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Background: The Zika virus (ZIKV) has been associated with Guillain-Barré syndrome (GBS) in epidemiological studies. Whether ZIKV-associated GBS is related to a specific clinical or electrophysiological phenotype has not been established. To this end, we performed a systematic review and meta-analysis of all published studies on ZIKV-related GBS. Methods: We searched Pubmed, EMBASE and LILACS, and included all papers, reports or bulletins with full text in English, Spanish or Portuguese, reporting original data of patients with GBS and a suspected, probable or confirmed recent ZIKV infection. Data were extracted according to a predefined protocol, and pooled proportions were calculated. Results: Thirty-five studies were included (13 single case reports and 22 case series, case-control or cohort studies), reporting on a total of 601 GBS patients with a suspected, probable or confirmed ZIKV infection. Data from 21 studies and 587 cases were available to be summarized. ZIKV infection was confirmed in 21%, probable in 22% and suspected in 57% of cases. ZIKV PCR was positive in 30% (95%CI 15–47) of tested patients. The most common clinical features were: limb weakness 97% (95%CI 93–99), diminished/absent reflexes 96% (95%CI 88–100), sensory symptoms 82% (95%CI 76–88), and facial palsy 51% (95%CI 44–58). Median time between infectious and neurological symptoms was 5–12 days. Most cases had a demyelinating electrophysiological subtype and half of cases were admitted to the Intensive Care Unit (ICU). Heterogeneity between studies was moderate to substantial for most variables. Conclusions: The clinical phenotype of GBS associated with ZIKV infection reported in literature is generally a sensorimotor demyelinating GBS with frequent facial palsy and a severe disease course often necessitating ICU admittance. Time between infectious and neurological symptoms and negative PCR in most cases suggests a post-infectious disease mechanism. Heterogeneity between studies was considerable and results may be subject to reporting bias. This study was registered on the international Prospective Register of Systematic Reviews (CRD42018081959). Author summary: Guillain-Barré syndrome (GBS) is a rare but severe neurological disease, characterized by an acute onset flaccid paralysis. GBS is thought to be caused by an exaggerated immune response to common infections that damages the peripheral nerves. The Zika virus (ZIKV) is the most recent pathogen to be connected to GBS, when large outbreaks of ZIKV infection in French Polynesia and Latin America were followed by an increased incidence of GBS patients. To better understand the clinical features and outcome of ZIKV-related GBS, we have performed a systematic review and meta-analysis of all published studies on GBS related to ZIKV. We identified 35 studies, reporting on a total of 601 patients with GBS and a suspected, probable or confirmed Zika virus infection, and were able to summarize data of 587 patients from 21 studies in a pooled analysis. Our study shows that published cases with ZIKV-related GBS generally have both sensory and motor symptoms, facial palsy, demyelination on electrophysiological examination, and a severe disease course that often necessitates ICU admittance. The relatively long time between infectious and neurologic symptoms and the lack of detection of viral particles in bodily fluids in most patients suggest a post-infectious rather than an infectious pathogenesis. However, these results should be interpreted taking into account the heterogeneity between studies, which was considerable for many variables, and a possible reporting bias of more severe cases. Outbreaks of ZIKV and GBS may appear in the future and our study can help clinicians in diagnosing and managing GBS patients in ZIKV endemic areas, and increases our understanding of the neuropathology of ZIKV. [ABSTRACT FROM AUTHOR]