Guillain-Barre syndrome

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

Last reviewed: 5 Aug 2025

Last updated: 10 Nov 2022

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.

GBS is associated with outbreaks of Zika virus. As with other viral infections, there are occasional reports of GBS associated with coronavirus disease 2019 (COVID-19) infection, although this is very rare.

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

Guillain-Barre syndrome (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]

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

ptosis
altered level of consciousness
ataxia

Full details

Risk factors

preceding viral illness
preceding bacterial infection
preceding mosquito-borne viral infections
hepatitis E infection
immunization
cancer and lymphoma
older age
HIV infection
COVID-19 infection
male

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
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

Emerging tests

ultrasound imaging of peripheral nerves

Treatment algorithm

ACUTE

ambulatory within 2 weeks of onset or nonambulatory within 4 weeks of onset

Contributors

Authors

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

Consultant Neurologist

Queen Elizabeth Neurosciences Centre

University Hospital Birmingham

Birmingham

Disclosures

SJ has served as an international advisory board member for Alexion, Alnylam, ArgenX, Regeneron, Immunovant, and UCB pharmaceuticals. He is currently an expert panel member of the Myasthenia Gravis consortium for ArgenX, and has received speaker fees from Terumo BCT and Eisai.

Acknowledgements

Dr Saiju Jacob would like to gratefully acknowledge Dr 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

Cigdem Akman, MD

Division of Pediatric Neurology

Columbia University College of Physicians and Surgeons

New York

Disclosures

CA 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

Willison HJ, Jacobs BC, van Doorn PA. Guillain-Barré syndrome. Lancet. 2016 Aug 13;388(10045):717-27.Full text Abstract

Stowe J, Andrews N, Wise L, et al. Investigation of the temporal association of Guillain-Barré syndrome with influenza vaccine and influenzalike illness using the United Kingdom General Practice Research Database. Am J Epidemiol. 2009 Feb 1;169(3):382-8.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

Lawn ND, Fletcher DD, Henderson RD, et al. Anticipating mechanical ventilation in Guillain-Barré syndrome. Arch Neurol. 2001 Jun;58(6):893-8.Full text Abstract

Hughes RA, Brassington R, Gunn AA, et al. Corticosteroids for Guillain-Barré syndrome. Cochrane Database Syst Rev. 2016 Oct 24;(10):CD001446.Full text Abstract

Walgaard C, Jacobs BC, Lingsma HF, et al. Second intravenous immunoglobulin dose in patients with Guillain-Barré syndrome with poor prognosis (SID-GBS): a double-blind, randomised, placebo-controlled trial. Lancet Neurol. 2021 Apr;20(4):275-83. 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
- Transverse myelitis
- Myasthenia gravis
- Lambert-Eaton myasthenic syndrome (LEMS)
More Differentials
Guidelines
- Diagnosis and treatment of Guillain-Barre syndrome in childhood and adolescence: an evidence- and consensus-based guideline
- Diagnosis and management of Guillain-Barré syndrome in ten steps
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

Emerging tests

Treatment algorithm

ambulatory within 2 weeks of onset or nonambulatory within 4 weeks of onset

Contributors

Authors

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

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Cigdem Akman, 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