Phys · neurological
Guillain-Barre Syndrome
Also known as GBS · acute inflammatory demyelinating polyradiculoneuropathy · AIDP · Landry ascending paralysis · Miller Fisher syndrome · AMAN · AMSAN · Bickerstaff brainstem encephalitis
Consultant-physician guide to Guillain-Barré syndrome — variants and antecedent infections (Campylobacter, Zika), anti-ganglioside antibodies (anti-GQ1b in Miller Fisher), diagnosis with CSF and electrophysiology (Brighton validation), the 20/30/40 rule and EGRIS, EAN/PNS 2023 treatment (IVIg or plasma exchange; no corticosteroids), the trial evidence, treatment-related fluctuations versus A-CIDP, and prognosis (EGOS, mEGOS).
Checked against its sources on 8 Oct 2026
On this page
Study tools
Your progress
Saved on this device.
Practise this topic
Target exams
FRACP DWEFRACP DCEMRCP Part 1MRCP Part 2MRCP PACESABIM Internal Medicine
Red flags
- Imminent respiratory insufficiency (VC under 15-20 mL/kg or 1 L, inability to count to 15, accessory muscle use) or severe autonomic dysfunction — admit to ICU
- 20/30/40 rule: VC under 20 mL/kg, MIP under 30 cmH2O or MEP under 40 cmH2O signals risk of respiratory failure
- Autonomic involvement contributes to mortality of 3-10%
- CSF over 50 cells/μL suggests another diagnosis
- Deterioration after 8 weeks or three or more times — consider acute-onset CIDP
Meet the patient
A 54-year-old mechanic presents two weeks after Campylobacter enteritis with four days of ascending symmetric weakness and areflexia. He is pausing mid-sentence to breathe. Campylobacter jejuni is one of six pathogens temporally associated with GBS, and his first questions are respiratory and autonomic.[1]
References21ShowHide
- [1]Leonhard SE, Mandarakas MR, Gondim FAA, et al. Diagnosis and management of Guillain-Barré syndrome in ten steps. Nature reviews. Neurology, 2019.PMID 31541214
- [2]Willison HJ, Jacobs BC, van Doorn PA Guillain-Barré syndrome. Lancet (London, England), 2016.PMID 26948435
- [3]van Doorn PA, Van den Bergh PYK, Hadden RDM, et al. European Academy of Neurology/Peripheral Nerve Society Guideline on diagnosis and treatment of Guillain-Barré syndrome. European journal of neurology, 2023.PMID 37814552
- [4]Lawn ND, Fletcher DD, Henderson RD, et al. Anticipating mechanical ventilation in Guillain-Barré syndrome. Archives of neurology, 2001.PMID 11405803
- [5]Walgaard C, Lingsma HF, Ruts L, et al. Prediction of respiratory insufficiency in Guillain-Barré syndrome. Annals of neurology, 2010.PMID 20517939
- [6]Walgaard C, Lingsma HF, Ruts L, et al. Early recognition of poor prognosis in Guillain-Barre syndrome. Neurology, 2011.PMID 21403108
- [7]van Koningsveld R, Steyerberg EW, Hughes RA, et al. A clinical prognostic scoring system for Guillain-Barré syndrome. The Lancet. Neurology, 2007.PMID 17537676
- [8]Fokke C, van den Berg B, Drenthen J, et al. Diagnosis of Guillain-Barré syndrome and validation of Brighton criteria. Brain : a journal of neurology, 2014.PMID 24163275
- [9]van der Meché FG, Schmitz PI A randomized trial comparing intravenous immune globulin and plasma exchange in Guillain-Barré syndrome. Dutch Guillain-Barré Study Group. The New England journal of medicine, 1992.PMID 1552913
- [10]Randomised trial of plasma exchange, intravenous immunoglobulin, and combined treatments in Guillain-Barré syndrome. Plasma Exchange/Sandoglobulin Guillain-Barré Syndrome Trial Group. Lancet (London, England), 1997.PMID 9014908
- [11]Plasmapheresis and acute Guillain-Barré syndrome. The Guillain-Barré syndrome Study Group. Neurology, 1985.PMID 4022342
- [12]van Koningsveld R, Schmitz PI, Meché FG, et al. Effect of methylprednisolone when added to standard treatment with intravenous immunoglobulin for Guillain-Barré syndrome: randomised trial. Lancet (London, England), 2004.PMID 14738791
- [13]Hughes RA, Brassington R, Gunn AA, et al. Corticosteroids for Guillain-Barré syndrome. The Cochrane database of systematic reviews, 2016.PMID 27775812
- [14]Ruts L, Drenthen J, Jacobs BC, et al. Distinguishing acute-onset CIDP from fluctuating Guillain-Barre syndrome: a prospective study. Neurology, 2010.PMID 20427754
- [15]Chiba A, Kusunoki S, Obata H, et al. Serum anti-GQ1b IgG antibody is associated with ophthalmoplegia in Miller Fisher syndrome and Guillain-Barré syndrome: clinical and immunohistochemical studies. Neurology, 1993.PMID 8413947
- [16]Kusunoki S, Kaida K, Ueda M Antibodies against gangliosides and ganglioside complexes in Guillain-Barré syndrome: new aspects of research. Biochimica et biophysica acta, 2008.PMID 17976386
- [17]Cao-Lormeau VM, Blake A, Mons S, et al. Guillain-Barré Syndrome outbreak associated with Zika virus infection in French Polynesia: a case-control study. Lancet (London, England), 2016.PMID 26948433
- [18]van den Berg B, Walgaard C, Drenthen J, et al. Guillain-Barré syndrome: pathogenesis, diagnosis, treatment and prognosis. Nature reviews. Neurology, 2014.PMID 25023340
- [19]Wijdicks EF, Roy TK BiPAP in early guillain-barré syndrome may fail. The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques, 2006.PMID 16583732
- [20]Hor JY Cardiac arrhythmia after succinylcholine administration in a patient with Guillain-Barré syndrome--a case report. Middle East journal of anaesthesiology, 2010.PMID 21526679
- [21]Lawn ND, Wijdicks EF Tracheostomy in Guillain-Barré syndrome. Muscle & nerve, 1999.PMID 10417787