Guillain-Barre syndrome

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 28 Dec 2025

Last updated: 13 Jan 2026

Guillain-Barre syndrome (GBS) is an acute inflammatory polyneuropathy that is classified according to symptoms and divided into axonal and demyelinating forms.

Two-thirds of patients have a history of gastroenteritis or influenza-like illness weeks before onset of neurologic symptoms. The acute infectious illness is usually viral, but sometimes bacterial.

Approximately 20% to 30% of patients with GBS will develop respiratory muscle weakness requiring ventilation.

Neurophysiology is confirmatory and is abnormal in most patients, even early in the disease.

Lumbar puncture is useful, and the classic finding is elevated protein with normal cell count (albuminocytologic dissociation).

Treatment combines supportive and disease-modifying therapy (high-dose immune globulin or plasma exchange).

Definition

GBS is an acute inflammatory neuropathy.[1][2] It is a clinically defined syndrome characterized by motor difficulty, absence of deep tendon reflexes, paresthesias without objective sensory loss, and increased cerebrospinal fluid albumin with a normal cell count (albuminocytologic dissociation).[1][3] Acute inflammatory demyelinating polyradiculoneuropathy is the most commonly encountered variant.[4] The acute infectious illness is usually viral (e.g., cytomegalovirus, Epstein-Barr virus, hepatitis E), but sometimes bacterial (e.g., Campylobacter jejuni, Mycoplasma species). Several arthropod-borne viral infections have been linked to GBS including Zika, dengue, chikungunya, Japanese encephalitis and Oropouche fever.[5][6][7][8][9][10] This topic focuses on diagnosis and management of GBS in adults.

History and exam

Key diagnostic factors

muscle weakness
paresthesia
back/leg pain
respiratory distress
speech problems
areflexia/hyporeflexia
facial weakness
bulbar dysfunction causing oropharyngeal weakness
extraocular muscle weakness
facial droop
diplopia
dysarthria
dysphagia
dysautonomia
pupillary dysfunction
ophthalmoplegia

Full details

Other diagnostic factors

ataxia
ptosis
altered level of consciousness

Full details

Risk factors

preceding viral illness
preceding bacterial infection
preceding arthropod-borne viral infections
hepatitis E infection
immunization
cancer and lymphoma
immune checkpoint inhibitor or chimeric antigen receptor (CAR) T-cell immunotherapy
older age
HIV infection
COVID-19 infection
male sex

Full details

Diagnostic tests

1st tests to order

nerve conduction studies
lumbar puncture
LFTs
spirometry

Full details

Tests to consider

antiganglioside antibody
serology
stool culture
HIV antibodies
spinal MRI
ultrasound imaging of peripheral nerves
Borrelia burgdorferi serology
cerebrospinal fluid (CSF) meningococcal polymerase chain reaction
CSF cytology
CSF angiotensin-converting enzyme
chest x-ray
CSF VDRL
CSF West Nile polymerase chain reaction

Full details

Treatment algorithm

ACUTE

nonambulatory or severe bulbar weakness or autonomic instability within 4 weeks of onset; or ambulatory with mild disease within 2 weeks of onset

Contributors

Authors

Saiju Jacob, MD, DPhil, MRCP (UK), FRCP (Lon), FAAN

Consultant Neurologist

Queen Elizabeth Neurosciences Centre

University Hospital Birmingham

Birmingham

Disclosures

SJ has served as a paid international advisory board member or invited speaker for Alexion, Alnylam, ArgenX, Immunovant, Janssen, Merck, Novartis, Regeneron and UCB pharmaceuticals, is currently an expert panel member of the Myasthenia Gravis Consortium for Argenx pharmaceuticals. He has received speaker’s fees from Terumo BCT and Eisai pharmaceuticals. SJ declares that none of these are relevant to the current article.

Roshan Iqbal, MD, DM, MRCP (UK)

Neurology Specialist Registrar

Queen Elizabeth Neurosciences Centre

University Hospital Birmingham

Birmingham

Disclosures

RI declares that he has no competing interests.

Acknowledgements

Prof Saiju Jacob would like to gratefully acknowledge Prof John B. Winer, Dr Michael T. Torbey, Dr Dhruvil J. Pandya, and Dr Prem A. Kandiah, previous contributors to this topic.

Disclosures

JBW, MTT, DJP, and PAK declare that they have no competing interests.

Peer reviewers

Long Davalos Loo, MD

Assistant Professor of Neurology

University of Cincinnati

Cincinnati

Disclosures

LDL declares that he has no competing interests.

Robert Hadden, FRCP, PhD

Consultant Neurologist

King's College Hospital

London

Disclosures

RH has been paid by Baxter Healthcare Ltd for membership of its neurology advisory board, and is a co-author of several studies referenced in this topic.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

van Doorn PA, Van den Bergh PYK, Hadden RDM, et al. European Academy of Neurology/Peripheral Nerve Society guideline on diagnosis and treatment of Guillain-Barré syndrome. Eur J Neurol. 2023 Dec;30(12):3646-74.Full text Abstract

Leonhard SE, Mandarakas MR, Gondim FAA, et al. Diagnosis and management of Guillain-Barré syndrome in ten steps. Nat Rev Neurol. 2019 Nov;15(11):671-83.Full text Abstract

Hughes RA, Swan AV, van Doorn PA. Intravenous immunoglobulin for Guillain-Barré syndrome. Cochrane Database Syst Rev. 2014 Sep 19;(9):CD002063.Full text Abstract

Hughes RA, Wijdicks EF, Barohn R, et al. Practice parameter: immunotherapy for Guillain-Barré syndrome: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2003 Sep 23;61(6):736-40.Full text Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Acute-onset chronic inflammatory demyelinating polyradiculoneuropathy (A-CIDP)
- Transverse myelitis
- Myasthenia gravis
More Differentials
Guidelines
- Guideline on diagnosis and treatment of Guillain-Barré syndrome
- Diagnosis and treatment of Guillain-Barre syndrome in childhood and adolescence: an evidence- and consensus-based guideline
More Guidelines
Patient information
Lumbar puncture
Guillain-Barre syndrome
More Patient information
Videos
Diagnostic lumbar puncture in adults: animated demonstration
Tracheal intubation: animated demonstration
More videos
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Guillain-Barre syndrome

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

nonambulatory or severe bulbar weakness or autonomic instability within 4 weeks of onset; or ambulatory with mild disease within 2 weeks of onset

Contributors

Authors

Saiju Jacob, MD, DPhil, MRCP (UK), FRCP (Lon), FAAN

Disclosures

Roshan Iqbal, MD, DM, MRCP (UK)

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Long Davalos Loo, MD

Disclosures

Robert Hadden, FRCP, PhD

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Videos

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice