Patient Basics: Guillain-Barre Syndrome

Guillain-Barre syndrome (GBS) is a rare condition in which the immune system attacks the nerves outside the brain and spinal cord. It usually starts with tingling and weakness in the feet and legs that spreads upward over days. It can weaken the muscles used for breathing, so it needs care in a hospital. Most people recover well, though recovery can take months.

Key points

• GBS often starts a few weeks after a stomach bug or a respiratory infection.
• Weakness usually begins in both legs and climbs upward, reaching its worst within 2 to 4 weeks.
• Get emergency care for quickly worsening weakness, or any trouble breathing or swallowing.
• Treatment with immune globulin (IVIG) or plasma exchange speeds recovery.
• Most people walk again on their own, but some have lasting weakness, tiredness or pain.

What causes Guillain-Barre syndrome

Nerves carry signals between the spinal cord and the muscles and skin. Many nerves are wrapped in a fatty coating called myelin, which helps signals travel fast. In GBS, the immune system attacks the myelin, and sometimes the nerve fibers themselves. Signals slow down or stop, which causes weakness and numbness.

About two in three people with GBS had an infection in the weeks before. Doctors think the immune system, while fighting the germ, makes antibodies that also hit the nerves by mistake. Common triggers include:

• Campylobacter, a bacteria that causes food poisoning, often from undercooked chicken
• Flu and other respiratory viruses, including COVID-19
• Epstein-Barr virus and cytomegalovirus
• Zika virus

Rarely, GBS follows surgery or a vaccine, including some flu vaccines and the RSV vaccines for older adults. The flu itself causes GBS more often than the flu vaccine does.

GBS affects about 1 or 2 in 100,000 people each year. It can happen at any age but is more common in older adults and slightly more common in men. It is not contagious.

Symptoms

• Tingling or pins and needles in the toes and fingers
• Weakness in both legs that spreads to the arms and upper body
• Trouble walking, climbing stairs or getting up from a chair
• Deep, aching pain in the back or legs
• Weakness of the face, trouble chewing, swallowing or speaking
• Double vision or trouble moving the eyes
• Shortness of breath
• A fast or uneven heartbeat, swings in blood pressure, or trouble peeing

Symptoms usually affect both sides of the body evenly and can worsen over hours or days. Doctors call this pattern of limp weakness that climbs from the feet upward ascending paralysis. One form, called Miller Fisher syndrome, starts with weak eye muscles and an unsteady walk rather than leg weakness.

How it’s diagnosed

The doctor will check strength and feeling and test reflexes with a small rubber hammer. In GBS, reflexes in the knees and ankles are weak or missing. Tests that help confirm it:

• Lumbar puncture (spinal tap). A thin needle takes a small sample of the fluid around the spinal cord from the lower back. In GBS, the fluid often has a high protein level but few white blood cells. The protein may be normal in the first week.
• Nerve conduction studies and EMG. Small electric pulses and a thin needle in the muscles measure how well nerves carry signals.
• Breathing tests to measure how strongly you can breathe in and out. These are repeated often in the hospital.
• Blood tests and sometimes an MRI to rule out other causes, such as a spinal cord problem.

Treatment

People with GBS are watched in the hospital, often in an intensive care unit at first, because weakness can spread quickly.

Treatments that calm the immune attack

• Intravenous immune globulin (IVIG). Antibodies from healthy donors are given through a vein over several days. They seem to block the harmful antibodies.
• Plasma exchange. A machine removes the liquid part of the blood (plasma), which carries the harmful antibodies, and replaces it. This is done several times over one to two weeks.

Both work about equally well, especially when started within the first 2 weeks. Steroid medicines don’t help GBS.

Supportive care

• A breathing machine (ventilator) for a time if the breathing muscles become too weak. Many people with severe GBS need one.
• A feeding tube if swallowing isn’t safe
• Close watch of heart rate and blood pressure
• Blood thinners and leg compression to prevent clots while you can’t move much
• Medicine for nerve pain
• Physical and occupational therapy, started early

Recovery from Guillain-Barre syndrome

Symptoms usually stop getting worse within 4 weeks. After a steady period, recovery begins slowly as the nerves repair. Many people move to a rehab center to rebuild strength and learn to walk again. Most can walk on their own within 6 months to a year. Some keep weakness, numbness, tiredness or pain for longer, and a small number never fully recover.

A long hospital stay and slow recovery can be hard on mood. Talk with your care team if you feel down or anxious. Support groups for people with GBS can help too.

GBS comes back in only a small number of people. If weakness keeps worsening for more than 8 weeks, or keeps returning, doctors check for a related long-term condition called CIDP (chronic inflammatory demyelinating polyneuropathy).

Vaccines after GBS

Most people who have had GBS can still get their routine vaccines. If GBS started within about 6 weeks of a particular vaccine, your doctor may advise skipping that vaccine in the future. Talk it over with your doctor before your next shots.

When to get help

Get emergency care or call 911 for:

• Weakness or tingling that spreads up the legs or into the arms over hours or days
• Shortness of breath, or trouble breathing while lying flat
• Trouble swallowing or choking on saliva
• Weakness of the face or double vision with leg weakness

See your doctor soon for new tingling in both feet or hands, even if it seems mild.

Common questions about Guillain-Barre syndrome

What is the life expectancy with Guillain-Barre syndrome?

Most people who get through the first weeks go on to a normal life span. A small number die, usually from breathing failure, blood clots, infections or heart rhythm problems early in the illness. Close watch in the hospital and quick care of complications have made deaths much less common than in the past.

Can Guillain-Barre syndrome be cured?

There is no single cure, but the illness usually runs its course and the nerves slowly repair. IVIG or plasma exchange speeds recovery, and rehab rebuilds strength. Most people regain the ability to walk and return to daily life, though some keep mild weakness, numbness or tiredness for good.

How long does Guillain-Barre syndrome last?

Weakness usually worsens for up to 4 weeks, levels off for days to weeks, and then slowly improves. Most recovery happens in the first year, but some people keep getting better for two years or more. People with mild cases may recover within a few weeks or months.

Is Guillain-Barre syndrome painful?

It often is. Many people have deep, aching pain in the back and legs, or burning and tingling nerve pain, sometimes before the weakness starts. Pain can last into recovery. Medicines for nerve pain, gentle movement and physical therapy help, so tell your care team when you hurt.

Is Guillain-Barre syndrome hereditary?

No. GBS isn’t passed down in families, and having a relative with it doesn’t mean you will get it. It comes from an immune reaction, usually set off by an infection. Some gene differences may make a person a little more likely to react this way, but this is still being studied.

Questions to ask your doctor

• What type of GBS do I have?
• Should I have IVIG or plasma exchange?
• How will you watch my breathing?
• What will rehab look like, and how long might it take?
• Which vaccines are safe for me in the future?

Learn more

• Guillain-Barre syndrome (National Institute of Neurological Disorders and Stroke)
• Guillain-Barre syndrome (MedlinePlus, U.S. National Library of Medicine)

This guide is general information and doesn’t replace advice from your own doctor. Last updated October 2026.