COVID‐19–associated Guillain‐Barré syndrome: The early pandemic experience

• Published in: Muscle & nerve Vol. 62; no. 4; pp. 485 - 491
• Main Authors: Caress, James B., Castoro, Ryan J., Simmons, Zachary, Scelsa, Stephen N., Lewis, Richard A., Ahlawat, Aditi, Narayanaswami, Pushpa
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.10.2020; Wiley Subscription Services, Inc
• Subjects: Antibodies; Betacoronavirus; Brain - diagnostic imaging; Case reports; Cerebrospinal fluid; Coronaviridae; Coronavirus Infections - complications; Coronavirus Infections - epidemiology; coronavirus, COVID‐19; Coronaviruses; COVID-19; Demyelination; Early experience; electrodiagnosis; electrophysiology; Gangliosides; Guillain-Barre syndrome; Guillain-Barre Syndrome - diagnosis; Guillain-Barre Syndrome - etiology; Guillain-Barre Syndrome - physiopathology; Humans; Inflammation; Intravenous administration; Issues & Opinions; Magnetic Resonance Imaging; Neural Conduction - physiology; neurological diseases; Pandemics; Pneumonia, Viral - complications; Pneumonia, Viral - epidemiology; Respiratory distress syndrome; SARS-CoV-2; SARS‐CoV‐2 virus; Severe acute respiratory syndrome coronavirus 2; Signs and symptoms; Time Factors; Viral diseases; neurological diseases; Guillain-Barre syndrome; electrophysiology; electrodiagnosis; SARS-CoV-2 virus; coronavirus, COVID-19
• ISSN: 0148-639X; 1097-4598; 1097-4598
• DOI: 10.1002/mus.27024

Guillain‐Barré syndrome (GBS) is an inflammatory polyradiculoneuropathy associated with numerous viral infections. Recently, there have been many case reports describing the association between coronavirus disease‐2019 (COVID‐19) and GBS, but much remains unknown about the strength of the association and the features of GBS in this setting. We reviewed 37 published cases of GBS associated with COVID‐19 to summarize this information for clinicians and to determine whether a specific clinical or electrodiagnostic (EDx) pattern is emerging. The mean age (59 years), gender (65% male), and COVID‐19 features appeared to reflect those of hospitalized COVID‐19 patients early in the pandemic. The mean time from COVID‐19 symptoms to GBS symptoms was 11 days. The clinical presentation and severity of these GBS cases was similar to those with non–COVID‐19 GBS. The EDx pattern was considered demyelinating in approximately half of the cases. Cerebrospinal fluid, when assessed, demonstrated albuminocytologic dissociation in 76% of patients and was negative for severe acute respiratory distress syndrome–coronavirus‐2 (SARS‐CoV‐2) in all cases. Serum antiganglioside antibodies were absent in 15 of 17 patients tested. Most patients were treated with a single course of intravenous immunoglobulin, and improvement was noted within 8 weeks in most cases. GBS‐associated COVID‐19 appears to be an uncommon condition with similar clinical and EDx patterns to GBS before the pandemic. Future studies should compare patients with COVID‐19–associated GBS to those with contemporaneous non–COVID‐19 GBS and determine whether the incidence of GBS is elevated in those with COVID‐19.