Guillain-Barré syndrome (pronounced: Ghee-yan Bah-ray) or GBS is a rare, acute autoimmune disorder where the immune system suddenly attacks healthy nerve cells.
With GBS, the immune system attacks myelin, the insulation around nerve fibers. This results in damage to the cells and the nervous system.
- Not all patients fully recover from Guillain-Barré syndrome. Most patients recover from GBS spontaneously, according to Johns Hopkins Medicine.
- When GBS becomes chronic and worsens, it may develop into chronic inflammatory demyelinating polyneuropathy (CIDP).
- GBS symptoms range from mild body weakness to paralysis. Severe cases may cause difficulty breathing and may lead to death.
- About 1 in 100,000 people get GBS each year, according to the National Institutes of Health.
- Men and women are equally vulnerable to GBS. People of any age can get the disease, but the risk is greatest in people older than 50.
- People may get GBS after bacterial or viral infections.
- On rare occasions, people may get GBS after getting a vaccine — especially the flu vaccine.
Guillain-Barré Syndrome Causes
Scientists don’t know the exact cause of Guillaine-Barré syndrome. But, a bacterial or viral infection, surgery or vaccines may trigger the syndrome.
When a person has GBS, the immune system goes to fight a virus or bacteria, but it attacks healthy cells instead. Researchers think this happens because bacteria or chemicals may resemble healthy cells.
GBS and Infections
Two-thirds of people who get GBS develop the disease days or weeks after having diarrhea or a lung or sinus infection, according to the CDC.
One of the most common risk factors for GBS is infection with Campylobacter jejuni — the bacteria that causes gastroenteritis.
People may also develop GBS after the flu or other viral infections. Recently, some people also reported GBS after Zika virus infections.
- Campylobacter jejuni
- Lung or sinus infection
- Influenza (flu)
- Zika virus
- Epstein Barr virus
- Pneumonia (mycoplasma)
- Chicken pox (varicella zoster)
- Human immunodeficiency virus (HIV)
Guillain Barré Syndrome and Vaccines
GBS cases linked to vaccines are rare, the CDC says. Guillain Barré syndrome can happen with any vaccine, but most vaccine-related cases occur after the flu vaccine.
Of the 1,000 cases of GBS reported to the Vaccine Adverse Event Reporting System (VAERS) from 1990 to 2005, 632 involved people who received the flu vaccine, according to findings published in Journal of Clinical Neuromuscular Disease.
The second highest number of GBS cases (94 cases) was observed in people who received the hepatitis B vaccine. Another 274 cases were associated with other vaccines or combinations of vaccines.
The average age in the reported GBS cases was 47. GBS happened more often in people older than 65, especially with the hepatitis vaccine.
About 3 percent of the cases ended in death. Nearly 7 percent resulted in disability. Death was more frequent in people older than 65.
Flu Vaccine Side Effects: Guillain-Barré Syndrome
The National Vaccine Injury Compensation Program (VICP) recognizes GBS as a flu vaccine injury. People who develop GBS after a flu shot or other vaccine may file a VICP claim for compensation.
“I hear of a case at least once per year locally where people develop GBS within a month of the flu shot. Most of the time, doctors do relate the cause and effect.”
In 2003, the Institute of Medicine (IOM) investigated an increase of GBS following H1N1 swine flu vaccinations in 1976. The scientific review found a small increased risk — about one additional case for every 100,000 vaccinations, the CDC said.
The IOM initially concluded that the evidence favored acceptance of a causal relationship between GBS in adults and the swine flu vaccines from 1976. But the IOM Committee to Review Adverse Effects of Vaccines concluded more recently that the evidence wasn’t enough to definitively say the vaccines did or did not cause GBS.
A 2012 Canadian study published in JAMA followed 4.4 million people who received the H1N1 vaccine in Quebec. The number of confirmed GBS cases was about two per 1 million doses of the H1N1 flu vaccine, researchers found.
Authors acknowledged “a small but significant risk of GBS” linked to the H1N1 vaccine. But, researchers found the benefit of receiving the vaccine outweighed the risk of GBS.
“The data on an association between seasonal influenza vaccine and GBS have been variable from season-to-season. When there has been an increased risk, it has consistently been in the range of one to two additional GBS cases per million flu vaccine doses administered.”
How Long Does It Take to Get GBS After Getting a Vaccine?
If people develop GBS after getting a vaccine, symptoms usually show up days or weeks after the shot.
Symptoms of GBS started within six weeks of vaccination in 774 cases reported to VAERS between 1990 and 2005. In 101 cases, symptoms started after six weeks.
Filing a VICP Claim for Vaccine-Induced Guillain-Barré Syndrome
People may petition the VICP for compensation if they get GBS after receiving a flu shot or other vaccine. The federal government manages the program.
- GBS occurs within three to 42 days following a shot; and
- GBS symptoms last for more than six months after the vaccine was given; or
- GBS results in a hospital stay and surgery; or
- GBS results in death
Guillain-Barré Syndrome Symptoms
Guillain-Barré syndrome symptoms involve some type of muscle weakness, cramping or paralysis on both sides of the body. These are usually the first signs of GBS. Symptoms start in the legs and make their way to the arms.
- Odd sensations in the legs
- Muscle weakness, cramping
- Loss of reflexes
- Difficulty breathing
- Difficulty walking
- Difficulty swallowing
- Blood pressure fluctuations
- Cardiac arrhythmias
GBS progresses quickly. The worst symptoms — such as difficulty breathing — can manifest within a few hours of when the first symptoms start. People with symptoms of GBS should seek emergency medical attention.
Types of Guillain-Barré Syndrome
There are subtypes of GBS. The main four are: acute inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal neuropathy (AMAN), acute motor and sensory neuropathy (AMSAN) and Miller-Fisher Syndrome (MFS). MFS is also called Fisher Syndrome (FS).
Acute Inflammatory Demyelinating Polyneuropathy (AIDP)
Acute inflammatory demyelinating polyneuropathy (AIDP) is the most common subtype of GBS in the U.S. and Europe. About 90 percent of GBS cases present as AIDP.
AIDP begins with muscle weakness starting in the feet before moving to all four limbs. Before the weakness starts, people may feel tingling in the limbs.
About 20 percent of people with AIDP suffer respiratory failure.
Acute Motor Axonal Neuropathy (AMAN)
Acute motor axonal neuropathy (AMAN) is closely related to Campylobacter jejuni, the bacteria that cause stomach infections.
AMAN affects muscle movement and does not have the tingling sensations found in AIDP. Unlike other forms of GBS, AMAN does not damage the sheaths that cover nerve cells (demyelination).
As little as 5 percent of cases occur in Europe and North America. Most cases affect children in China.
Acute Motor and Sensory Neuropathy (AMSAN)
Acute Motor and Sensory Neuropathy (AMSAN) is a severe form of GBS and recovery is poor. It accounts for about 3 percent to 5 percent of cases of GBS in Western countries. Most cases occur in Asia and Latin America.
Severe muscle wasting is a characteristic of AMSAN. Symptoms also include loss of reflexes and sensory problems such as pain, burning and tingling.
Miller-Fisher Syndrome (MFS)
Miller-Fisher Syndrome or sometimes just Fisher syndrome accounts for about 5 percent of GBS cases. The most common symptom is paralysis of muscles surrounding the eye.
People with MFS may suffer from mild limb weakness, facial palsy or decreased reflexes.
Because Guillain-Barré affects nerves and muscles, it can cause serious complications. Some people never fully recover from GBS.
Several years after the initial attack, some people may have a relapse of muscle weakness and tingling. About 3 percent to 5 percent of patients may die from complications, according to American International Medical University.
- Blood infection (sepsis)
- Heart attack (cardiac arrest)
- Blood clots in the lungs (pulmonary embolism)
- Paralysis of muscles that control breathing
Guillain-Barré Syndrome Diagnosis
Diagnosis of Guillain-Barré syndrome requires physical examination, patient history and lab tests. These tests include nerve conduction studies, blood tests and spinal fluid analysis.
Except in mild cases, people newly diagnosed with GBS usually end up admitted to the Intensive Care Unit (ICU). Doctors monitor breathing and other body functions.
GBS affects breathing, movement and mental processes. So, patients will have a team of doctors helping them recover. These include a neurologist, physical therapist, psychologist and family physician.
The most serious phase of GBS can last from a few days to several months. Over 90 percent of patients begin rehabilitation about four weeks after being diagnosed, according to GBS/CIDP International.
But, in some patients recovery can be slow and take years. About 20 percent to 30 percent of adults continue to suffer disability, according to a 2011 study in the Annals of Indian Neurology.
- Plasma exchange to clean the blood
- Blood pressure medication for high blood pressure
- Ventilator for breathing issues
- Tube feeding for patients who cannot swallow
- Speech therapy and physical therapy
- Support stockings and blood thinners to prevent blood clots
- Immune system therapy such as intravenous immune globulins help shorten symptoms of GBS
Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)
Chronic inflammatory demyelinating polyneuropathy (CIDP) is an autoimmune disease similar to Guillain-Barré syndrome where the immune system attacks the covering of nerve cells.
Like GBS, CIDP may occur after vaccinations. It also has similar symptoms such as difficulty walking, numbness and loss of reflexes.
Unlike GBS, CIDP is not usually a medical emergency. CIDP progresses slowly. Doctors diagnose the disease by taking cells from nerves and studying them under a microscope.
Treatment for CIDP includes corticosteroids, anti-seizure medications and antidepressants.
Please seek the advice of a medical professional before making health care decisions.