Diseases and Conditions

Guillain-Barre syndrome

DefinitionBy Mayo Clinic Staff

Guillain-Barre (gee-YAH-buh-RAY) syndrome is a rare disorder in which your body's immune system attacks

your nerves. Weakness and tingling in your extremities are usually the first symptoms.

These sensations can quickly spread, eventually paralyzing your whole body. In its most severe form Guillain-

Barre syndrome is a medical emergency. Most people with the condition must be hospitalized to receive

treatment.

The exact cause of Guillain-Barre syndrome is unknown. But it is often preceded by an infectious illness such

as a respiratory infection or the stomach flu.

There's no known cure for Guillain-Barre syndrome, but several treatments can ease symptoms and reduce the

duration of the illness. Most people recover from Guillain-Barre syndrome, though some may experience

lingering effects from it, such as weakness, numbness or fatigue.

SymptomsBy Mayo Clinic Staff

Guillain-Barre syndrome often begins with tingling and weakness starting in your feet and legs and spreading to

your upper body and arms. In about 10 percent of people with the disorder, symptoms begin in the arms or

face. As Guillain-Barre syndrome progresses, muscle weakness can evolve into paralysis.

Signs and symptoms of Guillain-Barre syndrome may include:

Prickling, "pins and needles" sensations in your fingers, toes, ankles or wrists

Weakness in your legs that spreads to your upper body

Unsteady walking or inability to walk or climb stairs

Difficulty with eye or facial movements, including speaking, chewing or swallowing

Severe pain that may feel achy or cramp-like and may be worse at night

Difficulty with bladder control or bowel function

Rapid heart rate

Low or high blood pressure

Difficulty breathing

People with Guillain-Barre syndrome usually experience their most significant weakness within two to four

weeks after symptoms begin. Recovery usually begins two to four weeks after weakness plateaus.

Types

Once thought to be a single disorder, Guillain-Barre syndrome is now known to occur in several forms. The

main types are:

Acute inflammatory demyelinating polyradiculoneuropathy (AIDP), the most common form in the U.S.

The most common sign of AIDP is muscle weakness that starts in the lower part of your body and spreads

upward. Miller Fisher syndrome (MFS), in which paralysis starts in the eyes. MFS is also associated with unsteady

gait. MFS occurs in about 5 percent of people with Guillain-Barre syndrome in the U.S. but is more common

in Asia. Acute motor axonal neuropathy (AMAN)and acute motor-sensory axonal neuropathy (AMSAN), which

are less common in the U.S. but more frequent in China, Japan and Mexico.

When to see a doctor

Call your doctor if you have mild tingling in your toes or fingers that doesn't seem to be spreading or getting

worse. Seek emergency medical help if you have any of these severe signs or symptoms:

Tingling that started in your feet or toes and is now moving up your body

Tingling or weakness that's spreading rapidly

Difficulty catching your breath or shortness of breath when lying flat

Choking on saliva

Guillain-Barre syndrome is a serious condition that requires immediate hospitalization because it can worsen

rapidly. The sooner appropriate treatment is started, the better the chance of a good outcome.

CausesBy Mayo Clinic Staff

The exact cause of Guillain-Barre syndrome isn't known. The disorder usually appears days or weeks after a

respiratory or digestive tract infection. Rarely, recent surgery or immunization can trigger Guillain-Barre

syndrome.

In Guillain-Barre syndrome, your immune system — which usually attacks only invading organisms — begins

attacking the nerves. In AIDP, the most common form of Guillain-Barre syndrome in the U.S., the nerves'

protective covering (myelin sheath) is damaged. The damage prevents nerves from transmitting signals to your

brain, causing weakness, numbness or paralysis.

Risk factorsBy Mayo Clinic Staff

Guillain-Barre syndrome can affect all age groups. But you're at slightly greater risk if:

You're a man

You're an older adult

Guillain-Barre syndrome may be triggered by:

Most commonly, infection with campylobacter, a type of bacteria often found in undercooked poultry

Influenza virus

Epstein-Barr virus

HIV, the virus that causes AIDS

Mycoplasma pneumonia

Surgery

Hodgkin's lymphoma

Rarely, influenza vaccinations or childhood vaccinations

Complications

Guillain-Barre syndrome affects your nerves. Because nerves control your movements and body functions,

people with Guillain-Barre may experience:

Breathing difficulties. The weakness or paralysis can spread to the muscles that control your breathing, a

potentially fatal complication. Up to 30 percent of people with Guillain-Barre syndrome need temporary help

from a machine to breathe when they're hospitalized for treatment. Residual numbness or other sensations. Most people with Guillain-Barre syndrome recover completely or

have only minor, residual weakness, numbness or tingling. Heart and blood pressure problems. Blood pressure fluctuations and irregular heart rhythms (cardiac

arrhythmias) are common side effects of Guillain-Barre syndrome. Pain. Up to half of people with Guillain-Barre syndrome experience severe nerve pain, which may be eased

with medication. Bowel and bladder function problems. Sluggish bowel function and urine retention may result from

Guillain-Barre syndrome. Blood clots. People who are immobile due to Guillain-Barre syndrome are at risk of developing blood clots.

Until you're able to walk independently, taking blood thinners and wearing support stockings may be

recommended. Pressure sores. Being immobile also puts you at risk of developing bedsores (pressure sores). Frequent

repositioning may help avoid this problem. Relapse. Up to 5 percent of people with Guillain-Barre syndrome experience a relapse.

Severe, early symptoms of Guillain-Barre syndrome significantly increase the risk of serious long-term

complications. Rarely, death may occur from complications such as respiratory distress syndrome and heart

attack.

Tests and diagnosisBy Mayo Clinic Staff

Guillain-Barre syndrome can be difficult to diagnose in its earliest stages. Its signs and symptoms are similar to

those of other neurological disorders and may vary from person to person.

Your doctor is likely to start with a medical history and thorough physical examination.

Your doctor may then recommend:

Spinal tap (lumbar puncture). A small amount of fluid is withdrawn from the spinal canal in your lower back.

The fluid is tested for a type of change that commonly occurs in people who have Guillain-Barre syndrome. Electromyography. Thin-needle electrodes are inserted into the muscles your doctor wants to study. The

electrodes measure nerve activity in the muscles. Nerve conduction studies. Electrodes are taped to the skin above your nerves. A small shock is passed

through the nerve to measure the speed of nerve signals.

Treatments and drugsBy Mayo Clinic Staff

There's no cure for Guillain-Barre syndrome. But two types of treatments can speed recovery and reduce the

severity of the illness:

Plasma exchange (plasmapheresis). The liquid portion of part of your blood (plasma) is removed and

separated from your blood cells. The blood cells are then put back into your body, which manufactures more

plasma to make up for what was removed. Plasmapheresis may work by ridding plasma of certain antibodies

that contribute to the immune system's attack on the peripheral nerves. Immunoglobulin therapy. Immunoglobulin containing healthy antibodies from blood donors is given through

a vein (intravenously). High doses of immunoglobulin can block the damaging antibodies that may contribute

to Guillain-Barre syndrome.

These treatments are equally effective. Mixing them or administering one after the other is no more effective

than using either method alone.

You also are likely to be given medication to:

Relieve pain, which can be severe

Prevent blood clots, which can develop while you're immobile

People with Guillain-Barre syndrome need physical help and therapy before and during recovery. Your care

may include:

Movement of your arms and legs by caregivers before recovery, to help keep your muscles flexible and

strong Physical therapy during recovery to help you regain strength and proper movement

Training with adaptive devices, such as a wheelchair or braces, to give you mobility and self-care skills

Exercise therapy, to cope with fatigue

Recovery

Although some people can take months and even years to recover, most people with Guillain-Barre syndrome

experience this general timeline:

After the first signs and symptoms, the condition tends to progressively worsen for about two weeks

Symptoms reach a plateau within four weeks

Recovery begins, usually lasting six to 12 months, though for some people it could take as long as three

years

Among adults recovering from Guillain-Barre syndrome:

About 80 percent can walk independently six months after diagnosis

About 60 percent fully recover motor strength one year after diagnosis

About 5 to 10 percent have very delayed and incomplete recovery

Children, who rarely develop Guillain-Barre syndrome, generally recover more completely than adults.