Guillain-Barré syndrome: what it is, symptoms and neurological rehabilitation

Guillain-Barré syndrome (GBS) is a rare but serious autoimmune neurological disorder in which the body’s own immune system attacks the peripheral nerves. This results in paralysis that typically begins in the feet and progresses upward to the legs, trunk, arms, and, in the most severe cases, the respiratory muscles.

Although it can occur at any age, it is more common in young adults and those over 50. It is usually preceded by a respiratory or gastrointestinal infection in the preceding weeks. With appropriate treatment and rehabilitation, most patients recover, although the process can be lengthy.

Symptoms of Guillain-Barré syndrome

GBS has a characteristic presentation of ascending weakness or paralysis. Symptoms appear and progress rapidly, reaching their peak within days or weeks.

• Tingling or numbness in the toes and fingers (common initial symptom)
• Ascending muscle weakness: begins in the legs and moves up to the arms and torso
• Difficulty walking or climbing stairs
• Intense pain in the back, legs, or arms (frequent and sometimes underestimated)
• Difficulty moving facial muscles, chewing, or swallowing
• Double vision or difficulty moving the eyes
• In severe cases: respiratory distress that may require mechanical ventilation
• Heart rhythm and blood pressure disturbances (autonomic nervous system)

Stages of Guillain-Barré syndrome

Progression phase (days to 4 weeks)

The symptoms worsen progressively. The patient may go from feeling tingling in their feet to being unable to walk within a few days. This phase requires hospitalization and constant monitoring of respiratory and cardiovascular function.

Plateau phase (days to weeks)

The symptoms stabilize. The patient has reached their peak and is ready to begin active rehabilitation. This phase can last from days to several weeks.

Recovery phase (months to years)

The nervous system begins to regenerate. Improvement is slow but steady. Intensive neurological rehabilitation at this stage is key to maximizing functional recovery. Full recovery can take between 6 months and 2-3 years, and in some cases, permanent aftereffects remain.

Medical treatment of GBS

Medical treatment in the acute phase primarily includes intravenous immunoglobulin or plasmapheresis, both aimed at halting the immune system’s attack on the nerves. This treatment is administered in the hospital, and the earlier it is given, the better the prognosis.

Neurological rehabilitation in Guillain-Barré syndrome

Rehabilitation is the cornerstone of long-term recovery. It begins in the hospital during the plateau phase and continues on an outpatient basis for months or years after discharge .

In the hospital phase

• Respiratory physiotherapy: work on the respiratory muscles in patients with lung involvement
• Correct positioning to prevent ulcers and joint complications
• Passive mobilizations to maintain joint range of motion and prevent stiffness
• Progressive sensory stimulation

In the outpatient phase (the major rehabilitation work)

• Progressive muscle strengthening: from proximal muscles (hip, shoulder) to distal muscles
• Gait retraining: first with technical aids, progressively towards independent walking
• Balance and coordination work: fundamental due to the impact on the proprioceptive system
• Treatment of residual neuropathy: tingling, neuropathic pain, altered sensation
• Occupational therapy: recovery of manual function and activities of daily living
• Addressing neuropathic pain in coordination with the medical team
• Psychological support: the emotional impact of GBS is very significant

How long does recovery take?

Recovery from GBS is highly variable. Most patients improve significantly within the first 6–12 months. Approximately 80% regain independent walking ability. However, many report persistent fatigue, neuropathic pain, or fine motor difficulties that can last for years.

The key is not to abandon rehabilitation prematurely. The peripheral nervous system has regenerative capacity, but it is slow: improvement may continue for 2-3 years after the onset of the disease.