Guillain-Barré Syndrome, or GBS for short, is a rare but potentially serious condition that can occur after an infection. 

GBS is caused by the body’s immune system attacking the peripheral nervous system – this is made up of nerves that branch out from the spinal cord and allow you to move, feel sensations and control bodily functions such as breathing and urinating.

GBS symptoms can range from mild to severe and include:

• Double vision

• Speech and swallowing problems

• Muscle weakness resulting in paralysis

• Incoordination / unsteadiness

• Numbness (reduced or altered sensation, including pain)

• Severe breathing difficulties requiring intensive care

Symptoms develop rapidly, often after a prior infection, and generally begin to reverse six weeks after they start. 

While many patients make a good recovery and go back to their ‘normal’ lives, some can have slower recovery and suffer from long term residual functional impairment including immobility and difficulties with self-care.

What are the early signs of GBS? What are the risk factors? Can it be prevented? If you have these questions or more, submit them now – but hurry, this Q&A is only for a limited time!

About Dr Christen Lim

Dr Christen Lim graduated from Yong Loo Lin School of Medicine, National University of Singapore, in 2014 and he qualified as a neurologist in 2021. 

His interest in Guillain-Barre Syndrome was sparked after seeing a patient with GBS while he was a medical student, and he has since been actively conducting research to improve understanding and diagnosis of the condition.

Questions and answers on Guillain-Barré Syndrome (GBS)

1. Question by Phyllis

Dear Dr,

I have weak legs (both legs) but able to walk normally. Do I have GBS?

Answer by Dr Christen Lim

Dear Phyllis, I would advise you to seek medical attention to properly evaluate your condition.

Weakness of the legs can arise from a wide variety of conditions, of which GBS is one of the possibilities. S

ome features that we look for when diagnosing patients with GBS include (but are not limited to) the development of rapid onset of weakness and numbness (developing/progressing within hours to days), involvement of the upper and/or lower limbs, blurring of vision, and speech and swallowing problems.

2. Question by Shahid

Dear Dr Lim,

May I know if there's a check-up for this? Is it covered by Medisave? Thanks!

Answer by Dr Christen Lim

Dear Shahid, GBS is a condition with a fairly rapid onset of symptoms (limb weakness/numbness, blurring of vision, speech and swallowing problems, to name a few); this develops over a matter of hours to days. 

If you or your loved ones are experiencing such symptoms, I would advise for you to seek an early/urgent review at the Emergency Department. Depending on the outcome of the doctors’ evaluation, you will be recommend a plan that may include hospital admission for investigation and treatment. 

Specific details regarding MediSave coverage will depend on your disposition (admission or follow-up in clinic) and investigations/treatments planned.

3. Question by Chan

Hi Dr Lim,

If one had prior stroke, does it predispose one to GBS?

Answer by Dr Christen Lim

Dear Chan, GBS is an inflammation of the peripheral nerves in the body resulting from an abnormal immune system response. This abnormal immune response typically arises following an infection. 

Stroke is not a predisposing factor for the development of GBS.

4. Question by Richard

Dear Dr Lim,

Few questions I would want to enquire:

a) Is GBS also closely associated or link to Myasthenia gravis? I am a myasethnia gravis patient

b) One of the symptoms is muscles numbness on leg, at one stage I encountered muscle numbness on left thighs couple with severe allergies on the skin.. It has since subsided but the thigh feel sensation is no longer the same as my normal right thigh.

I have seek medical treatment and they told me potentially could be shingles due to symptoms.. I only received some applied cream to relieve the itch as they could not prescribed medicine due to my medication for myasethnia gravis (predisolone, cellcept and mestinon). Thank you.

Answer by Dr Christen Lim

Dear Richard, thank you for the questions.

a) Although both GBS and myasthenia gravis (MG) involve abnormalities in the immune system response that result in damage to neurological structures (peripheral nerves in GBS, and neuromuscular junctions in MG), the underlying processes driving these diseases are different. There is no close linkage between the two conditions.

b) I am sorry to hear that you developed what sounds like shingles. Shingles arises from a reactivation of a previously dormant varicella zoster virus infection (which initially causes chickenpox), and this is a completely different process from GBS. Do reach out to your doctor to discuss strategies to manage your symptoms.

5. Question by Vincent

Dear Dr Christen Lim,

I was glad to learn more about GBS on HealthXchange.

Recently, I have experienced the following symptoms:

• Binocular double vision

• Numbness in the big toe of my left foot, occurring at bedtime

How can I determine whether these symptoms are caused by Guillain-Barré Syndrome (GBS)? Thank you.

Answer by Dr Christen Lim

Dear Vincent, thank you for the question. 

As a clarification, the term “binocular double vision” means that you are experiencing double vision when both eyes are open but have normal vision when one eye is closed and the other open. This results from the inability to align the eyes to focus on a visual target, due to weakness of the muscles controlling eye movements.

GBS is a condition with a fairly rapid onset of symptoms (limb weakness/numbness, blurring of vision, speech and swallowing problems, to name a few); this develops over a matter of hours to days. 

Should you have concerns of having GBS, do seek medical attention for proper evaluation.

6. Question by Sunderason

Hello Dr,

I have been diagnosed with GBS in 2013, and now the diagnosis has changed to Cryoglubulinaemia related vasculitis mononeuritis multiplex.

I have the tingling and the burning sensation with pins and needles on all my limps.

I'm prescribed with cellcept 1000 mg a day. But my pins and needles, burning sensation and tingling feelings have not subsided yet.

If you could advise, it would be greatly appreciated. Thank you.

Answer by Dr Christen Lim

Dear Sunderason, thank you for your sharing and I’m sorry to hear you are still experiencing symptoms.

The experience you shared raises an important point. GBS is one of the diagnoses we consider when a person first develops a peripheral nerve condition of fairly rapidly onset.

However, a key feature of GBS is that it stabilises after approximately 6 weeks — this is not the case for many other inflammatory nerve conditions, including vasculitic neuropathy (which you were subsequently diagnosed with). 

The treatment goals for vasculitic neuropathy would include control of the nerve inflammation (drugs such as cellcept achieve this), and management of symptoms. Do speak with your doctor regarding treatment options.

7. Question by Ang KH

Dear Dr Christen Lim,

I have consulted a specialist for double vision. Both of my eyes already go through cataract surgery and left eye seeing near sight with big image, right eye for far sight so that I can do my outdoor activities without wearing spectacles.

I have a spectacles suppose to do the vertical prism correction for my double issue but it is not really work. This is because from the first look I got a clear single vision but it will slowly go away after 5 secs approx.

According to the Dr, it is due to the neuro issue from my brain but not serious enough for any surgery at the moment.

I would be highly appreciative it if you are able to offer any advice or treatment for this case. Thank you.

Answer by Dr Christen Lim

Dear Ang KH, thank you for the sharing. 

Unfortunately the issue you describe will require more detailed evaluation than what can be provided in this Q&A section. I would encourage you to discuss your condition further with your doctor regarding further evaluation and management.

8. Question by Lau BH

Dear Dr Christen Lim,

I have been having both feet tired after exercise for about 1 hours. This has been happened for a year. Another issue is also standing too long waiting for transport or queuing for payment my right side back feels painful.

I would like to ask, what is my problems and what advice for treatment. I am a retiree and 75 years old. Thank you.

Answer by Dr Christen Lim

Dear Lau, thank you for reaching out. 

GBS is an inflammatory condition affecting the nerves in the body, arising from an abnormal immune system response, typically to a prior infection. The condition typically stabilises after approximately 6 weeks following onset, and gradually improves thereafter over time.

Your condition being present for a year, and pain in the back from standing too long suggests a separate condition – I would advise for you to seek formal medical attention to evaluate your condition and to obtain medical advice specific for your complaints.

9. Question by Hwee Ho

Hi Dr Christen Lim,

I would like to ask you does Parkinson Disease also similar to GBS as I have a brother who had Parkinson disease and cannot swallow and finally passed on.

Hope you can enlighten on this issue. I myself also have Parkinson disease but is minor. My hands tremors. Thank you.

Answer by Dr Christen Lim

Dear Hwee Ho, sorry to hear about your brother. 

Swallowing difficulties can be caused by a large variety of conditions, including diseases like Parkinson’s Disease and GBS. However, I would like to point out that these two diseases are very different conditions.

Parkinson’s disease is a degenerative condition affecting the brain, particularly areas of the brain that control the fluidity of movement. This degenerative condition is expected to progress over time, i.e. if there is swallowing difficulty, this can become worse over time. It is typically associated with slowed movements and limb stiffness, rather than limb weakness and numbness

GBS, on the other hand, results from an abnormal immune system repsonse causing inflammation of the peripheral nerves in the body. Neurological impairments like weakness, numbness and swallowing problems are expected to stabilise within 6 weeks from onset and thereafter recover gradually.

10. Question by Wei Ngo

Dear Dr Christen Lim,

I have developed weakness in my knees since two plus years ago.

I find it challenging to stand from a seated position, especially if the seat is low. I have difficulties walking up and down stairs. 

Normal stairs are still manageable but stairs of different heights is challenging and I have to use the banister to pull myself up.  I do not have pain when walking.  Walking downstairs I experience stiffness in my knees - not really pain, just very stiff.

I do leg strengthening exercises consistently for past 2 years.  Gym work. Weights.  But the improvement has been limited.

What do I have? I have been active all my life, from childhood to just around the COVID years when I did not exercise as much as I used to. Looking forward to your advice, thank you.

Answer by Dr Christen Lim

Dear Wei Ngo, thank you for your detailed description. 

Guillain-Barré Syndrome (GBS) is an inflammatory nerve condition that typically presents with rapid onset of weakness, often progressing over days to weeks, and usually affects both sides of the body. 

Your symptoms have developed gradually over a few years and are mainly limited to your knees, which is not typical for GBS. There are many possible causes for your symptoms, including joint, muscle, or nerve issues, and sometimes age-related changes. 

As your improvement with exercise has been limited, I would recommend seeing a doctor for a thorough evaluation to determine the cause and explore further management options.

11. Question by Kalai

Hi Doctor, 

I am a diabetic patient and am under medication (metformin - 2 tabs per day).

I have numbness on both my feet which shoots up when I start walking and it remains like this for a good ten to 15 minutes and it goes away after that. This happens at least 2 or 3 times a day.

During the numbness I am unable to walk properly and become weak on both my feet and legs.

For your kind advice doctor, thank you.

Answer by Dr Christen Lim

Dear Kalai, thank you for sharing your symptoms. 

Numbness and weakness in both feet are common in people with diabetes due to a condition called diabetic neuropathy, which is a result of long-term high blood sugar affecting the nerves. 

Control of the diabetes is very important to avoid long term complications of the diabetes, which includes diabetic neuropathy and other complications like stroke and heart disease.

Guillain-Barré Syndrome (GBS) usually presents with rapid progression of weakness and numbness over hours to days. The condition typically stabilises after approximately 6 weeks following onset, and gradually improves thereafter over time. 

I recommend discussing your symptoms with your doctor, in particular the shooting quality of your numbness, whether this is related to the underlying diabetes or other issues such as nerve root compression, and whether additional investigations are necessary.

12. Question by YSL

Dear Dr,

I’m experiencing weakness in my left leg. It is not excessively painful per se but I can feel the weakness as if the leg could buckle down anytime.

This happened 4 months ago spontaneously, not the result of any illness or infection. An MRI scan of my spine does not reveal compressed discs, only natural wear and tear of a couple of them.

I’m still experiencing the weakness in the affected leg after 4 months.

Any advice would be appreciated. Thank you and best regards.

Answer by Dr Christen Lim

Dear YSL, thank you for your question. 

GBS usually presents with rapidly progressive weakness affecting both sides of the body, often following an infection, and typically stabilises within 6 weeks. 

Persistent weakness in one leg for several months without other symptoms is not typical for GBS. The causes of leg weakness and knee buckling can be broad, and include problems with the bones, joints, muscles or nerves of the affected limb. 

It would be best to discuss with your doctor on the best way to further evaluate your specific condition and institute appropriate management.

13. Question by Menon

Hi Dr Lim,

Is or are there inter-linked threats with other potential diseases like diabetes, or even IBS? Thank you for your advice.

Answer by Dr Christen Lim

Dear Menon, thank you for your question. 

Guillain-Barré Syndrome (GBS) is not directly linked to chronic conditions like diabetes or irritable bowel syndrome (IBS). 

However, people with diabetes may be more susceptible to nerve problems in general, such as diabetic neuropathy, which is different from GBS. GBS is usually triggered by infections rather than chronic diseases. 

If you have concerns about nerve symptoms, it is best to discuss them with your doctor.

14. Question by Mukand

Dear Dr Lim,

Thank you for the interesting article on GBS and great to know you are the expert.

I do have the tingling feelings sometimes / cramps / toes / sleeping or driving. I do exercise off and on… I am young @ 82.

Any advice, Dr Lim?

Answer by Dr Christen Lim

Dear Mukand, thank you for your kind words. 

Tingling and cramps in the toes and feet can have many causes, including age-related changes, circulation issues, or nerve conditions. 

Guillain-Barré Syndrome (GBS) typically presents with rapidly worsening weakness and numbness over hours to days, often after an infection. 

The condition typically stabilises after approximately 6 weeks following onset, and gradually improves thereafter over time. 

If your symptoms are persistent or worsening, I recommend seeing your doctor for a thorough assessment to determine the cause and discuss management options.

15. Question by Ms Li

Dear Doctor Lim,

My mom has a brain tumour on her right, does it can cause weakness in their legs and hands?

During a seizure attack, does she experience weakness and drooling from the mouth?

What are the best ways to treat and assist her in such situations? Thank you for your advice.

Answer by Dr Christen Lim

Dear Ms Li, thank you for your questions, and sorry to hear about your mother’s diagnosis. 

A brain tumour can indeed cause weakness in the arms or legs, especially on the side opposite to the tumour. 

Seizures can also result in temporary weakness and drooling, which usually resolve after the episode. 

These symptoms are not related to Guillain-Barré Syndrome (GBS), which affects the peripheral nerves rather than the brain. 

Management of her brain tumour and her seizures should be discussed with her treating doctors, who can provide specific advice on seizure control and supportive care during and after episodes.

16. Question by Martin

Dear Dr Lim,

I understand from the article that Guillain-Barré Syndrome (GBS) is a potentially serious condition.

My mom has left leg back calf numbness and has been diagnosed with the veins are too weak to enable the blood to flow back properly due to her old age.

How to know that it is not GBS and how can she reduce this numbness which can occur for hours daily?

Her doctor at a hospital has suggested an operation to tighten the vein vessels but this is a last resort due to her age and if it is very severe. She is 87 yes old.

Answer by Dr Christen Lim

Dear Martin, thank you for your question. 

GBS usually presents with rapidly progressive weakness and numbness (developing over hours to days), often affecting both sides of the body and sometimes spreading upwards. 

In your mother’s case, the numbness is localised to the left posterior calf and linked to vein problems, which is quite different from GBS.

Do continue to follow up with her blood vessel doctors for the best management plan. You may wish to discuss with your doctors if the specific complaint of left calf numbness can be accounted for by the vein problem, and consider if further investigation is required.

17. Question by Seah MK

Dear Dr Lim,

I have been having a tingling sensation on my calf on both legs over the past few years, at times more pronounced than others.

Over the past 4 months I have felt it more acutely. Apart from that, my lower legs are cold. I feel less uncomfortable when I lift my legs when seated.

I do not have a problem walking but have slight difficulty climbing stairs. When I stand up from a sitting position my knees crack. 

I have brought the matter up to the doctors who saw me at Outram Polyclinic since the tingling sensation first started.  I have been given B12 but it has not helped.

My question is: Do I have GBS?  If so, how do I get referred to a neurologist for consultation. Thank you.

Answer by Dr Christen Lim

Dear Seah MK, thank you for your detailed account. 

GBS typically presents with rapidly worsening weakness and numbness over days, not years.

Tingling and cold sensations in the legs over a long period are unlikely to be due to GBS and may be due to nerve issues, such as diabetes or vitamin deficiencies, or circulatory problems in the legs. 

If your symptoms are worsening or you develop new weakness, do seek medical attention. If you wish to see a neurologist, you can discuss with your polyclinic or family doctor on the utility of a referral.

18. Question by Pat

Dear Dr Lim,

I'm having left leg weakness during climbing stairs after a slipped and fell on my left buttock.

Normal activities such as walking and cycling not a problem on both legs. May I know if it has anything to do with GBS?

Answer by Dr Christen Lim

Dear Pat, thank you for your question. 

Weakness following a fall is most likely related to injury to the muscles, joints, or nerves in the affected area. 

GBS typically presents with rapidly progressive weakness affecting both sides of the body, not just one leg, and not as a result of trauma. 

I would recommend seeing your doctor for assessment and advice on recovery from your injury.

19. Question by Peggy

Hi Dr,

Firstly, my fingers tend to feel tingling on my fingers and feet.  Lately my hands are hurting with numbness and pain. This has been going on for more than 2 weeks.

What is causing these sensations lately? Please advise what I should do.

Thank you for your advice, Doctor.

Answer by Dr Christen Lim

Dear Peggy, thank you for sharing your symptoms. 

Tingling, numbness in the hands and feet can have many causes, such as (but not limited to) nerve compression, diabetes, or vitamin deficiencies. 

You report pain in the hands as well, which may either be directly related to nerve problems, or be due to a concurrent issues such as problems with the bones, muscles and soft tissues of the hands. 

GBS usually presents with rapidly progressive weakness and numbness, often affecting both sides and developing over days. 

If your symptoms are persistent or worsening, I recommend seeing your doctor for a thorough evaluation to determine the cause and discuss appropriate treatment.

20. Question by Siew Hoon

Dear Dr,

How do we differentiate numbness caused by GBS from normal leg numbness? Thank you.

Answer by Dr Christen Lim

Dear Siew Hoon, 

leg numbness has many potential causes, and your doctor will have to consider several factors to evaluate the underlying cause of the numbness in your specific case.

The way that numbness presents in GBS can vary from person to person, but most commonly results in numbness involving the legs and hands and worsening over the next few days. 

The key factor underlying GBS is that the numbness (along with its other associated features such as limb weakness and clumsiness), progress over days and typically stabilise within 6 weeks. If you experience rapidly spreading numbness, especially with weakness or difficulty walking, please seek medical attention promptly.

21. Question by Lily

Dear Dr Lim,

May I know what kind of infection causes GBS? Would Shingles be considered an infection? Are elderly more vulnerable? Thank you.

Answer by Dr Christen Lim

Dear Lily, thank you for your questions. 

GBS is most commonly associated with Campylobacter jejuni infection, which typically results in gastrointestinal upset. 

Several studies have investigated the association between GBS and other infections, including herpes zoster (otherwise known as Shingles), although the strength of these associations are less well established.

GBS is overall a fairly rare condition, and can affect people of any age, although it is slightly more common in older adults.

22. Question by Kunnath

Dear Doctor Lim,

My 45-year-old niece in India was recently diagnosed with GBS.

The problem is with her feet as she cannot stand and walk. She is now undergoing physiotherapy, and immunoglobulin injections. I want to know what are the outcomes of these treatments.

Are there any other treatment options available to her? Will this condition be completely cured, and if so how long will it take? Thank you for your advice.

Answer by Dr Christen Lim

Dear Kunnath, 

Thank you for sharing about your niece, and I hope that her condition improves. 

The treatments that you described (intravenous immunoglobulin (IVIG) and physiotherapy) are the standard approach to treatment for GBS.

Treatment with IVIG helps to reduce the extent of the immune attack on the nerves; an alternative to this treatment is plasma exchange. 

However, in the treatment of GBS, it is not usual practice to administer these two forms of therapy together (or even sequentially). 

Physiotherapy is crucial for maintaining muscle strength and preventing complications during recovery. 

It may be best to speak with the doctors caring for your niece to better understand the treatment progress in your niece’s specific context.

While the disease typically stabilises after 6 weeks, the time taken for recovery – and how fully one recovers – varies from person to person.

23. Question by Aisha

Hi Dr,

My 7-year-old son was diagnosed with GBS 3 weeks agovand hospitalised. He has gone through IVIG drip and has been discharge since then. Now going through physio and occupational therapy.

Till now, I have not heard a satisfying answer to why he has GBS. Long story short, he went through few episodes of bully at school including a fall that causes limping. Went to A&E, had an x-ray, swollen knee. Came back for appt 1 week after still cannot walk. Put him on a cast. Came back for the 3rd time, doctor sees that he lost his muscle tone etc. got admitted and went for MRI, diagnosed with GBS.

The thing is, there's no lesion, not genetic and no infection. Could it be a trauma that he has gone through in school that trigger his immune system?

I know it's very rare and it is very rare also for someone to get sick without a reason. Please advise.

Answer by Dr Christen Lim

Dear Aisha, 

Thank you for sharing your son's experience, and I hope he is on the path to recovery. 

The treatments you described (intravenous immunoglobulin (IVIG), and physical therapy) are indeed the treatments commonly recommended when treating patients with GBS.

While GBS is typically triggered by infections, such preceding infections may not always be recognised. 

You mentioned that your son was exposed to bullying episodes in school and whether trauma resulted in triggering of the immune system. Post-traumatic GBS is itself a very rare entity; the reports that discuss this topic typically describe significant trauma such as occurring after major surgery. 

It may be best for you to discuss your specific queries with the doctor caring for your son to better understand the specific considerations they have that are relevant to your son’s situation.

24. Question by M

Dear Dr,

My friend had GBS last year and was in hospital for a few weeks. She is now better but she is scared the GBS will come back again.

Please advise what she can do to prevent a recurrence, thank you.

Answer by Dr Christen Lim

Dear M, 

Thank you for your question about your friend. 

GBS recurrence is quite rare; studies on the subject suggest about 1-6% of patients experience a second episode. There is no guaranteed way to prevent recurrence. 

However, since GBS has been shown to be associated with recent prior infections, adhering to recommended vaccinations such as seasonal influenza vaccination may help limit exposure to infections that increase the risk of GBS.

If a recurrence occurs, the treatment approach would generally involve treatments like intravenous immunoglobulins or plasma exchange to limit the immune attack on the nerves, and rehabilitation. 

If she ever experiences symptoms similar to her previous episode, seeking prompt medical attention would be beneficial.

Ref: G25