Guillain-Barré syndrome in an era of global infections and 21st century vaccination

Lunn, Michael P.

doi:10.1097/wco.0000000000001086

Cited by 6 publications

(8 citation statements)

References 40 publications

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“…Guillain-Barré syndrome is a post-infectious disease triggered by molecular mimicry of neural epitopes on invading pathogens, driving a break in immunological tolerance to these epitopes, and targeted attack on axons and myelin mediated by macrophages. To date, and despite a number of different approaches, no linear, non-linear, protein, glycoprotein or carbohydrate epitopes, or immunological responses that might result from such drivers have been found in covid-19 127…”

Section: Neurological Syndromesmentioning

confidence: 99%

Pathophysiology, diagnosis, and management of neuroinflammation in covid-19

Brown,

Benjamin,

Lunn

et al. 2023

BMJ

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Although neurological complications of SARS-CoV-2 infection are relatively rare, their potential long term morbidity and mortality have a significant impact, given the large numbers of infected patients. Covid-19 is now in the differential diagnosis of a number of common neurological syndromes including encephalopathy, encephalitis, acute demyelinating encephalomyelitis, stroke, and Guillain-Barré syndrome. Physicians should be aware of the pathophysiology underlying these presentations to diagnose and treat patients rapidly and appropriately. Although good evidence has been found for neurovirulence, the neuroinvasive and neurotropic potential of SARS-CoV-2 is limited. The pathophysiology of most complications is immune mediated and vascular, or both. A significant proportion of patients have developed long covid, which can include neuropsychiatric presentations. The mechanisms of long covid remain unclear. The longer term consequences of infection with covid-19 on the brain, particularly in terms of neurodegeneration, will only become apparent with time and long term follow-up.

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Section: Neurological Syndromesmentioning

confidence: 99%

Pathophysiology, diagnosis, and management of neuroinflammation in covid-19

Brown,

Benjamin,

Lunn

et al. 2023

BMJ

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“…However, neither SARS-CoV-2 nor adenoviruses have been convincingly associated with GBS pathogenesis. Whether the vaccine data indicate that adenovirus may be of undetermined pathogenic importance in GBS is unclear, 34 but it would not be impossible. Discussion of the underlying pathogenesis of AV vaccine-driven GBS remains purely hypothetical owing to rarity, unstructured case ascertainment, and absence of widespread clinical biomarker sampling.…”

Section: Discussionmentioning

confidence: 99%

SARS-CoV-2 Vaccination and Neuroimmunological Disease

Willison,

Pawlitzki,

Lunn

et al. 2024

JAMA Neurol

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ImportanceThe temporal association between the occurrence of neurological diseases, many autoimmune diseases, and vaccination against SARS-CoV-2 has been topically interesting and remains hotly debated both in the medical literature and the clinic. Given the very low incidences of these events both naturally occurring and in relation to vaccination, it is challenging to determine with certainty whether there is any causative association and most certainly what the pathophysiology of that causation could be.ObservationsData from international cohorts including millions of vaccinated individuals suggest that there is a probable association between the adenovirus-vectored vaccines and Guillain-Barré syndrome (GBS). Further associations between other SARS-CoV-2 vaccines and GBS or Bell palsy have not been clearly demonstrated in large cohort studies, but the possible rare occurrence of Bell palsy following messenger RNA vaccination is a topic of interest. It is also yet to be clearly demonstrated that any other neurological diseases, such as central nervous system demyelinating disease or myasthenia gravis, have any causative association with vaccination against SARS-CoV-2 using any vaccine type, although it is possible that vaccination may rarely trigger a relapse or worsen symptoms or first presentation in already-diagnosed or susceptible individuals.Conclusions and RelevanceThe associated risk between SARS-CoV-2 vaccination and GBS, and possibly Bell palsy, is slight, and this should not change the recommendation for individuals to be vaccinated. The same advice should be given to those with preexisting neurological autoimmune disease.

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“…Relapse of cryoglobulins vasculitis [9,15] or other autoimmune diseases [7,11] after SARS-COV-2 vaccines have already been described. Although autoimmune diseases seem more commonly triggered after adenovirus vectored SARS-CoV-2 vaccines [8], also mRNA vaccines, stimulating the immune system, may worsen autoimmune diseases [7,9,11,15]. However mRNA vaccine for SARS-COV-2 is recommended in cryoglobulinemic vasculitis being the benefit/risk in favor of vaccination [10].…”

Section: Discussionmentioning

confidence: 99%