Guillain-Barré syndrome after SARS-CoV-2 infection in an international prospective cohort study

Abstract

In the wake of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, an increasing number of patients with neurological disorders, including Guillain-Barré syndrome (GBS), have been reported following this infection. It remains unclear, however, if these cases are coincidental or not, as most publications were case reports or small regional retrospective cohort studies. The International GBS Outcome Study is an ongoing prospective observational cohort study enrolling patients with GBS within 2 weeks from onset of weakness. Data from patients included in this study, between 30 January 2020 and 30 May 2020, were used to investigate clinical and laboratory signs of a preceding or concurrent SARS-CoV-2 infection and to describe the associated clinical phenotype and disease course. Patients were classified according to the SARS-CoV-2 case definitions of the European Centre for Disease Prevention and Control and laboratory recommendations of the World Health Organization. Forty-nine patients with GBS were included, of whom eight (16%) had a confirmed and three (6%) a probable SARS-CoV-2 infection. Nine of these 11 patients had no serological evidence of other recent preceding infections associated with GBS, whereas two had serological evidence of a recent Campylobacter jejuni infection. Patients with a confirmed or probable SARS-CoV-2 infection frequently had a sensorimotor variant 8/11 (73%) and facial palsy 7/11 (64%). The eight patients who underwent electrophysiological examination all had a demyelinating subtype, which was more prevalent than the other patients included in the same time window [14/30 (47%), P = 0.012] as well as historical region and age-matched control subjects included in the International GBS Outcome Study before the pandemic [23/44 (52%), P = 0.016]. The median time from the onset of infection to neurological symptoms was 16 days (interquartile range 12–22). Patients with SARS-CoV-2 infection shared uniform neurological features, similar to those previously described in other post-viral GBS patients. The frequency (22%) of a preceding SARS-CoV-2 infection in our study population was higher than estimates of the contemporaneous background prevalence of SARS-CoV-2, which may be a result of recruitment bias during the pandemic, but could also indicate that GBS may rarely follow a recent SARS-CoV-2 infection. Consistent with previous studies, we found no increase in patient recruitment during the pandemic for our ongoing International GBS Outcome Study compared to previous years, making a strong relationship of GBS with SARS-CoV-2 unlikely. A case-control study is required to determine if there is a causative link or not.

Inflammatory demyelinating polyneuropathy after the ChAdOx1 nCoV-19 vaccine may follow a chronic course

“…About 70% of cases of GBS are preceded by an infectious respiratory or gastrointestinal illness [ 23 ]. Twenty-two percent of the GBS patients included in the prospective International GBS Outcome Study during the first four months of the Covid-19 pandemic had a preceding SARS-CoV-2 infection, and data indicate this to be due to a post-infectious disease mechanism rather than direct viral invasion [ 24 ]. In CIDP, however, there is paucity as well as heterogeneity of data on preceding infections, with these implicated in approximately 10–20% [ 15 , 25 , 26 ].…”

Neurological sequela and disruption of neuron-glia homeostasis in SARS-CoV-2 infection

“…Although it was initially thought that the pandemic would trigger a spike in GBS cases, data has shown otherwise. Instead, three studies found either stable incidence or a decline in GBS cases during the SARS-CoV-2 era ( Keddie et al, 2021 ; Luijten et al, 2021 ; Umapathi et al, 2021 ). As with other novel viral pathogens, like Zika, there is an incontrovertible and emerging, albeit small, body of evidence that suggests a temporal link between COVID-19 infection and GBS ( Aladawi et al, 2022 ).…”

COVID‐19 and the peripheral nervous system. A 2‐year review from the pandemic to the vaccine era

“…110 A higher prevalence of COVID-19 was noted among GBS cases when compared to the general population, but this could have been secondary to substantial recruitment bias. 110…”