What are the symptoms and signs of Guillain-Barré Syndrome (GBS)?

From the Guidelines

Guillain-Barré Syndrome (GBS) is characterized by rapidly progressive bilateral weakness of the legs and/or arms, often accompanied by distal paraesthesias or sensory loss, and can lead to respiratory failure without symptoms of dyspnoea 1.

Typical Clinical Features

The typical clinical presentation of GBS includes:

• Bilateral weakness of the legs and/or arms
• Distal paraesthesias or sensory loss
• Decreased or absent reflexes
• Dysautonomia, including blood pressure or heart rate instability, pupillary dysfunction, and bowel or bladder dysfunction
• Pain, which can be muscular, radicular, or neuropathic
• Acute or subacute disease onset, with patients typically reaching maximum disability within 2 weeks 1

Monitoring Disease Progression

Regular assessment is required to monitor disease progression and the occurrence of complications, including:

• Respiratory function, using measurements such as vital capacity, maximum inspiratory and expiratory pressure, and the "20/30/40 rule" 1
• Muscle strength, using the Medical Research Council grading scale or a similar scale
• Functional disability, using the GBS disability scale
• Autonomic dysfunction, via electrocardiography and monitoring of heart rate, blood pressure, and bowel and bladder function 1

Electrodiagnostic Studies

Electrodiagnostic studies, such as electromyography and nerve conduction studies, can support the diagnosis of GBS, but are not required for diagnosis 1. These studies can reveal a sensorimotor polyradiculoneuropathy or polyneuropathy, indicated by reduced conduction velocities, reduced sensory and motor evoked amplitudes, abnormal temporal dispersion, and/or partial motor conduction blocks. It is essential to note that the clinical presentation and disease course of GBS can be heterogeneous, and the diagnosis can be challenging due to the lack of highly sensitive and specific diagnostic tools or biomarkers 1.

From the Research

Symptoms and Signs of Guillain-Barré Syndrome (GBS)

The symptoms of GBS may vary greatly in presentation and severity, and can include:

• Weakness and sensory disturbances
• Cranial nerve involvement
• Respiratory insufficiency
• Autonomic dysfunction
• Pain
• Tingling
• Progressive weakness
• Diminished deep tendon reflexes
• Nonspecific sensory symptoms 2, 3, 4, 5

Clinical Features

GBS is characterized by:

• Rapidly progressive, symmetrical weakness of the extremities
• About 25% of patients develop respiratory insufficiency
• Many show signs of autonomic dysfunction
• CSF protein is raised with normal or only slightly elevated cell count 2, 4

Diagnosis

Diagnosis can usually be made on clinical grounds, but:

• Lumbar puncture and electrophysiological studies can help to substantiate the diagnosis and to differentiate demyelinating from axonal subtypes of GBS
• Electrodiagnostic testing is advised to support the diagnosis
• Testing for anti-ganglioside antibodies is of limited clinical value in most patients with typical motor-sensory GBS
• Nodal-paranodal antibodies should be tested when autoimmune nodopathy is suspected
• MRI or ultrasound imaging should be considered in atypical cases 2, 3, 4

Prognosis

The prognosis of GBS is generally favourable, but:

• It is a serious disease with a mortality of approximately 10%
• Approximately 20% of patients are left with severe disability
• Full recovery is often seen, but disability remains in up to 10% and perhaps more
• The long-term prognosis is more favorable in children than in adults 4, 5, 6