Guillain–Barré syndrome

Overview

Guillain–Barré syndrome (GBS) is a rare but serious autoimmune disorder in which the body’s immune system mistakenly attacks the peripheral nerves. It often begins with tingling and weakness in the legs and can progress to muscle paralysis and life-threatening complications if not promptly treated. GBS can affect individuals of any age, but it is more commonly seen in adults and slightly more frequent in males. The condition is considered a medical emergency and often requires hospitalization. With proper medical care, most people recover, though some may experience lasting effects.

Causes

Guillain–Barré syndrome is typically triggered by an infection. In most cases, it develops several days to weeks after a respiratory or gastrointestinal illness. Common triggers include:

• Campylobacter jejuni: A bacterial infection often associated with food poisoning

• Cytomegalovirus (CMV)

• Epstein-Barr virus (EBV)

• Zika virus

• Influenza virus

• COVID-19 or post-vaccination in rare cases

The exact mechanism involves the immune system mistakenly targeting the myelin sheath or axons of peripheral nerves, leading to inflammation, demyelination, or axonal damage.

Symptoms

Symptoms of GBS often start suddenly and progress rapidly over days or weeks. Common signs and symptoms include:

• Tingling or prickling sensations in the fingers, toes, ankles, or wrists

• Muscle weakness that typically starts in the legs and can ascend to the arms and upper body

• Loss of reflexes in the arms and legs

• Unsteady walking or inability to walk

• Difficulty with facial movements, speech, or swallowing

• Severe pain, including back or nerve pain

• Breathing difficulty if respiratory muscles are affected

• Autonomic dysfunction: Irregular heart rate, blood pressure instability

In some cases, GBS can progress to full-body paralysis, requiring mechanical ventilation and intensive care.

Diagnosis

Diagnosis of Guillain–Barré syndrome is based on clinical evaluation, history of recent infection, and supportive tests:

• Neurological examination: Assessment of muscle strength, reflexes, and sensory response

• Lumbar puncture (spinal tap): Elevated protein levels with normal white cell count in cerebrospinal fluid (albuminocytologic dissociation)

• Nerve conduction studies (NCS): Detect slowed or blocked nerve signals

• Electromyography (EMG): Evaluates electrical activity in muscles

• Blood tests: To rule out other causes of neuropathy or autoimmune disease

Treatment

There is no cure for Guillain–Barré syndrome, but early treatment can improve outcomes and speed recovery. Standard treatments include:

• Intravenous immunoglobulin (IVIG): Provides healthy antibodies that block the harmful ones

• Plasmapheresis (plasma exchange): Removes harmful antibodies from the bloodstream

• Supportive care: Includes respiratory support, physical therapy, and prevention of complications such as blood clots or infections

• Pain management: Neuropathic pain is common and treated with medications like gabapentin or amitriptyline

Early hospital admission is crucial for monitoring respiratory function and autonomic stability.

Prognosis

The prognosis for Guillain–Barré syndrome varies depending on the severity and timing of treatment. Most individuals begin to recover within weeks of symptom onset, and around 80% regain the ability to walk independently within 6 months. However, some patients may have residual weakness, fatigue, or numbness that can persist long term. Approximately 5% to 10% of patients may experience severe disability, and a small percentage may die due to complications. Early diagnosis, prompt treatment, and comprehensive rehabilitation greatly improve the chances of a favorable outcome.