Guillain-Barré syndrome is a neurological disorder and autoimmune disease that affects the peripheral nervous system. Guillain-Barré syndrome can lead to tingling, weakness, and paralysis that may last for months or years.

Guillain-Barré syndrome (GBS) often appears after a respiratory infection or gastroenteritis, better known as food poisoning. Symptoms start within a few days or weeks after the infection. In rare cases, GBS may follow a vaccination.

In the United States, around 1 in 100,000 people develop GBS each year. Experts do not know why this disease occurs in some people and not others. It is not inherited or contagious.

This article explores the symptoms, causes, diagnosis, and treatment of GBS. It also looks at possible links with vaccinations.

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GBS is a rare, serious autoimmune disease that can affect any part of the nervous system outside the brain and spinal cord. This is called the peripheral nervous system.

An autoimmune disease causes the immune system to attack and destroy certain groups of healthy cells. In the case of GBS, it attacks the myelin sheaths of peripheral nerves.

Myelin sheaths coat the axons of nerves. The myelin helps these long, thin extensions of nerve cells pass on messages. In some cases, GBS also attacks the axons themselves.

The damage prevents the nerves from sending certain information, such as touch sensations, to the spinal cord and brain. This causes a feeling of numbness. In addition, the brain and spinal cord can no longer transmit signals back to the body, leading to muscle weakness.

Anyone who develops unexplained tingling sensations and weakness should receive medical attention as soon as possible.

Types of GBS

GBS can take a number of forms.

Acute inflammatory demyelinating polyradiculoneuropathy is the most common type of GBS in the U.S. Typically, the weakness begins in the lower part of the body and gradually moves upward to affect other areas.

Miller Fisher syndrome is an acquired nerve disease and a variant of GBS. It represents around 5–10% of GBS cases in the U.S. This disease can lead to problems with walking and balance. It affects the eye muscles and tendon reflexes.

Another rare form of GBS is acute motor axonal neuropathy, which causes sudden weakness in the limbs and sometimes trouble breathing. It may involve nerves in the head. A similar form of GBS is acute motor-sensory axonal neuropathy, which starts with sensory changes, such as tingling or numbness.

Some types begin more slowly and involve ongoing symptoms. In chronic inflammatory demyelinating polyneuropathy, periods of weakness recur over a number of years. In multifocal motor neuropathy, weakness affects several muscles in a specific area of one or both arms or legs.

Symptoms of GBS often start within 3 weeks of an infection. They usually begin with tingling and weakness in the feet and hands or pain in the legs or back. Children may have difficulty walking.

The weakness sometimes begins in the upper body, but it usually starts in the lower legs and spreads up. In some cases, it may not spread beyond the legs.

If the weakness extends beyond the legs, a person may develop:

  • weakness on both sides of the body
  • difficulty breathing
  • muscle weakness in the arms
  • paralysis of the whole body

The symptoms can worsen over several hours, days, or weeks. In 9 out of 10 cases, the symptoms are worse in the third week. After 4 weeks, the weakness is unlikely to worsen.

As well as muscle weakness and tingling, nerve changes can lead to:

  • vision problems, due to weakness in the eye muscles
  • difficulty speaking, chewing, and swallowing
  • severe pain, especially at night
  • problems with coordination
  • changes in heart rate or blood pressure
  • problems with digestion and bladder control

Anyone with these symptoms needs urgent medical attention. In some cases, people lose the use of their muscles, resulting in paralysis. And breathing problems and cardiovascular changes can be life threatening.

GBS can have emotional effects as well. Adjusting to rapid paralysis and the need for help can be distressing.

After 4 weeks, when the symptoms have peaked, they remain stable for a time and the nerves gradually heal.

The exact causes of GBS are still unclear, but it often occurs after an infection. In rare cases, people have experienced it after a vaccination.

It can affect anyone, but those aged over 50 years appear to have a higher risk.

People have developed GBS after infection with:

  • Campylobacter jejuni bacteria, which can cause a bowel infection and diarrhea
  • the Epstein-Barr virus, which causes infectious mononucleosis, or glandular fever
  • cytomegalovirus, which may cause no symptoms
  • Mycoplasma pneumoniae bacteria, which can infect the respiratory tract
  • possibly the Zika virus, through researchers are still investigating this

One theory is that viral and bacterial infections change how the immune system reacts to the peripheral nerves. This results in the immune system misidentifying myelin and axons as a foreign substance and targeting them.

In July 2021, the Food and Drug Administration (FDA) warned that there may be an increased risk of developing GBS in the 42 days after a Johnson & Johnson (Janssen) COVID-19 vaccine. This has been administered under emergency use authorization from the FDA.

However, instances of GBS following this vaccine are rare. By July 12, healthcare staff had administered approximately 12.5 million doses of the vaccine, and there were reports of about 100 cases of GBS.

There may be a historical link between vaccination and GBS. In 1976, there was a small increase in the risk of developing GBS following a vaccination against swine flu. However, the increase was by just 1 case per 100,000.

Experts have looked at a possible link between GBS and flu vaccines, but the results have varied. At most, there may be 1–2 more cases of GBS than usual per million doses of these vaccines, according to the Centers for Disease Control and Prevention (CDC).

The CDC adds that the risk of developing GBS after a case of the flu is probably higher than the risk of it following the vaccination.

GBS can be difficult to diagnose, especially in its earlier phases. The symptoms vary between people, and they can resemble the symptoms of other neurological conditions.

A doctor will consider:

  • whether the weakness affects both sides of the body
  • how fast the symptoms have appeared
  • the order in which they have appeared

They may also recommend the following tests:

  • a nerve conduction exam, which can show whether nerve signals are slow
  • electromyography, sometimes called EMG, which tests the nerve function within muscle fibers
  • a lumbar puncture, which involves removing a sample of cerebrospinal fluid for testing

There is currently no cure for GBS, but treatment can help manage it.

One approach is immunoglobulin therapy, which involves receiving antibodies from a donor intravenously, through an IV. This may help reduce the autoimmune response.

Another approach is plasma exchange, which involves removing blood and sending it through a machine that separates the plasma from the blood cells. This removes some of the antibodies that are attacking healthy cells and allows the body to regenerate its plasma.

These two methods are equally effective, as long as a person receives them within 2 weeks of GBS symptoms appearing. Using both treatments does not appear to improve the outcome.

When symptoms are severe, a person may need help with breathing, a heart monitor, and help preventing saliva or food from entering their airways.

During recovery, a lack of movement can result in complications, such as blood clots. Receiving injected blood thinners can help prevent this. A physical therapist can also help.

Later, a rehabilitation plan may include physical and other types of therapy to rebuild strength and restore mobility and other functions. A person may also benefit from counseling, as GBS can affect mental and emotional well-being.

Some research has suggested that corticosteroid injections may help reduce the harmful immune response, but there is currently not enough evidence to support this.

In most cases, the nerve damage from GBS worsens quickly for 2–3 weeks and stops worsening after 4 weeks. Some people experience paralysis, but most recover in 6–12 months.

Here are some facts about the symptoms and recovery from the National Institute of Neurological Diseases and Stroke:

  • At 4 weeks, the weakness may be at its worst.
  • The duration of symptoms can range from days to weeks or months.
  • Recovery can occur within weeks, but some people are still recovering after 2 years.
  • Around 30% of people still have some weakness after 3 years.
  • Around 70% of people make a full recovery.
  • Around 15% have long-term weakness and may need to use a walker or another device for support.
  • Around 3% experience a relapse of weakness or tingling several years later.
  • GBS can be fatal in 5% of cases.

Recovery can take time, and a person will need support during this process.

Overall, 1 in 20 cases of GBS is fatal, usually due to cardiovascular problems, breathing difficulty, or an infection. However, most people make a full recovery.

GBS is a rare, serious neurological disease. It is an autoimmune condition that can arise after certain infections. Symptoms include tingling and muscle weakness. In some cases, it can lead to paralysis.

Most people make a full recovery, but this can take time. There is currently no cure for GBS, but various treatments can reduce its impact.

Anyone who believes that they have symptoms of GBS should receive medical attention immediately because the disease can lead to life threatening complications.