Guillain Barre Syndrome as a Complication of COVID-19: A Systematic Review

Abstract

Background: In January 2020, the first case of Guillain Barre syndrome (GBS) due to COVID-19 was documented in China. GBS is known to be postinfectious following several types of infections. Although causality can only be proven through large epidemiological studies, we intended to study this association by a thorough review of the literature. Methods: We searched PubMed, EMBASE, and Google scholar and included all papers with English or Spanish full text and original data of patients with GBS and recent COVID infection. Variables of interest were demographics, diagnostic investigations, and the latency between arboviral and neurological symptoms. Further variables were pooled to identify GBS clinical and electrophysiological variants, used treatments, and outcomes. The certainty of GBS diagnosis was verified using Brighton criteria. Results: We identified a total of 109 GBS cases. Ninety-nine cases had confirmed COVID-19 infection with an average age of 56.07 years. The average latency period between the arboviral symptoms and neurologic manifestations for confirmed COVID-19 cases was 12.2 d. The predominant GBS clinical and electromyography variants were the classical sensorimotor GBS and acute demyelinating polyneuropathy respectively. Forty cases required intensive care, 33 cases required mechanical ventilation, and 6 cases were complicated by death. Conclusions: Studies on COVID-19-related GBS commonly reported sensorimotor demyelinating GBS with frequent facial palsy. The time between the onset of infectious and neurological symptoms suggests a postinfectious mechanism. Early diagnosis of GBS in COVID-19 patients is important as it might be associated with a severe disease course requiring intensive care and mechanical ventilation.

A 50-Year-Old Patient with Guillain–Barré Syndrome after COVID-19: A Case Report

“…A worse course of GBS was observed in older patients who had a more severe course of COVID-19 infection. In the described case, the risk factor for GBS was only the patient's sex (GBS is more prevalent in men) [4,19]. Moreover, the relatively young age of the patient, the mild course of COVID-19, and the prompt treatment could positively affect the course of GBS.…”

“…A total of 72.1% (49/68) of patients with post-COVID-19 GBS achieved a partial or complete remission, whereas 5% (4/68) died [18]. In the study by Aladawi et al, which reviewed 109 cases of post-COVID-19 GBS, 40/99 patients required intensive care treatment, 33.3% (33/99) required mechanical ventilation, and 6.1% (6/99) of patients died [19]. A worse course of GBS was observed in older patients who had a more severe course of COVID-19 infection.…”

Guillain-Barré Syndrome After Ad26.COV2.S Vaccination

“…A 2021 review identified a total of 109 published cases of GBS with confirmed SARS-CoV-2 infection. Although causality could not be proven, the authors found that AIDP with facial palsy was the most common presentation [ 27 ]. On the other hand, an epidemiological and cohort study by Keddie and colleagues did not find evidence of a causative relationship between SARS-CoV-2 and GBS [ 28 ].…”

Comparison of electrodiagnostic findings in patients with post-COVID-19 and non-COVID-19 Guillain-Barre syndrome

“…In various studies evaluating GBS cases which has developed after COVID-19, it has been reported that the AIDP form of GBS is seen most frequently, followed by AMSAN and AMAN forms, respectively (15,16). While our study was conducted on all forms of GBS, the fact that this study was conducted only on the AIDP form of GBS and not including AMAN and AMSAN forms in the study may have caused different results for CMAP and SNAP amplitude values of nerves between two studies.…”