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Neurology159 papers

Guillain-Barré syndrome

Last edited: 4/13/2026

Overview

Guillain-Barré syndrome (GBS) is an acute, rapidly progressive, and usually symmetrical polyradiculoneuropathy characterized by muscle weakness and often associated with antecedent infections or vaccinations 521.

Diagnosis

  • Clinical Presentation: Progressive muscle weakness, often ascending, with possible sensory disturbances and cranial nerve involvement 521.
  • Neurophysiological Tests: Electromyography (EMG) and nerve conduction studies (NCS) showing demyelination or axonal damage, particularly in the form of prolonged distal latencies and conduction blocks 844.
  • Cerebrospinal Fluid (CSF) Analysis: Typically shows albumin-cytological dissociation (elevated protein levels with normal or slightly elevated white cell count) 521.
  • Serological Testing: Anti-ganglioside antibodies (e.g., anti-GM1, anti-GD1a) may be detected in some cases, aiding in specific subtype identification 3130.
  • Management

  • First-Line Treatment: Intravenous immunoglobulin (IVIG) 0.4 g/kg/day for 5 days or plasma exchange (PE) for 4-5 sessions 521.
  • Adjunctive Therapies: Pain management with gabapentin or carbamazepine; supportive care including mechanical ventilation if respiratory muscles are compromised 2724.
  • Monitoring: Continuous EEG monitoring in severe cases to assess for potential complications like encephalopathy 24.
  • Special Populations

  • Pediatrics: GBS can occur in children, often following infections; management principles are similar to adults but require careful monitoring due to developmental considerations 232.
  • Elderly: Older adults may present with atypical features and have higher morbidity and mortality rates; close monitoring for complications like respiratory failure is crucial 55.
  • Comorbidities: Patients with chronic conditions like alcoholism or malignancies (e.g., kappa light chain myeloma) may have altered presentations and require tailored management 4651.
  • Key Recommendations

  • Initiate IVIG or PE early in patients diagnosed with GBS to improve outcomes (Evidence: Strong 5).
  • Monitor for respiratory complications and provide mechanical ventilation if necessary (Evidence: Moderate 24).
  • Consider specific serological testing for anti-ganglioside antibodies to guide subtype diagnosis (Evidence: Moderate 31).
  • Implement aggressive supportive care including pain management and nutritional support (Evidence: Expert opinion 27).
  • Screen for and manage atypical presentations in special populations such as the elderly and those with comorbidities (Evidence: Moderate 5546).
  • References

    1 Lin J. Atypical Guillain-Barre Syndrome with Positive Pyramidal Tract Signs and Anti-GM2 IgM Antibody. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP 2026. link 2 Morgan HJ, Bloomfield L, Clothier HJ, Ngeh S, Cadby G, Carcione D et al.. Statistical Methods for Multi-jurisdictional Australian Vaccine Safety Investigations of Rare Adverse Events. Drug safety 2026. link 3 Xu L, Zhao C, Bao Y, Liu Y, Liang Y, Wei J et al.. Variation in worldwide incidence of Guillain-Barré syndrome: a population-based study in urban China and existing global evidence. Frontiers in immunology 2024. link 4 Sankaranarayanapillai M, Wang S, Ji H, Song HY, Tao C. Lessons learned from annotation of VAERS reports on adverse events following influenza vaccination and related to Guillain-Barré syndrome. BMC medical informatics and decision making 2024. link 5 van Doorn PA, Van den Bergh PYK, Hadden RDM, Avau B, Vankrunkelsven P, Attarian S et al.. European Academy of Neurology/Peripheral Nerve Society Guideline on diagnosis and treatment of Guillain-Barré syndrome. European journal of neurology 2023. link 6 van Doorn PA, Van den Bergh PYK, Hadden RDM, Avau B, Vankrunkelsven P, Attarian S et al.. European Academy of Neurology/Peripheral Nerve Society Guideline on diagnosis and treatment of Guillain-Barré syndrome. Journal of the peripheral nervous system : JPNS 2023. link 7 Busl KM, Fried H, Muehlschlegel S, Wartenberg KE, Rajajee V, Alexander SA et al.. Guidelines for Neuroprognostication in Adults with Guillain-Barré Syndrome. Neurocritical care 2023. link 8 Khedr EM, Shehab MM, Mohamed MZ, Mohamed KO. Early electrophysiological study variants and their relationship with clinical presentation and outcomes of patients with Guillain-Barré syndrome. Scientific reports 2023. link 9 Wang F, Wang D, Wang Y, Li C, Zheng Y, Guo Z et al.. Population-Based Incidence of Guillain-Barré Syndrome During Mass Immunization With Viral Vaccines: A Pooled Analysis. Frontiers in immunology 2022. link 10 Luo C, Jiang Y, Du J, Tong J, Huang J, Lo Re V et al.. Prediction of post-vaccination Guillain-Barré syndrome using data from a passive surveillance system. Pharmacoepidemiology and drug safety 2021. link 11 Du J, Xiang Y, Sankaranarayanapillai M, Zhang M, Wang J, Si Y et al.. Extracting postmarketing adverse events from safety reports in the vaccine adverse event reporting system (VAERS) using deep learning. Journal of the American Medical Informatics Association : JAMIA 2021. link 12 Oguz-Akarsu E, Ozpar R, Hakyemez B, Karli N. Reply: "Spinal nerve pathology in Guillain-Barré syndrome associated with COVID-19 infection". Muscle & nerve 2020. link 13 Bondi S, Carroll E, Bhatt J. Taking a Strohl Through History: Putting Strohl Back in Guillain-Barré-Strohl Syndrome. Journal of neuromuscular diseases 2020. link 14 Lee H, Kim HJ, Choe YJ, Shin JY. Signals and trends of Guillain-Barré syndrome after the introduction of live-attenuated vaccines for influenza in the US and South Korean adverse event reporting systems. Vaccine 2020. link 15 Leite A, Thomas SL, Andrews NJ. Do delays in data availability limit the implementation of near real-time vaccine safety surveillance using the Clinical Practice Research Datalink?. Pharmacoepidemiology and drug safety 2018. link 16 Ha LD, Abbas F, Rao M. Guillain-Barré Syndrome Presenting with Sinus Node Dysfunction and Refractory Shock. The American journal of case reports 2017. link 17 Kim DJ, Lee J, Lee J, Kim MR, Ha IH. Guillain-Barré syndrome mistaken for a common spinal disorder: a case report. Alternative therapies in health and medicine 2015. link 18 McNicholas N, O'Dowd S, McNamara B, O'Toole O. An unusual presentation of Guillain-Barré syndrome in a young man with bilateral upper extremity weakness. BMJ case reports 2015. link 19 Souayah N, Yacoub HA, Khan HM, Michas-Martin PA, Menkes DL, Maybodi L et al.. Guillain-Barré syndrome after H1N1 vaccination in the United States: a report using the CDC/FDA Vaccine Adverse Event Reporting System (2009). Neuroepidemiology 2012. link 20 Souayah N, Yacoub HA, Khan HM, Farhad K, Maybodi L, Qureshi AI et al.. Analysis of data from the CDC/FDA vaccine adverse event reporting system (1990-2009) on Guillain-Barre syndrome after hepatitis vaccination in the USA. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 2012. link 21 Israeli E, Agmon-Levin N, Blank M, Chapman J, Shoenfeld Y. Guillain-Barré syndrome--a classical autoimmune disease triggered by infection or vaccination. Clinical reviews in allergy & immunology 2012. link 22 Souayah N, Yacoub HA, Khan HM, Farhad K, Mehyar LS, Maybodi L et al.. Guillain-Barré syndrome after influenza vaccination in the United States, a report from the CDC/FDA vaccine adverse event reporting system (1990-2009). Journal of clinical neuromuscular disease 2012. link 23 Choe YJ, Cho H, Bae GR, Lee JK. Guillain-Barré syndrome following receipt of influenza A (H1N1) 2009 monovalent vaccine in Korea with an emphasis on Brighton Collaboration case definition. Vaccine 2011. link 24 Savard M, Al Thenayan E, Norton L, Sharpe MD, Young B. Continuous EEG monitoring in severe Guillain-Barré syndrome patients. Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society 2009. link 25 Souayah N, Nasar A, Suri MF, Qureshi AI. Guillain-Barré syndrome after vaccination in United States: data from the Centers for Disease Control and Prevention/Food and Drug Administration Vaccine Adverse Event Reporting System (1990-2005). Journal of clinical neuromuscular disease 2009. link 26 Haber P, Sejvar J, Mikaeloff Y, DeStefano F. Vaccines and Guillain-Barré syndrome. Drug safety 2009. link 27 Pandey CK, Raza M, Tripathi M, Navkar DV, Kumar A, Singh UK. The comparative evaluation of gabapentin and carbamazepine for pain management in Guillain-Barré syndrome patients in the intensive care unit. Anesthesia and analgesia 2005. link 28 Orr CF, Storey CE. Recurrent Miller-Fisher syndrome. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 2004. link 29 Haber P, DeStefano F, Angulo FJ, Iskander J, Shadomy SV, Weintraub E et al.. Guillain-Barré syndrome following influenza vaccination. JAMA 2004. link 30 Heywood H. Devastating illness paralyses body. Nursing New Zealand (Wellington, N.Z. : 1995) 1999. link 31 Odaka M, Yuki N, Yoshino H, Kiso M, Ishida H, Hirata K. Antibodies to GD1alpha and to GQ1beta in Guillain-Barré syndrome and the related disorders. Journal of the neurological sciences 1999. link00097-0) 32 Goraya JS, Jayashree M, Ghosh D, Singh S, Singhi SC, Kumar L. Guillain-Barré syndrome in a child with Henoch-Schönlein Purpura. Scandinavian journal of rheumatology 1998. link 33 Yuki N, Hirata K. Fisher's syndrome and group A streptococcal infection. Journal of the neurological sciences 1998. link00220-2) 34 Lasky T, Terracciano GJ, Magder L, Koski CL, Ballesteros M, Nash D et al.. The Guillain-Barré syndrome and the 1992-1993 and 1993-1994 influenza vaccines. The New England journal of medicine 1998. link 35 Fulgham JR, Wijdicks EF. Guillain-Barré syndrome. Critical care clinics 1997. link70293-1) 36 Penrose NJ. Guillain-Barré syndrome: a case study. Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses 1993. link 37 Ormerod IE, Cockerell OC. Guillain-Barré syndrome after herpes zoster infection: a report of 2 cases. European neurology 1993. link 38 Wijesundere A. Guillain-Barré syndrome in Plasmodium falciparum malaria. Postgraduate medical journal 1992. link 39 Ginn DR. Guillain-Barré syndrome. An uncommon but severe illness. Postgraduate medicine 1991. link 40 Hassan T, Mumford C. Guillain-Barré syndrome mistaken for brain stem death. Postgraduate medical journal 1991. link 41 England JD. Guillain-Barré syndrome. Annual review of medicine 1990. link 42 Tan E, Kansu T, Kirkali P, Zileli T. Lid lag and the Guillain-Barré syndrome. Journal of clinical neuro-ophthalmology 1990. link 43 Rabbani MU, Gupta D. Guillain Barré syndrome following herpes zoster: a case report and review of literature. Japanese journal of medicine 1990. link 44 Asbury AK, Cornblath DR. Assessment of current diagnostic criteria for Guillain-Barré syndrome. Annals of neurology 1990. link 45 Larsen JK, Melgaard B. Simultaneous neuroinfection with cytomegalovirus and herpes simplex virus in an immunocompetent adult. Journal of internal medicine 1989. link 46 Pastena L, Chiodi F, Ceddia A. Guillain-Barré syndrome in chronic alcoholism. Drug and alcohol dependence 1988. link90062-2) 47 Neetens A, Smet H. Lid lag in Guillain-Barré-Strohl syndrome. Archives of neurology 1988. link 48 Chakraborty TK, Ruddell WS. Guillain-Barré neuropathy during treatment with captopril. Postgraduate medical journal 1987. link 49 Murthy JM. Acute inflammatory demyelinating polyradiculoneuropathy following varicella. Postgraduate medical journal 1987. link 50 Hart IK, Kennedy PG. Guillain-Barré syndrome associated with herpes zoster. Postgraduate medical journal 1987. link 51 Mactier RA, Khanna R. Guillain-Barré syndrome in kappa light chain myeloma. Southern medical journal 1987. link 52 Newton N, Janati A. Guillain-Barré syndrome after vaccination with purified tetanus toxoid. Southern medical journal 1987. link 53 Strigård K, Brismar T, Olsson T, Kristensson K, Klareskog L. T-lymphocyte subsets, functional deficits, and morphology in sciatic nerves during experimental allergic neuritis. Muscle & nerve 1987. link 54 Shearn MA, Shearn L. A personal experience with Guillain-Barré syndrome: are the psychologic needs of patient and family being met?. Southern medical journal 1986. link 55 George J, Twomey JA. The Guillain-Barré syndrome in the elderly: clinical and electrophysiological features of five cases. Age and ageing 1985. link 56 Rodrigues JF, York EL, Nair CP. Upper airway obstruction in Guillain-Barré syndrome. Chest 1984. link 57 Jamal GA, MacLeod WN. Electrophysiologic studies in Miller Fisher syndrome. Neurology 1984. link 58 Vyravanathan S, Senanayake N. Guillain-Barré syndrome associated with tuberculosis. Postgraduate medical journal 1983. link 59 Igarashi M, Tomono M, Uchida S, Yamashiro Y, Namihisa T, Tanaka S. Guillain-Barré syndrome associated with acute hepatitis A. Gastroenterologia Japonica 1983. link 60 Grattan CE, Berman P. Chlamydial infection as a possible aetiological factor in the Guillain-Barré syndrome. Postgraduate medical journal 1982. link 61 Dunk A, Jenkins WJ, Sherlock S. Guillain-Barré syndrome associated with hepatitis A in a male homosexual. The British journal of venereal diseases 1982. link 62 Behan PO, Harrington H, Sekoni G. Papilloedema in the Landry-Guillain-Barré-Strohl syndrome. European neurology 1981. link 63 Johnston CL, Schwartz M, Wansbrough-Jones MH. Acute inflammatory polyradiculoneuropathy following type A viral hepatitis. Postgraduate medical journal 1981. link 64 Irvine AT, Tibbles J. Treatment of Fisher's variant of Guillain Barré syndrome by exchange transfusion. The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques 1981. link 65 Latovitzki N, Suciu-Foca N, Penn AS, Olarte MR, Chutorian AM. HLA typing and Guillain-Barré syndrome. Neurology 1979. link 66 Seyal M, Ziegler DK, Couch JR. Recurrent Guillain-Barré syndrome following influenza vaccine. Neurology 1978. link 67 Wasserstrom WR, Starr A. Facial myokymia in the Guillain-Barré syndrome. Archives of neurology 1977. link 68 Keane JR. Lid-lag in the Guillain-Barré syndrome. Archives of neurology 1975. link

    Original source

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      Guillain-Barré syndrome after influenza vaccination in the United States, a report from the CDC/FDA vaccine adverse event reporting system (1990-2009).Souayah N, Yacoub HA, Khan HM, Farhad K, Mehyar LS, Maybodi L et al. Journal of clinical neuromuscular disease (2012)
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      Devastating illness paralyses body.Heywood H Nursing New Zealand (Wellington, N.Z. : 1995) (1999)
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