Miller‐Fisher syndrome after COVID‐19: neurochemical markers as an early sign of nervous system involvement

Şenel, Makbule; Abu‐Rumeileh, Samir; Michel, Detlef; Garibashvili, Tamara; Althaus, Katharina; Kassubek, Jan; Otto, Markus

doi:10.1111/ene.14473

Cited by 54 publications

(73 citation statements)

References 8 publications

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“…However, a possible bias might rely on the lack of systematic data concerning the latency between symptom onset and CSF sampling in COVID-19 GBS cases. On another issue, in a further case of MFS associated with-COVID-19, who came to our attention, we observed the absence of intrathecal synthesis of SARS-CoV-2 antibodies together with a massive increase of CSF phosphorylated neurofilament heavy chain (pNfH) and serum neurofilament light chain (NfL) proteins, supporting the role of neurochemical markers as easily implementable tools for the detection of nervous system affection in COVID-19-related diseases [81,82].…”

Section: Discussionsupporting

confidence: 52%

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

et al. 2020

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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.

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Section: Discussionsupporting

confidence: 52%

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

et al. 2020

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“…1 patient had a SARS-CoV-2 IgG and IgA:blood antibody level<1, negative oligoclonal bands and no evidence of synthesis in the Reiber diagram [ 119 ]…”

Section: Resultsmentioning

confidence: 99%

“…CSF antibodies to SARS-CoV-2 were tested in 58/414 (14%) patients who did not have a positive CSF SARS-CoV-2 PCR (49/58 (84%) of whom had symptoms that localized to the CNS and 9/58 (16%) of whom had symptoms that localized to the PNS) [ 6 , 13 , 25 , 31 , 43 , 46 , 98 , 101 , 113 , 119 , 127 , 141 , 182 , 193 , 197 , 209 , 220 , 224 , 231 , 233 , 237 , 246 ]. Of these, 42/58 (72%) tested positive for SARS-CoV-2 antibodies in the CSF [ 6 , 25 , 31 , 43 , 46 , 98 , 119 , 127 , 193 , 197 , 209 , 224 , 231 , 237 ]. Keller et al noted that the 5 patients they reported did not have intrathecal synthesis of SARS-CoV-2 IgG, but did not comment on whether any SARS-CoV-2 antibodies were present in the CSF [ 182 ].…”

Section: Resultsmentioning

confidence: 99%

Cerebrospinal fluid in COVID-19: A systematic review of the literature

Lewis

Frontera

Placantonakis

et al. 2021

Journal of the Neurological Sciences

154

152

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We sought to review the literature on cerebrospinal fluid (CSF) testing in patients with COVID-19 for evidence of viral neuroinvasion by SARS-CoV-2. Methods: We performed a systematic review of Medline and Embase between December 1, 2019 and November 18, 2020 to identify case reports or series of patients who had COVID-19 diagnosed based on positive SARS-CoV-2 polymerase chain reaction (PCR) or serologic testing and had CSF testing due to a neurologic symptom. Results: We identified 242 relevant documents which included 430 patients with COVID-19 who had acute neurological symptoms prompting CSF testing. Of those, 321 (75%) patients had symptoms that localized to the central nervous system (CNS). Of 304 patients whose CSF was tested for SARS-CoV-2 PCR, there were 17 (6%) whose test was positive, all of whom had symptoms that localized to the central nervous system (CNS). The majority (13/17, 76%) of these patients were admitted to the hospital because of neurological symptoms. Of 58 patients whose CSF was tested for SARS-CoV-2 antibody, 7 (12%) had positive antibodies with evidence of intrathecal synthesis, all of whom had symptoms that localized to the CNS. Of 132 patients who had oligoclonal bands evaluated, 3 (2%) had evidence of intrathecal antibody synthesis. Of 77 patients tested for autoimmune antibodies in the CSF, 4 (5%) had positive findings. Conclusion: Detection of SARS-CoV-2 in CSF via PCR or evaluation for intrathecal antibody synthesis appears to be rare. Most neurological complications associated with SARS-CoV-2 are unlikely to be related to direct viral neuroinvasion.

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“…We reviewed all the cases excluded by Abu-Rumeileh et al also and found no positive ganglioside antibodies among those excluded patients. We have identified seven more reported individual cases, which have not been included in any case review to date [ 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. Including our current case, there are 83 individual cases of COVID-19 related GBS or MFS being reported to date.…”

Section: Results Of Literature Reviewmentioning

confidence: 99%

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

Dufour

Liu

2021

Brain, Behavior, & Immunity - Health

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Miller‐Fisher syndrome after COVID‐19: neurochemical markers as an early sign of nervous system involvement

Cited by 54 publications

References 8 publications

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

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

Cerebrospinal fluid in COVID-19: A systematic review of the literature

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

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