Diagnostic criteria Diagnostic criteria for GBS from the National Institute of Neurological

Disorders and Stroke (NINDS) [52] have an important role in research and are widely used in
clinical practice. These criteria are based on expert consensus.
Required features include:
1. Progressive weakness of more than one limb, ranging from minimal weakness of the
legs to total paralysis of all four limbs, the trunk, bulbar and facial muscles, and
external ophthalmoplegia
2. Areflexia. While universal areflexia is typical, distal areflexia with hyporeflexia at the
knees and biceps will suffice if other features are consistent.
Supportive features include:
1. Progression of symptoms over days to four weeks
2. Relative symmetry
3. Mild sensory symptoms or signs
4. Cranial nerve involvement, especially bilateral facial nerve weakness
5. Recovery starting two to four weeks after progression halts
6. Autonomic dysfunction
7. No fever at the onset
8. Elevated protein in CSF with a cell count <10/mm3
9. Electrodiagnostic abnormalities consistent with GBS
The following features make the diagnosis of GBS doubtful:
1. Sensory level (decrement or loss of sensation below a spinal cord root level as
determined by neurologic examination)
2. Marked, persistent asymmetry of weakness
3. Severe and persistent bowel and bladder dysfunction
4. More than 50 white cells in the CSF

These diagnostic criteria have been used for years in research studies and are applicable to about
80 or 90 percent of patients with GBS in North America and Europe, particularly those with the AIDP
form. Patients with GBS who do not meet the required criteria will typically have one of the other
GBS variants such as AMAN, in which reflexes can be retained, MFS, or a regional variant.
(See 'GBS variants'above.)