Abstract
In January 2020, the first case of Guillain Barre syndrome (GBS) due to COVID-19 was documented in China. GBS is known to be postinfectious following several types of infections. Although causality can only be proven through large epidemiological studies, we intended to study this association by a thorough review of the literature. We searched PubMed, EMBASE, and Google scholar and included all papers with English or Spanish full text and original data of patients with GBS and recent COVID infection. Variables of interest were demographics, diagnostic investigations, and the latency between arboviral and neurological symptoms. Further variables were pooled to identify GBS clinical and electrophysiological variants, used treatments, and outcomes. The certainty of GBS diagnosis was verified using Brighton criteria. We identified a total of 109 GBS cases. Ninety-nine cases had confirmed COVID-19 infection with an average age of 56.07 years. The average latency period between the arboviral symptoms and neurologic manifestations for confirmed COVID-19 cases was 12.2 d. The predominant GBS clinical and electromyography variants were the classical sensorimotor GBS and acute demyelinating polyneuropathy respectively. Forty cases required intensive care, 33 cases required mechanical ventilation, and 6 cases were complicated by death. Studies on COVID-19-related GBS commonly reported sensorimotor demyelinating GBS with frequent facial palsy. The time between the onset of infectious and neurological symptoms suggests a postinfectious mechanism. Early diagnosis of GBS in COVID-19 patients is important as it might be associated with a severe disease course requiring intensive care and mechanical ventilation.
Highlights
In December 2019, the COVID-19 epidemic emerged in Wuhan, China, causing global alterations in the field of healthcare, and in all walks of life
Cases with either positive polymerase chain reaction (PCR) or SARSCoV2 antibodies were categorized as confirmed cases, whereas patients diagnosed based on abnormal chest radiographs or clinical suspicion only were categorized as suspected cases
We have identified 99 cases of COVID-19 complicated by Guillain Barre syndrome (GBS) that has been confirmed with either PCR testing or serology (Table 1)
Summary
In December 2019, the COVID-19 epidemic emerged in Wuhan, China, causing global alterations in the field of healthcare, and in all walks of life. It was documented that SARS-CoV-2 is associated with neurologic manifestations, including headache, dizziness, hypogeusia, and hyposmia.[1] Beside hypogeusia and hyposmia, there has been increased reporting of distinct peripheral nervous system (PNS) diseases in COVID-19 patients. Cranial nerves involvement can be present in GBS patients, with facial and bulbar muscles often being affected.[2] GBS can be classified into different distinct clinical variants including classical sensorimotor, paraparetic, pure motor, pure sensory, Miller Fisher syndrome (MFS), pharyngeal-cervical-brachial variant (PCB), bilateral facial palsy with paranesthesia, and Bickerstaff brainstem encephalitis.[3] Another classification of GBS based on the electromyography (EMG) findings has been described, with acute inflammatory demyelinating polyneuropathy (AIDP) being the most common variant. The average latency period between the arboviral symptoms and neurologic manifestations for confirmed COVID-19 cases was 12.2 d. Diagnosis of GBS in COVID-19 patients is important as it might be associated with a severe disease course requiring intensive care and mechanical ventilation
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