Guillain-Barré Syndrome Fact Sheet 
 
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 Síndrome de Guillain-Barré 
 
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 What is Guillain-Barré syndrome? 
 
 Guillain-Barré syndrome (GBS) is a disorder in which the body's immune system attacks part of the peripheral nervous system. The first symptoms of this disorder include varying degrees of weakness or tingling sensations in the legs. In many instances the symmetrical weakness and abnormal sensations spread to the arms and upper body. These symptoms can increase in intensity until certain muscles cannot be used at all and, when severe, the person is almost totally paralyzed. In these cases the disorder is life threatening - potentially interfering with breathing and, at times, with blood pressure or heart rate - and is considered a medical emergency. Such an individual is often put on a ventilator to assist with breathing and is watched closely for problems such as an abnormal heart beat, infections, blood clots, and high or low blood pressure. Most individuals, however, have good recovery from even the most severe cases of Guillain-Barré syndrome, although some continue to have a certain degree of weakness. 
 
 Guillain-Barré syndrome can affect anybody. It can strike at any age and both sexes are equally prone to the disorder. The syndrome is rare, however, afflicting only about one person in 100,000. Usually Guillain-Barré occurs a few days or weeks after the patient has had symptoms of a respiratory or gastrointestinal viral infection. Occasionally surgery will trigger the syndrome. Recently, some countries worldwide have reported an increased incidence of GBS following infection with the Zika virus. In rare instances vaccinations may increase the risk of GBS. 
 
 After the first clinical manifestations of the disease, the symptoms can progress over the course of hours, days, or weeks. Most people reach the stage of greatest weakness within the first 2 weeks after symptoms appear, and by the third week of the illness 90 percent of all patients are at their weakest. 
 
 What causes Guillain-Barré syndrome? 
 
 No one yet knows why Guillain-Barré — which is not contagious — strikes some people and not others. Nor does anyone know exactly what sets the disease in motion. 
 
 What scientists do know is that the body's immune system begins to attack the body itself, causing what is known as an autoimmune disease. Usually the cells of the immune system attack only foreign material and invading organisms. In Guillain-Barré syndrome, however, the immune system starts to destroy the myelin sheath that surrounds the axons of many peripheral nerves, or even the axons themselves (axons are long, thin extensions of the nerve cells; they carry nerve signals). The myelin sheath surrounding the axon speeds up the transmission of nerve signals and allows the transmission of signals over long distances. 
 
 In diseases in which the peripheral nerves' myelin sheaths are injured or degraded, the nerves cannot transmit signals efficiently. That is why the muscles begin to lose their ability to respond to the brain's commands, commands that must be carried through the nerve network. The brain also receives fewer sensory signals from the rest of the body, resulting in an inability to feel textures, heat, pain, and other sensations. Alternately, the brain may receive inappropriate signals that result in tingling, "crawling-skin," or painful sensations. Because the signals to and from the arms and legs must travel the longest distances they are most vulnerable to interruption. Therefore, muscle weakness and tingling sensations usually first appear in the hands and feet and progress upwards. 
 
 When Guillain-Barré is preceded by a viral or bacterial infection, it is possible that the virus has changed the nature of cells in the nervous system so that the immune system treats them as foreign cells. It is also possible that the virus makes the immune system itself less discriminating about what cells it recognizes as its own, allowing some of the immune cells, such as certain kinds of lymphocytes and macrophages, to attack the myelin. Sensitized T lymphocytes cooperate with B lymphocytes to produce antibodies against components of the myelin sheath and may contribute to destruction of the myelin. In two forms of GBS, axons are attacked by antibodies against the bacteria Campylobacter jejuni, which react with proteins of the peripheral nerves. Acute motor axonal neuropathy is particularly common in Chinese children. Scientists are investigating these and other possibilities to find why the immune system goes awry in Guillain-Barré syndrome and other autoimmune diseases. The cause and course of Guillain-Barré syndrome is an active area of neurological investigation, incorporating the cooperative efforts of neurological scientists, immunologists, and virologists. 
 
 How is Guillain-Barré syndrome diagnosed? 
 
 Guillain-Barré is called a syndrome rather than a disease because it is not clear that a specific disease-causing agent is involved. A syndrome is a medical condition characterized by a collection of symptoms (what the patient feels) and signs (what a doctor can observe or measure). The signs and symptoms of the syndrome can be quite varied, so doctors may, on rare occasions, find it difficult to diagnose Guillain-Barré in its earliest stages. 
 
 Several disorders have symptoms similar to those found in Guillain-Barré, so doctors examine and question patients carefully before making a diagnosis. Collectively, the signs and symptoms form a certain pattern that helps doctors differentiate Guillain-Barré from other disorders. For example, physicians will note whether the symptoms appear on both sides of the body (most common in Guillain-Barré) and the quickness with which the symptoms appear (in other disorders, muscle weakness may progress over months rather than days or weeks). In Guillain-Barré, reflexes such as knee jerks are usually lost. Because the signals traveling along the nerve are slower, a nerve conduction velocity (NCV) test can give a doctor clues to aid the diagnosis. In Guillain-Barré patients, the cerebrospinal fluid that bathes the spinal cord and brain contains more protein than usual. Therefore a physician may decide to perform a spinal tap, a procedure in which a needle is inserted into the patient's lower back and a small amount of cerebrospinal fluid from the spinal column is withdrawn for study. 
 
 How is Guillain-Barré treated? 
 
 There is no known cure for Guillain-Barré syndrome. However, there are therapies that lessen the severity of the illness and accelerate the recovery in most patients. There are also a number of ways to treat the complications of the disease. 
 
 Currently, plasma exchange (also called plasmapheresis) and high-dose immunoglobulin therapy are used. Both of them are equally effective, but immunoglobulin is easier to administer. Plasma exchange is a method by which whole blood is removed from the body and processed so that the red and white blood cells are separated from the plasma, or liquid portion of the blood. The blood cells are then returned to the patient without the plasma, which the body quickly replaces. Scientists still don't know exactly why plasma exchange works, but the technique seems to reduce the severity and duration of the Guillain-Barré episode. This may be because plasmapheresis can remove antibodies and other immune cell-derived factors that could contribute to nerve damage. 
 
 In high-dose immunoglobulin therapy, doctors give intravenous injections of the proteins that, in small quantities, the immune system uses naturally to attack invading organisms. Investigators have found that giving high doses of these immunoglobulins, derived from a pool of thousands of normal donors, to Guillain-Barré patients can lessen the immune attack on the nervous system. Investigators don't know why or how this works, although several hypotheses have been proposed. 
 
 The use of steroid hormones has also been tried as a way to reduce the severity of Guillain-Barré, but controlled clinical trials have demonstrated that this treatment not only is not effective but may even have a deleterious effect on the disease. 
 
 The most critical part of the treatment for this syndrome consists of keeping the patient's body functioning during recovery of the nervous system. This can sometimes require placing the patient on mechanical ventilatory assistance, a heart monitor, or other machines that assist body function. The need for this sophisticated machinery is one reason why Guillain-Barré syndrome patients are usually treated in hospitals, often in an intensive care ward. In the hospital, doctors can also look for and treat the many problems that can afflict any paralyzed patient - complications such as pneumonia or bed sores. 
 
 Often, even before recovery begins, caregivers may be instructed to manually move the patient's limbs to help keep the muscles flexible and strong and to prevent venous sludging (the buildup of red blood cells in veins, which could lead to reduced blood flow) in the limbs which could result in deep vein thrombosis. Later, as the patient begins to recover limb control, physical therapy begins. Carefully planned clinical trials of new and experimental therapies are the key to improving the treatment of patients with Guillain-Barré syndrome. Such clinical trials begin with the research of basic and clinical scientists who, working with clinicians, identify new approaches to treating patients with the disease. 
 
 What is the long-term outlook for those with Guillain-Barré syndrome? 
 
 Guillain-Barré syndrome can be a devastating disorder because of its sudden and unexpected onset. In addition, recovery is not necessarily quick. As noted above, patients usually reach the point of greatest weakness or paralysis days or weeks after the first symptoms occur. Symptoms then stabilize at this level for a period of days, weeks, or, sometimes, months. The recovery period may be as little as a few weeks or as long as a few years. About 30 percent of those with Guillain-Barré still have a residual weakness after 3 years. About 3 percent may suffer a relapse of muscle weakness and tingling sensations many years after the initial attack. 
 
 Guillain-Barré syndrome patients face not only physical difficulties, but emotionally painful periods as well. It is often extremely difficult for patients to adjust to sudden paralysis and dependence on others for help with routine daily activities. Patients sometimes need psychological counseling to help them adapt. 
 
 What research is being done? 
 
 Scientists are concentrating on finding new treatments and refining existing ones. Scientists are also looking at the workings of the immune system to find which cells are responsible for beginning and carrying out the attack on the nervous system. The fact that so many cases of Guillain-Barré begin after a viral or bacterial infection suggests that certain characteristics of some viruses and bacteria may activate the immune system inappropriately. Investigators are searching for those characteristics. Certain proteins or peptides in viruses and bacteria may be the same as those found in myelin, and the generation of antibodies to neutralize the invading viruses or bacteria could trigger the attack on the myelin sheath. As noted previously, neurological scientists, immunologists, virologists, and pharmacologists are all working collaboratively to learn how to prevent this disorder and to make better therapies available when it strikes. 
 
 Where can I get more information? 
 
 For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute's Brain Resources and Information Network (BRAIN) at: 
 
 BRAIN 
 
 P.O. Box 5801 
 
 Bethesda, MD 20824 
 
 800-352-9424 
 
 http://www.ninds.nih.gov 
 
 Information also is available from the following organizations: 
 
 Column1 Column2 GBS/CIDP Foundation International 
 
 The Holly Building 104 1/2 Forrest Ave. 
 
 Narberth, PA 19072 
 
 info@gbs-cidp.org 
 
 http://www.gbs-cidp.org 
 
 Tel: 610-667-0131; 866-224-3301 
 
 Fax: 610-667-7036 
 
 
 
 
 
 "Guillain-Barré Syndrome Fact Sheet", NINDS, Publication date July 2011. 
 
 NIH Publication No. 11-2902 
 
 Back to Guillain-Barré Syndrome Information Page 
 
 See a list of all NINDS Disorders 
 
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 National Institute of Neurological Disorders and Stroke 
 
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 NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient's medical history. 
 
 All NINDS-prepared information is in the public domain and may be freely copied. Credit to the NINDS or the NIH is appreciated. ||||| More Videos 1:40 This robot can walk and swim — inside you Pause 1:18 Pregnant woman takes "extra" precautions against Zika in Miami 2:26 Police board Greyhound bus, demand proof of citizenship from passengers 0:54 Video purportedly shows Hallandale Beach mayor Joy Cooper slurring her words 2:03 Man wrangles alligator, frees it from plastic ring wrapped around its body 1:22 Comedian Conan O’Brien visit lives on in Haiti 2:38 Accused killer's mom speaks about her son and the crime he is accused of 0:14 Surveillance video captures drive-by shooting in Philadelphia 1:35 Robber, hands full with cash and lotto tickets, stuffs gun into pants 1:01 Police looking for suspects in lottery scam Video Link copy Embed Code copy 
 
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 Miami-Dade County workers search communities to identify mosquito-breeding grounds and curb the potential spread of the Zika virus and other mosquito-related illnesses. Daniel Chang and Brittany Peterson bpeterson@miamiherald.com 
 
 Miami-Dade County workers search communities to identify mosquito-breeding grounds and curb the potential spread of the Zika virus and other mosquito-related illnesses. Daniel Chang and Brittany Peterson bpeterson@miamiherald.com ||||| Breaking News Emails Get breaking news alerts and special reports. The news and stories that matter, delivered weekday mornings. 
 
 / Updated By Maggie Fox 
 
 Florida health officials said Tuesday they were investigating a possible case of Zika that wasn’t carried back by a traveler. 
 
 If it's confirmed, it would be the first evidence that Zika has spread to mosquitoes in the continental U.S. All cases up to now have been in people who traveled to Zika-affected regions or their sexual partners. 
 
 Small, local outbreaks of Zika virus are fully expected in southern states such as Florida, Louisiana and Texas. These states are home to the Aedes aegypti mosquitoes that most commonly transmit the virus. 
 
 Aedes aegypti mosquitos are seen in a lab at the Fiocruz Institute on June 2, 2016 in Recife, Brazil. Microcephaly is a birth defect linked to the mosquito-borne Zika virus where infants are born with abnormally small heads. Mario Tama / Getty Images 
 
 “Today the Florida Department of Health announced that it is conducting an investigation into a possible non-travel related case of Zika virus in Miami-Dade County,” the health department said in a statement. 
 
 “The department is actively conducting an epidemiological investigation, is collaborating with the Centers for Disease Control and will share additional details as they become available.” 
 
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 The CDC said it will help investigate. 
 
 "At this time, state and local officials in Florida are leading the investigation, and CDC is closely coordinating with Florida officials. To date, Florida public health officials have confirmed Zika infection through laboratory testing; upon request, CDC will conduct additional laboratory testing," the agency said in a statement. 
 
 "CDC has been working with state, local, and territorial health officials to prepare for the possibility of locally acquired Zika infection in the United States." 
 
 Zika can be transmitted by mosquitoes and, less commonly, through sex. The CDC has predicted that a traveler would eventually be bitten by local mosquitoes and infect them with the virus. After about 10 days, an infected mosquito can then transmit the virus to another person. 
 
 But in the U.S., it’s less common for people to live in the conditions that allow the virus to cause a full epidemic. So the CDC predicts any outbreaks would be limited. 
 
 "CDC has been working with state, local, and territorial health officials to prepare for the possibility of locally acquired Zika infection in the United States," the CDC said. 
 
 "To date, CDC has provided Florida more than $2 million in Zika-specific funding and about $27 million in emergency preparedness funding that can be used toward Zika response efforts. " 
 
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 The Florida health department said it would give out Zika prevention kits and repellant in the area under investigation. “Zika kits are intended for pregnant women,” it said. 
 
 “Mosquito control has already conducted reduction and prevention activities in the area of investigation. Residents and visitors are reminded that the best way to protect themselves is to prevent mosquito bites through practicing good drain and cover methods.” 
 
 Zika virus is most dangerous to pregnant women, because it can cause severe birth defects in babies if they are infected in the womb. It can cause rare complications such as the paralyzing Guillain-Barre syndrome and very rarely can kill or help kill an already ill patient. An elderly man in Puerto Rico died last spring and Utah reported the death of an elderly patient with Zika last week. 
 
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 In Utah, a family caregiver of the patient who died was also infected with Zika and officials there are investigating how it happened, since sexual transmission and mosquitoes can likely be ruled out. 
 
 The CDC’s reported more than 1,300 cases of Zika in the continental U.S., all linked to travelers. Among them, 346 are or have been pregnant women. Nine babies have been born so far with Zika birth defects and another six were miscarried or aborted. 
 
 Health experts caution people in areas where Aedes mosquitoes live to use mosquito repellant, to drain even the smallest reservoirs of standing water in and around homes and to use screens to keep insects out of the house. The mosquitoes that spread Zika bite during the day and prefer to live in and around houses and other structures. 
 
 "It was only a matter of time before the right circumstances aligned in Florida," said Dr. Amesha Adalja of the University of Pittsbuch Medical Center's Center for Health Security. ||||| Story highlights Zika can cause birth defects and neurological issues 
 
 Florida has been closely monitoring the spread of the virus 
 
 (CNN) The Florida Department of Health said it is investigating a possible non-travel related case of Zika virus in Miami-Dade County. 
 
 As of July 13, there have been 1,306 cases of Zika reported in the continental United States and Hawaii, the Centers for Disease Control and Prevention said. None of those has been the result of local spread by mosquitoes. 
 
 The CDC said it is closely coordinating with Florida officials leading the investigation. 
 
 The Florida Department of Health is considering all known routes of transmission, including the possibility that it could be travel related, spokeswoman Mara Gambineri said. 
 
 Cases of infection through sexual transmission with someone who traveled to a Zika zone are counted as travel related. 
 
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– There have been more than 1,300 reported cases of Zika reported in the US so far, per the CDC, but a new case in Florida is especially worrisome: The Florida Department of Health says it's looking into what may be the first non-travel-related infection in the continental US, meaning the virus could be harbored by local mosquitoes, CNN reports. Florida health officials have teamed up with the CDC to look into the infection in Miami-Dade County, which claims the highest number of Zika cases in the state (88 to date this year, including seven reported this week), per the Miami Herald. The affected neighborhood, which hasn't been named, has already been sprayed down, and Zika prevention kits and bug repellent are being distributed and made available for pickup in the county. "It was only a matter of time before the right circumstances aligned in Florida," a doctor at the University of Pittsburgh Medical Center's Center for Health Security tells NBC News. But although there's the possibility the disease may be flying around in local bugs, it's still a big "may": The state DOH is exploring every transmission possibility, including the fact that the infection may somehow be tied to travel outside the country, a rep tells CNN; cases of those who have sex with individuals who traveled to Zika hot spots are still considered travel-related cases. The virus has not only been linked to microcephaly and other birth defects in babies, but also to Guillain-Barre syndrome, a rare disorder in which the body's immune system attacks the nervous system, sometimes leading to paralysis. The CDC and health officials are also checking out a puzzling case in Utah, the site of the first Zika-related death on the US mainland, per the Herald; a "family contact" of the deceased, who had traveled outside the US, also contracted the disease. (A "startling" first in Zika transmission happened in NYC.)