Guillain–Barré syndrome spectrum associated with COVID-19: an up-to-date systematic review of 73 cases

Abstract

Since coronavirus disease-2019 (COVID-19) outbreak in January 2020, several pieces of evidence suggested an association between the spectrum of Guillain-Barré syndrome (GBS) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Most findings were reported in the form of case reports or case series, whereas a comprehensive overview is still lacking. We conducted a systematic review and searched for all published cases until July 20th 2020. We included 73 patients reported in 52 publications. A broad age range was affected (mean 55, min 11-max 94 years) with male predominance (68.5%). Most patients showed respiratory and/or systemic symptoms, and developed GBS manifestations after COVID-19. However, asymptomatic cases for COVID-19 were also described. The distributions of clinical variants and electrophysiological subtypes resemble those of classic GBS, with a higher prevalence of the classic sensorimotor form and the acute inflammatory demyelinating polyneuropathy, although rare variants like Miller Fisher syndrome were also reported. Cerebrospinal fluid (CSF) albuminocytological dissociation was present in around 71% cases, and CSF SARS-CoV-2 RNA was absent in all tested cases. More than 70% of patients showed a good prognosis, mostly after treatment with intravenous immunoglobulin. Patients with less favorable outcome were associated with a significantly older age in accordance with previous findings regarding both classic GBS and COVID-19. COVID-19-associated GBS seems to share most features of classic post-infectious GBS and possibly the same immune-mediated pathogenetic mechanisms. Nevertheless, more extensive epidemiological studies are needed to clarify these issues.

Prolonged Neuropsychological Deficits, Central Nervous System Involvement, and Brain Stem Affection After COVID-19—A Case Series

“…Although we cannot fully exclude some degree of preexisting neuropathy, lack of neuropathy in the medical history and prominent abnormal spontaneous activity in EMG suggest an acute type of neuropathy in our case series. It has already been reported that COVID-19 may be associated with the occurrence of GBS or Miller Fischer syndrome (5,(21)(22)(23). In our cases, neurological deficits were detected 4 to 5 weeks after disease onset, which may be considered rather late for GBS but more likely to result from critical illness polyneuropathy (CIP).…”

GM1 ganglioside antibody and COVID-19 related Guillain Barre Syndrome – A case report, systemic review and implication for vaccine development

“…Searches were performed cross referencing the following key terms “Covid-19”, “Guillain Barre”, “Miller Fisher”, “GM1”, “GQ1b”, and “Ganglioside”. Of the 102 articles found eight were large scale review papers [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ]; the other entries were all case reports. All cases included in the eight review papers and each separate case studies were reviewed.…”

SARS-CoV-2 Infection in the Central and Peripheral Nervous System-Associated Morbidities and Their Potential Mechanism

“…The absence of both the sural nerve sensory nerve action potential (SAP) and the tibial nerve compound muscle action potential (CMAP) by electroneurography measurements indicated peripheral neuropathy resulting from demyelination, typical of GBS. To date, 73 other cases of GBS have been confirmed in COVID-19 patients with male predominance around the world [ 119 – 123 ]. Fortunately, following immunoglobulin treatment, GBS symptoms were resolved in more than 70% of COVID-19 patients [ 123 ].…”