- Phases of the syndrome -

Progressive phase
Plateau phase
Recovery phase
Further reading

Patients suffering from Guilain-Barré syndrome usually experience just one attack that generally lasts for a few weeks, after which the attack stops spontaneously. The rest of the time is spent recovering from the attack.

The course of Guillain-Barré syndrome (GBS) can be split up into 3 phases.

Progressive phase
This phase lasts typically 2-3 weeks, measured from the observation of the first symptom until no further deterioration occurs. This point is known as the 'nadir'.

It is in this phase that GBS patients develop the pain, progressive weakening and sensory abnormalities that characterise this disease. The symptoms increase in severity and extent in a very unpredictable way, depending on how badly affected the patient is. Cases of mild GBS reach a clinical nadir in a similar time to those with more severe disease.

The difference in severity of the syndrome seems to be determined in this phase. Early treatment shortens the transition to the recovery phase, and reduces the risk of permanent physical damage. Treatments focus both on reducing pain and symptoms.
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Plateau phase
The infection phase is followed by a stable plateau phase, where neither worsening nor improvement occurs. The attack has ceased, but the degree of weakness remains unchanged until the recovery phase begins.

In this phase, emphasis is laid on supporting the functions that are weakened or lost. The patient's blood pressure, cardiac rhythm, respiration, nutritional and fluid status and general status are monitored carefully. Immunotherapy treatment begun in the progressive phase continues.

The patient is generally very weak and requires lots of rest, skillful care and physiotherapy. GBS patients generally experience a great deal of pain from inflamed nerves, stiff muscles and joints. This pain disappears when recovery begins.

The duration of the phase cannot be predicted with any accuracy. It may be a few days or several months. Some patients inexplicably move directly from the infection phase to the recovery phase, while others remain in the plateau phase for several months, before the recovery phase begins.
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Recovery Phase
Finally, the long-awaited recovery phase begins, with spontaneous improvement and recovery. The immune system stops producing the antibodies that destroy myelin, and the symptoms gradually disappear. Nerve healing commences.

Treatment during this phase focuses on physiotherapy, to build up the patient's muscles, regain muscle movement and strength, and teach the patient to use the muscles optimally.
Pain is still experienced, although it now stems from the regenerating nerve cells and physiotherapy.

The duration of this phase cannot be predicted. Recovery is individual, and may be achieved in a few weeks or after several years. Relapses may occur. Many patients are able to begin working again after 3-6 months, while others display slight symptoms for a long time after recovery. The degree of recovery depends on the severity of the nerve damage that occurred in the infection phase.

Check out 'Case Histories' for real-life stories on how others have experienced GBS, and the advice they pass on to fellow patients.

Further reading

- Case histories
English and foreign-language case histories that inspire and support patients and their families. Patients describe the course of their illness, how they handled the syndrome, how their families worked together with health personnel to ensure an optimal treatment. They also describe recovery and life post-GBS.
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