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

From the Guidelines

Guillain-Barré syndrome (GBS) is characterized by rapidly progressive muscle weakness and sensory disturbances, with the main signs and symptoms including muscle weakness, tingling or numbness, loss of reflexes, difficulty walking or climbing stairs, facial weakness, respiratory problems, pain, and autonomic dysfunction. The symptoms typically progress over hours to days, reaching maximum severity within 2-4 weeks 1. According to the most recent and highest quality study, the typical clinical features of GBS include rapidly progressive bilateral weakness of the legs and/or arms, in the absence of CNS involvement or other obvious causes, with patients presenting with distal paraesthesias or sensory loss, accompanied or followed by weakness that starts in the legs and progresses to the arms and cranial muscles 1.

Key Signs and Symptoms

• Muscle weakness: Usually starts in the legs and spreads upward, often becoming symmetrical
• Tingling or numbness: Begins in toes and fingers, spreading to arms and legs
• Loss of reflexes: Deep tendon reflexes diminish or disappear
• Difficulty walking or climbing stairs
• Facial weakness: May affect eye movements, speaking, chewing, or swallowing
• Respiratory problems: In severe cases, breathing muscles can be affected
• Pain: Muscle aches or nerve pain, particularly in the back
• Autonomic dysfunction: Can cause blood pressure fluctuations, heart rate changes, or bladder/bowel issues

The exact cause of GBS is unknown, but it often follows a viral or bacterial infection, triggering an autoimmune response against peripheral nerves 1. Prompt recognition is crucial as GBS can be life-threatening if respiratory muscles are affected. Treatment often involves immunotherapy (intravenous immunoglobulin or plasma exchange) and supportive care 1.

Disease Progression and Outcome

The disease progression can be rapid, with most patients reaching their maximum disability within 2 weeks 1. About 20% of patients with GBS develop respiratory failure and require mechanical ventilation 1. The mortality rate is estimated at 3–10% for patients with GBS even with the best medical care available 1. However, 60–80% of patients with GBS are able to walk independently 6 months after disease onset, with or without treatment 1.

From the Research

Signs and Symptoms of Guillain-Barré Syndrome (GBS)

The signs and symptoms of GBS may vary greatly in presentation and severity, including:

• Weakness and sensory disturbances 2, 3, 4, 5, 6
• Cranial nerve involvement 2
• Respiratory insufficiency 2, 3, 6
• Autonomic dysfunction 2, 5
• Pain 2
• Diminished or absent deep tendon reflexes 3, 4, 6
• Ascending symmetrical muscle weakness 3, 4, 6
• Ophthalmoplegia, ataxia, and areflexia in the Miller-Fisher variant 4
• Dysautonomia in atypical cases 5

Clinical Presentation

GBS typically presents with:

• Rapidly progressive and generally ascending symmetrical muscle weakness 4, 6
• Recent preceding upper or lower respiratory tract infection or gastrointestinal illness in approximately 70% of patients 3
• Quadriparesis in severe cases 3

Diagnostic Considerations

Diagnosis is based on:

• Albumin-cytological dissociation observed at the end of the first week after the onset of symptoms 4
• Specific neurophysiological alterations of each clinical form 4
• Electrodiagnostic testing, including nerve conduction studies and electromyography 2, 3
• CSF analysis showing an elevated protein 3