Objective:

To update risk factors and outcomes in Guillain-Barré Syndrome (GBS) among active component U.S. service members between 2014 and 2022.

Background:

GBS is an immune-mediated polyradiculoneuropathy associated with antecedent illness or immunization. While previous studies suggested a higher incidence in the military, a comprehensive update was needed.

Design/Methods:

Retrospective review of Defense Medical Surveillance System (DMSS) data identified 191 confirmed GBS cases. Incidence rates, clinical characteristics, electrodiagnostic findings, treatment, and long-term outcomes (Modified Rankin Scale (MRS), chronic pain) were analyzed. Multivariable logistic regression assessed independent associations with outcomes.

Results:

The incidence rate was 1.6 cases per 100,000 person-years, higher in males (1.7), those under 20 (3.6), and those in basic training status (11.5). Preceding illness noted in 49.2% and preceding immunization within 30 days in 14.7%. Pain was reported in 73.8%. At the acute nadir, 23.6% of cases had moderate to severe disability with an MRS of 4 or 5. At one year follow-up, 51% returned to baseline. There was no association between persistent disability and associated preceding event (e.g. infection or immunization).  Chronic pain associated with GBS diagnosis was seen in 28% of patients. Axonal/mixed electrodiagnostic results were associated with greater disability at one year. Acute neuropathic pain treatment predicted poorer functional outcomes and increased risk of chronic pain.

Conclusions:

GBS in the military population shares similar incidence to civilian cohorts, with certain groups at increased risk. Significant morbidity exists, with chronic pain being a major factor. Early neuropathic pain treatment predicted poorer long-term outcomes. Although recruits had higher incidence, they did not have a higher risk of long-term morbidity.