Research: CARESS and COLLEAGUES,

Listed in Issue 281

Abstract

CARESS and COLLEAGUES, 1 Department of Neurology, Wake Forest School of Medicine, North Carolina, USA; 2 Department of Neurology, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA; 3 Department of Neurology, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA; 4 Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA; 5 Department of Neurology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA reviewed the association between COVID-19 and Guillain-Barré syndrome.

Background

Guillain-Barré syndrome (GBS) is an inflammatory polyradiculoneuropathy [a slowly developing autoimmune disorder in which the body's immune system attacks the myelin that insulates and protects your body's nerves] associated with numerous viral infections.

Methodology

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.

Results

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 [elevation in CSF protein (>0.55 g/L) without an elevation in white blood cells] 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.

Conclusion

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.

References

James B Caress  1 , Ryan J Castoro  1 , Zachary Simmons  2 , Stephen N Scelsa  3 , Richard A Lewis  4 , Aditi Ahlawat  5 , Pushpa Narayanaswami  5. COVID-19-associated Guillain-Barré syndrome: The early pandemic experience Muscle Nerve. 62(4):485-491.  Oct 2020. doi: 10.1002/mus.27024. Epub Aug 11 2020 .

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