Guillain-Barré syndrome (GBS) is a rare autoimmune disorder that happens when your immune system mistakenly attacks the myelin sheath, which covers your peripheral nerves.
The myelin sheath protects your nerves and allows electrical signals to travel between your brain and the rest of your body. Damage to the myelin sheath causes neurological symptoms, including muscle weakness, numbness, tingling, and paralysis.
UPMC neurology experts provide advanced care for GBS, including treatment with medication, supportive care, plasma exchange, or intravenous immunoglobulin therapy (IVIG).
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What Is GBS?
GBS is a rare autoimmune disorder that occurs when your immune system mistakenly attacks the covering of your peripheral nerves called the myelin sheath.
The myelin sheath protects your nerves and allows electrical signals to travel between your brain and the rest of your body. Damage to the myelin sheath causes neurological symptoms, including muscle weakness, numbness, tingling, and paralysis.
What type of doctor treats GBS?
GBS is usually treated by a neurologist who either is a hospitalist or specializes in neuromuscular medicine.
Your care team may also include:
- Physical therapists.
- Pulmonologists.
- Occupational therapists.
- Speech-swallowing therapists.
What are the types of GBS?
There are several types of GBS, including:
- Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) — The most common type of GBS, AIDP occurs when your body’s immune response damages the myelin sheath.
- Acute motor axonal neuropathy (AMAN) — Causes damage to a part of the nerve cell called the axon.
- Acute motor-sensory axonal neuropathy (AMSAN) — Causes damage to the axon and sensory neurons, which detect stimuli from the environment, such as touch, pain, and temperature.
- Miller-Fisher syndrome — Affects the cranial nerves and causes problems with the muscles that control eye and facial movement and balance.
What are the stages of GBS?
There are three stages of GBS, including:
- Stage 1: progression — Symptoms begin and worsen suddenly, with the primary symptom being muscle weakness that starts in the legs and progresses up the body. Progression lasts up to four weeks.
- Stage 2: plateau — Symptoms peak and stabilize, but do not improve. This stage can last for a few days or up to a few months.
- Stage 3: recovery — Symptoms gradually improve over weeks, months, or years.
How common is GBS?
Approximately 100,000 people worldwide are diagnosed with GBS each year. It affects between six and 40 out of every 1 million people.
What causes GBS?
Researchers aren’t sure what causes GBS. Symptoms occur after an abnormal immune response causes your body to attack and damage the myelin sheath that protects your peripheral nerves.
What are common GBS triggers?
GBS may be triggered by infections, surgeries, vaccines, or medical conditions, including:
- COVID-19.
- Gastrointestinal infections, especially those caused by a bacterium called Campylobacter jejuni.
- HIV.
- Hodgkin lymphoma.
- Influenza (flu).
- Lupus.
- Mononucleosis (mono).
- Mycoplasma pneumoniae.
- Zika virus.
GBS risk factors
GBS can affect anyone at any age. However, it is most common in adults, and the risk increases with age.
Other risk factors for GBS include having a recent:
- Surgery.
- Vaccine.
- Viral or bacterial infection, such as Campylobacter jejuni.
Complications of GBS
Some cases of GBS can affect the autonomic nervous system, which controls heart rate, breathing, blood pressure, and digestive function.
This can cause potentially life-threatening complications, such as:
- Abnormal heart rhythms.
- Acute respiratory distress syndrome (ARDS).
- Bladder control problems.
- Blood clots.
- Cardiac arrest.
- Digestive problems.
- Pneumonia.
- Sepsis.
- Unstable blood pressure.
How can I prevent GBS?
There is nothing you can do to prevent GBS. However, taking steps to avoid infections and maintain a strong immune system may reduce your risk.
General wellness tips include:
- Eat a healthy diet.
- Exercise regularly.
- Follow your doctor’s vaccination recommendations.
- Disinfect frequently used surfaces, such as countertops, doorknobs, remote controls, and phones.
- Stay away from people who have respiratory or gastrointestinal infections.
- Wash your hands often.
What Are the Signs and Symptoms of GBS?
GBS symptoms come on suddenly and get worse over hours, days, or weeks. Symptoms often begin in your legs and spread to your torso, arms, and face.
In some cases, GBS can cause life-threatening paralysis and affect your breathing, heart rate, and blood pressure.
Other GBS symptoms, which may range from mild to severe, may include:
- Abnormal heart rate and blood pressure.
- Balance and coordination problems.
- Decreased or absent reflexes in the ankles and knees.
- Difficulty breathing.
- Difficulty speaking, swallowing, or chewing.
- Digestive and bladder control problems.
- Muscle weakness that causes difficulty with walking or climbing stairs.
- Numbness, tingling, or pain.
- Problems controlling eye muscles.
- Vision changes, such as blurred or double vision.
When should I see a doctor about my GBS symptoms?
If you experience symptoms of GBS that come on suddenly and worsen during the next few hours or days, you should call your doctor right away and consider going to your nearest hospital Emergency Department.
If symptoms are severe and affect your ability to walk, swallow, or breathe, go to the nearest hospital Emergency Department. Getting early treatment can reduce your risk of developing serious GBS complications.
How Do You Diagnose GBS?
To diagnose GBS, your doctor will perform physical and neurological examinations and review your symptoms and medical history. Your doctor may also order tests to confirm your diagnosis or rule out other problems.
What to expect during your visit
During your visit, your doctor will:
- Ask you about your symptoms.
- Order tests.
- Perform a physical and neurological exam.
- Review your medical history.
Tests to diagnose GBS
Tests to diagnose GBS include:
- Blood tests — Checks for signs of infection and rules out other conditions.
- Cerebral spinal fluid analysis (spinal tap or lumbar puncture) — Involves inserting a needle into your lower back to collect a sample of cerebrospinal fluid (CSF) for analysis in a lab.
- Electromyography (EMG)/Nerve conduction study (NCS) — Sometimes called an electromyogram, an EMG allows a doctor to record and study the electrical activity of your muscles.
- Magnetic resonance imaging (MRI) — Creates images of your spine using contrast dye to look for damaged or abnormal nerves.
- Neurological examination — A noninvasive test to check your reflexes, balance, movement, memory, and ability to think.
- Pulmonary function test — Measures how well your lungs are working.
GBS prognosis
Can a person recover from GBS?
With treatment, most people — even those with severe symptoms — recover completely from GBS. However, a full recovery often takes weeks, months, or years. Some people have mild permanent muscle weakness.
What is the life expectancy of someone with GBS?
After recovery from GBS, most people have a normal life expectancy. During the most severe stages of the disease, GBS can cause life-threatening complications that may affect life expectancy.
How Do You Treat GBS?
There is no cure for GBS. However, the goals of treatment are to reduce the risk of complications, prevent progression of GBS, and shorten recovery time.
Most people will need to stay in the intensive care unit (ICU) while they receive treatment for GBS.
Treatment options include:
Intravenous immunoglobulin therapy (IVIG)
During IVIG, you will receive an intravenous injection of donor immunoglobulins. Immunoglobulins are a natural part of your immune system and protect your body by attacking foreign organisms.
Immunoglobulins may prevent your immune system from further damaging your nerves. Depending on your condition, you may need to have more than one IVIG treatment.
Plasma exchange (plasmapheresis)
Plasmapheresis uses a machine to separate the liquid part of your blood, called plasma, from your blood cells. Your plasma is then filtered to remove the antibodies that cause nerve damage before being returned to your body.
You may need to have more than one plasmapheresis treatment during your recovery.
Rehabilitation
During your recovery, you may receive different types of rehabilitation therapy to help you regain strength, mobility, and independence. Rehabilitation treatment may include:
- Physical therapy — Improves strength, balance, and mobility using exercises, stretching, massage, electrical stimulation, and other techniques.
- Occupational therapy — Teaches techniques and strategies to help you perform everyday activities, such as bathing, dressing, cooking, and grooming, sometimes with the assistance of a cane, brace, walker, or wheelchair.
- Speech and swallowing therapy — Helps you regain the ability to swallow, chew, and speak.
Supportive care
Your doctor may prescribe treatments to manage symptoms and complications, including:
- Feeding and hydration support — If the muscles that help you chew and swallow are affected, IV fluids will prevent dehydration, and a nasogastric feeding tube will prevent malnutrition.
- Medications — Your doctor may prescribe corticosteroids, blood thinners, or other medications to treat symptoms or reduce your risk of complications.
- Respiratory therapy — If the muscles that control your breathing are affected, your doctor may recommend medications or mechanical ventilation to help you breathe.
Clinical trials
You may be eligible to participate in a clinical trial studying new treatments for GBS. Your doctor will let you know if you qualify for a clinical trial.
Why Choose UPMC for GBS Care?
When you choose UPMC for GBS care, you will receive:
- Multidisciplinary care — Our team of neurologists and autoimmune disease experts will work together to develop a customized treatment plan that reduces your risk of complications.
- Access to advanced clinical trials — Our team participates in national, multicenter clinical trials evaluating new treatment options, giving you the opportunity to contribute to research advancing care for autoimmune disorders.
- Seamless, ongoing treatment — If you are diagnosed with GBS, our team will develop a plan for your follow-up care, including ongoing rehabilitation as needed.
