Signs, Treatment and Management Of Guillain-Barré Syndrome
Know about the Guillain-Barré Syndrome (GBS), what it is, triggers of GBS, infections leading to GBS, signs, diagnosis, treatment, management and more.
Written by Dr. Rohinipriyanka Pondugula
Reviewed by Dr. Vasanthasree Nair MBBS
Last updated on 5th Sep, 2025
Introduction
Guillain-Barré Syndrome (GBS) is a rare but serious neurological disorder where the body's immune system mistakenly attacks its own peripheral nerves. This can lead to symptoms ranging from mild weakness to devastating paralysis.
This article will demystify GBS, exploring its potential triggers, the detailed progression of its symptoms, and the critical importance of a timely diagnosis. We'll break down the complex immune response into understandable terms, provide a clear timeline of what to expect, and guide you on the essential steps to take if you suspect GBS.
Understanding Guillain-Barré Syndrome (GBS)
GBS is a mix of a neurological and an autoimmune disorder, which has life-changing consequences. Let us see further about it.
What exactly is GBS?
Guillain-Barré Syndrome is not a single disease but a spectrum of autoimmune disorders. The common thread is an acute attack on the peripheral nervous system—the vast network of nerves located outside of the brain and spinal cord. These nerves are responsible for sending signals to your muscles (causing movement) and transmitting sensory information (like touch and temperature) back to your brain.
In GBS, the immune system, which typically fights off infections, gets confused. It creates antibodies that target the healthy myelin sheath, which is the protective covering of nerves or, in some cases, the axons, which are the nerve fibres themselves. This damage disrupts nerve signalling, leading to the hallmark symptoms of weakness, numbness, and paralysis.
Consult a Neurologist for Personalised Advice
The Primary Triggers: What Leads to GBS?
Medical research has established strong links between GBS and preceding events, most commonly infections. Understanding these Guillain-Barré syndrome causes and risk factors is key to identifying potential cases.
Post-Infectious Onset: The Most Common Culprit
Approximately two-thirds of GBS cases occur several days or weeks after a person has had a respiratory or gastrointestinal infection. The leading suspected mechanism is molecular mimicry. Here’s how it works:
1. Infection: A person contracts a virus or bacteria.
2. Immune Response: The body creates antibodies to fight the specific pathogen.
3. Mistaken Identity: The proteins on the surface of the invading pathogen look strikingly similar to the proteins present on the body's own nerve cells.
4. Autoimmune Attack: The antibodies, now programmed to attack the pathogen, cannot distinguish it from the nerve cells and begin to assault the body's own nerves.
Specific Infections Linked to GBS
Campylobacter jejuni: This is the most frequently identified trigger. It's a type of bacteria often found in undercooked poultry and is a common cause of food poisoning. Research indicates that up to 30% of GBS cases may be preceded by a Campylobacter infection.
Cytomegalovirus (CMV): A common virus that often causes mild or no symptoms in healthy individuals, but is a well-documented precursor to GBS.
Epstein-Barr Virus (EBV): The virus that causes infectious mononucleosis ("mono").
Zika Virus: Outbreaks of Zika virus have been associated with a significant increase in GBS cases
COVID-19: Both the SARS-CoV-2 virus and, in extremely rare cases, certain COVID-19 vaccines have been associated with a slightly increased risk of developing GBS. It's crucial to note that the risk from the COVID-19 infection itself is significantly higher than the minimal risk associated with the vaccine.
Other Rare Triggers and Risk Factors
Surgery or Trauma: Sometimes, a surgical procedure or an injury can precede the onset of GBS.
Vaccinations: While extremely rare, certain vaccines (like the seasonal flu shot) have a minimal associated risk. The CDC and WHO consistently stress that the protective benefits of vaccination far outweigh this exceedingly small risk.
Hodgkin’s Lymphoma: In rare instances, GBS can occur alongside this type of cancer.
Recognising the Signs: Guillain-Barré Syndrome Symptoms
The symptoms of Guillain-Barré syndrome typically appear rapidly and worsen over days or weeks. Most people reach the peak of their weakness within two to four weeks after the first symptoms begin.
Early Warning Signs and Symptoms
GBS often starts with subtle sensations that can easily be mistaken for other issues. The first symptoms usually include:
Tingling and Pins-and-Needles: A prickling sensation often beginning in the feet and hands. This is a classic early sign of acute inflammatory demyelinating polyneuropathy (AIDP), the most common form of GBS in the West.
Muscle Weakness: This starts symmetrically (affecting both sides of the body equally), beginning in the legs and gradually spreading upward to the arms and upper body. This progressive, ascending paralysis is a hallmark of the condition.
Pain: A significant number of patients experience severe, aching, crampy, or shooting pain, often in the lower back and legs.
Progressive and Advanced Symptoms
As the condition advances, the weakness evolves into paralysis. Other serious symptoms can develop:
Difficulty with Facial Movements: Weakness in the face can lead to trouble speaking, chewing, and swallowing, and double Vision or difficulty in moving the Eyes.
Severe Coordination Problems and Unsteadiness.
Autonomic Nervous System Dysfunction: This is a dangerous complication where the nerves controlling automatic body functions are affected.
It can lead to:
Severe fluctuations in blood pressure
Heart rhythm abnormalities (arrhythmias)
Problems with bladder control or bowel function
Excessive sweating or a lack of sweating
The Critical Danger: Respiratory Failure
In the most severe cases, the weakness can spread to the muscles that control breathing. This is a medical emergency. About 20-30% of patients with GBS require temporary assistance from a mechanical ventilator.
Signs of respiratory distress include:
Shortness of breath while resting or lying flat
Inability to take a deep breath
Feeling like you're not getting enough air
The Diagnostic Journey: How GBS is Confirmed
Diagnosing GBS can be challenging early on because its symptoms mimic other neurological conditions. Doctors use a combination of methods:
Clinical History and Neurological Examination
A physician will pay close attention to the pattern of symptom progression—specifically the symmetrical, ascending weakness and ask about any recent illnesses.
Key Diagnostic Tests
Lumbar Puncture (Spinal Tap): This test analyses cerebrospinal fluid (CSF). A tell-tale sign of GBS is "albuminocytological dissociation", a high protein level in the CSF with a normal white cell count. However, this finding may not be present in the very first few days.
Electromyography (EMG) and Nerve Conduction Studies (NCS): These tests measure the electrical activity in muscles and the speed of nerve signals. In GBS, the signals will be slowed or blocked due to demyelination.
Treatment and Management of GBS
While there is no cure for GBS, two highly effective treatments can slow the disease, reduce severity, and accelerate recovery.
First-Line Therapies
Intravenous Immunoglobulin (IVIG): This involves injecting donated immunoglobulins (antibodies) into a vein. The working theory is that these healthy antibodies help block the damaging antibodies attacking the nerves.
Plasma Exchange (Plasmapheresis): This process involves removing blood from the body, separating the liquid plasma (which contains the harmful antibodies) from the blood cells, and then returning the blood cells with a plasma substitute back into the body.
Supportive Care: A Cornerstone of Recovery
Critical care in a hospital setting is vital to manage complications:
Respiratory Support: Close monitoring of breathing function, with mechanical ventilation if necessary.
Pain Management: Using medications to control nerve pain.
Preventing Complications: This includes physical therapy to prevent muscle contractures, blood thinners to prevent clots, and careful management of heart rate and blood pressure.
Recovery and Long-Term Outlook
Recovery from GBS is a marathon, not a sprint. It can be a long and challenging process, but most people do make a significant recovery.
The Plateau Phase: After the initial worsening phase, symptoms typically stabilise for a period of days, weeks, or even months.
The Recovery Phase: Nerves slowly begin to heal. This phase can take anywhere from a few weeks to a few years.
Prognosis: According to the National Institute of Neurological Disorders and Stroke (NINDS), about 80% of people can walk independently at six months. However, many are left with some degree of long-term weakness, numbness, or fatigue. Approximately 5-10% of patients experience a permanent, significant disability.
Conclusion
Understanding what leads to signs of Guillain-Barré syndrome empowers individuals to recognise a medical emergency. If you or someone you know experiences a rapid onset of tingling, weakness that begins in the legs and moves upward, or any difficulty breathing, it is imperative to seek immediate medical attention. GBS is a serious condition, but with advanced supportive care and effective treatments, the majority of people survive. Continued research offers hope for even better therapies and a deeper understanding of this complex syndrome in the future.
Consult a Neurologist for Personalised Advice
Consult a Neurologist for Personalised Advice
Dr. Aditendraditya Singh Bhati
Neurosurgeon
18 Years • MBBS(2004), DNB Neurosurgery(2014); MNAMS; Fellow Neuroendoscopy
Delhi
Apollo Hospitals Indraprastha, Delhi
(100+ Patients)
Dr. Ganeshgouda Majigoudra
Neurologist
10 Years • MBBS, MD ( GENERAL MEDICINE) DM (NEUROLOGY)
Bengaluru
Apollo Clinic, JP nagar, Bengaluru
Dr. Sarthak Mehta
Neurologist
6 Years • MBBS , MS Mch ( Neuro )
Bengaluru
Apollo Clinic, JP nagar, Bengaluru
Dr. E Prabhakar Sastry
General Physician/ Internal Medicine Specialist
40 Years • MD(Internal Medicine)
Manikonda Jagir
Apollo Clinic, Manikonda, Manikonda Jagir
(125+ Patients)
Dr Rajashekar Mummadi
Neurologist
3 Years • MBBS, DNB General Medicine, DRNB Neurology
Hyderabad
Dr Ram's Neuro Clinic, Hyderabad
