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Guillain-Barré Syndrome

Guillain-Barré syndrome (GBS) is a rare autoimmune disease that affects the nerves. It causes muscle weakness, cramping and paralysis. GBS symptoms usually occur after stomach infections and illnesses like the flu. People who get GBS after receiving a vaccine can file a claim with the National Vaccine Injury Compensation Program (VICP).

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.

Guillain-Barré Syndrome Fast Facts:
  • 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.

What Causes Guillain-Barré Syndrome?
One of the most common risk factors for Guillain-Barré syndrome is a stomach infection.

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.

Infections that may cause GBS include:
  • Campylobacter jejuni
  • Lung or sinus infection
  • Influenza (flu)
  • Zika virus
  • Cytomegalovirus
  • Epstein Barr virus
  • Pneumonia (mycoplasma)
  • Chicken pox (varicella zoster)
  • Human immunodeficiency virus (HIV)
  • Dengue
Developed Guillain-Barré Syndrome after a vaccination? Get a Free Case Review

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.”

Dr. Cammy Benton of Benton Integrative Medicine told Drugwatch

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.

VICP requires the following to file a Guillain-Barré syndrome claim:
  • 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.

Symptoms of Guillain-Barré syndrome include:
  • Odd sensations in the legs
  • Numbness
  • Muscle weakness, cramping
  • Paralysis
  • Loss of reflexes
  • Difficulty breathing
  • Difficulty walking
  • Difficulty swallowing
  • Blood pressure fluctuations
  • Cardiac arrhythmias
  • Fatigue

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.

Guillain-Barré Complications

Because Guillain-Barré affects nerves and muscles, it can cause serious complications. Some people never fully recover from GBS.

Illustration of damaged nerve from Guillain-Barre-syndrome
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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.

Possible complications of GBS include:
  • 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.

Developed Guillain-Barré Syndrome after a vaccination? Get a Free Case Review

Guillain-Barré Treatment

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.

Treatment of Guillain-Barré syndrome includes:
  • 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.

Diagnoses
When GBS becomes a chronic problem, doctors may diagnose a patient with CIDP.

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.

Michelle Llamas, Senior Content Writer
Written By Michelle Llamas Senior Writer

Michelle Llamas has been writing articles and producing podcasts about drugs, medical devices and the FDA for seven years. She specializes in fluoroquinolone antibiotics, vaccines and products that affect women’s health such as Essure birth control, transvaginal mesh and talcum powder. Michelle collaborates with experts, including board-certified doctors, patients and advocates, to provide trusted health information to the public. Some of her qualifications include:

  • American Medical Writers Association (AMWA) Engage Committee and Membership Committee member
  • Centers for Disease Control and Prevention (CDC) Health Literacy certificates
  • Original works published or cited in The Lancet, British Journal of Clinical Pharmacology and the Journal for Palliative Medicine

17 Cited Research Articles

  1. Ramachandran, T.S. (2018, June 11). Acute Inflammatory Demyelinating Polyradiculoneuropathy. Retrieved from https://emedicine.medscape.com/article/1169959-overview
  2. Lunn, M. and Skeikh, K.A. (2014). Chapter 53 - Acute Motor Axonal Neuropathy. Retrieved from https://www.sciencedirect.com/topics/medicine-and-dentistry/acute-motor-axonal-neuropathy
  3. Jones, H.R. et al. (2015). Acute motor axonal neuropathy. Retrieved from https://www.sciencedirect.com/topics/medicine-and-dentistry/acute-motor-axonal-neuropathy
  4. Andary,M.T. (2017, October 6). What are the characteristics of the acute motor-sensory axonal neuropathy (AMSAN) subtype of Guillain-Barre syndrome (GBS)? Retrieved from https://www.medscape.com/answers/315632-14135/what-are-the-characteristics-of-the-acute-motor-sensory-axonal-neuropathy-amsan-subtype-of-guillain-barre-syndrome-gbs
  5. Andary, M.T. (2017, October 6). What are the characteristics of the Miller-Fisher syndrome (MFS) subtype of Guillain-Barre syndrome (GBS)? Retrieved from https://www.medscape.com/answers/315632-14136/what-are-the-characteristics-of-the-miller-fisher-syndrome-mfs-subtype-of-guillain-barre-syndrome-gbs
  6. American International Medical University. (n.d.). Guillain-Barré syndrome (GBS) : Symptoms, Diagnosis, Complications and Management. Retrieved from https://www.aimu.us/2017/09/25/guillain-barre-syndrome-gbs-symptoms-diagnosis-complications-and-management/
  7. National Institutes of Health. (n.d.) Guillain-Barré Syndrome Fact Sheet. Retrieved from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Guillain-Barr%C3%A9-Syndrome-Fact-Sheet
  8. CDC. (n.d.) Guillain-Barré Syndrome. Retrieved from https://www.cdc.gov/vaccinesafety/concerns/guillain-barre-syndrome.html
  9. GBS/CIDP Foundation International. (n.d.). Recently Diagnosed with CIDP. Retrieved from https://www.gbs-cidp.org/cidp/all-about-cidp/
  10. GBS/CIDP Foundation International. (n.d.). Recently Diagnosed GBS. Retrieved from https://www.gbs-cidp.org/gbs/all-about-gbs/
  11. Johns Hopkins Medicine. (n.d.). Guillian-Barre and CIDP. Retrieved from https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/peripheral_nerve/conditions/guillain_barre_and_cidp.html
  12. Meena, A.K., Khadilkar, S.V. & Murthy, J.M.K. (2011). Treatment guidelines for Guillain-Barre Syndrome. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3152164/
  13. U.S. Department of Health and Human Services. (2016). What You Need to Know About the National Vaccine Injury Compensation Program (VICP). Retrieved from https://www.hrsa.gov/sites/default/files/vaccinecompensation/resources/84521booklet.pdf
  14. Souayah, N. et al. (2009). Guillain-Barré syndrome after vaccination in United States: data from the Centers for Disease Control and Prevention/Food and Drug Administration Vaccine Adverse Event Reporting System (1990-2005). Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/19730016
  15. VICP. (2017). Vaccine Injury Table. https://www.hrsa.gov/sites/default/files/hrsa/vaccine-compensation/vaccine-injury-table.pdf
  16. De Wals, P. et al. (2012, July 11). Risk of Guillain-Barré Syndrome Following H1N1 Influenza Vaccination in Quebec. Retrieved from https://jamanetwork.com/journals/jama/fullarticle/1216476
  17. Harms, M. (2011, April). Inpatient Management of Guillain-Barré Syndrome. Neurohospitalist. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3726082/
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