerve pain
- Sluggish bowels, or the inability to completely empty the bladder
- Blood pressure fluctuations
- Irregular heart rhythm
Guillain-Barré Syndrome and the Zika Virus
Several countries have reported a surge in Guillain-Barré syndrome cases in people who have also been infected with the Zika virus.
It's not yet known whether the Zika virus can cause or trigger GBS.
Researchers from around the world are currently studying possible links between GBS and Zika.
Guillain-Barré Syndrome Treatment
There's no cure for Guillain-Barré syndrome, but there are treatments that can reduce the severity of the illness and help speed up recovery.
People with GBS are typically treated in a hospital. Some people with GBS require breathing assistance, a heart monitor, or other medical devices to assist with basic bodily functions while their nerves recover.
Two main types of therapies are used to treat GBS:
Plasma exchange (plasmapheresis): In this procedure, blood is removed from the body and processed so that the blood cells are separated from the liquid portion of blood. The blood cells are then returned to the body.
Plasma exchange appears to reduce the severity and length of symptoms in some people with GBS.
High-dose immunoglobulin therapy: You'll get injections of high doses of special proteins that help reduce the immune system's attack on the body's nerve cells.
Guillain-Barré Syndrome Prognosis
While most people make a full recovery from GBS, this can be a lengthy process. It may take as short as a few weeks — or as long as a few years — to recover.
About 3 to 5 percent of people with Guillain-Barré syndrome die from complications of the illness, according to the World Health Organization (WHO).