Neurology Xagena

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

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.

Researchers have conducted a systematic review and searched for all published cases until July 20th 2020. 73 patients reported in 52 publications were included.

A broad age range was affected ( mean 55, min 11–max 94 years ) with male predominance ( 68.5% ).

Most patients have shown respiratory and/or systemic symptoms, and developed Guillain–Barré syndrome 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 Guillain–Barré syndrome, 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 has shown 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.

In conclusion, COVID-19-associated Guillain–Barré syndrome seems to share most features of classic post-infectious Guillain–Barré syndrome and possibly the same immune-mediated pathogenetic mechanisms.
Nevertheless, more extensive epidemiological studies are needed to clarify these issues. ( Xagena )

Abu-Rumeileh S et al, Journal of Neurology 2021; 1133–1170