Guillain-Barré syndrome and COVID-19: an observational multicentre study from two Italian hotspot regions

Abstract

ObjectiveSingle cases and small series of Guillain-Barré syndrome (GBS) have been reported during the SARS-CoV-2 outbreak worldwide. We evaluated incidence and clinical features of GBS in a cohort of patients from two regions of northern Italy with the highest number of patients with COVID-19.MethodsGBS cases diagnosed in 12 referral hospitals from Lombardy and Veneto in March and April 2020 were retrospectively collected. As a control population, GBS diagnosed in March and April 2019 in the same hospitals were considered.ResultsIncidence of GBS in March and April 2020 was 0.202/100 000/month (estimated rate 2.43/100 000/year) vs 0.077/100 000/month (estimated rate 0.93/100 000/year) in the same months of 2019 with a 2.6-fold increase. Estimated incidence of GBS in COVID-19-positive patients was 47.9/100 000 and in the COVID-19-positive hospitalised patients was 236/100 000. COVID-19-positive patients with GBS, when compared with COVID-19-negative subjects, showed lower MRC sum score (26.3±18.3 vs 41.4±14.8, p=0.006), higher frequency of demyelinating subtype (76.6% vs 35.3%, p=0.011), more frequent low blood pressure (50% vs 11.8%, p=0.017) and higher rate of admission to intensive care unit (66.6% vs 17.6%, p=0.002).ConclusionsThis study shows an increased incidence of GBS during the COVID-19 outbreak in northern Italy, supporting a pathogenic link. COVID-19-associated GBS is predominantly demyelinating and seems to be more severe than non-COVID-19 GBS, although it is likely that in some patients the systemic impairment due to COVID-19 might have contributed to the severity of the whole clinical picture.

Clinical and Electrophysiological Outcome Measures of Patients With Post-Infectious Neurological Syndromes Related to COVID-19 Treated With Intensive Neurorehabilitation

“…Within our limited case series, we observed that two out of three GBS patients developed axonal forms of the disease, contrary to what was reported by Filosto et al (25), who instead reported a higher prevalence of COVID-related demyelinating forms of GBS in a broader case series. However, data from the literature are still too preliminary to understand whether the clinical and prognostic profile of GBS or myelitis related to SARS-CoV-2 infection may present peculiar features.…”

Long-COVID postural tachycardia syndrome: an American Autonomic Society statement

“…Does a sensory or autonomic neuropathy develop following the acute illness? In addition, there is also increased incidence of acute motor and sensory axonal neuropathy (AMSAN) and acute demyelinating inflammatory demyelinating polyneuropathy (AIDP) associated with COVID-19, both of which may have autonomic dysfunction as a component [ 18 , 19 ]. Long-COVID POTS may also represent a version of acute pan-dysautonomia which is typically post-infectious autonomic neuropathy similar to AIDP and AMSAN.…”

Could symptom overlap of COVID-19 and Guillain–Barré syndrome mask an epidemiological association?

“…Notably, several case series already conveyed a rapid sequence and even significant overlap of COVID-19 pneumonia and GBS [ 4 – 6 ]. We also observed such a rapid temporal sequence in three patients consecutively treated in our department between October 2020 and January 2021:…”