Onset Of Guillain-Barré Syndrome Research Articles

Efficacy and safety of eculizumab in Guillain-Barré syndrome: A phase 3, multicenter, double-blind, randomized, placebo-controlled clinical trial.

Guillain-Barré syndrome (GBS) is an acute, self-limited, immune-mediated peripheral neuropathy. Current treatments for GBS include intravenous immunoglobulin (IVIg) and plasma exchange, which may not sufficiently benefit severely affected patients. This study evaluated the efficacy and safety of eculizumab add-on therapy to IVIg (standard-of-care treatment) in patients with severe GBS. This phase 3, multicenter, double-blind, randomized, placebo-controlled clinical trial (NCT04752566), enrolled Japanese adults (age ≥ 18 years) with severe GBS (Hughes functional grade [FG] score FG3 or FG4/FG5 within 2 weeks of onset of GBS). Participants were randomized 2:1 to receive intravenous infusion of eculizumab or placebo (once weekly for 4 weeks) with IVIg treatment with 20 weeks of follow-up. Primary efficacy endpoint was the time to first reach FG score ≤1 (able to run). Key secondary endpoints were proportion of participants achieving FG ≤1 at weeks 8 and 24 and FG improvement ≥3 at week 24. Pharmacodynamic analysis of serum free C5 concentration over time was performed. Safety was evaluated. The analysis included 57 participants (eculizumab, n = 37; placebo, n = 20). Primary endpoint was not achieved (hazard ratio, 0.9; 95% CI, 0.45-1.97; p = .89). Key secondary endpoints did not reach statistical significance. Serum C5 concentration was reduced by 99.99% at 1 h postdose and sustained to week 5 but returned to baseline at the end of follow-up period. No new safety signals for eculizumab were identified. Although well tolerated, eculizumab treatment did not show significant effects on motor function recovery compared to placebo in patients with GBS.

Relative frequencies and clinical features of Guillain-Barré Syndrome before and during the COVID-19 pandemic in North China

ObjectiveMost studies investigated the relationship between COVID-19 and Guillain-Barré syndrome (GBS) by comparing the incidence of GBS before and during the pandemic of COVID-19. However, the findings were inconsistent, probably owing to varying degrees of the lockdown policy. The quarantine requirements and travel restrictions in China were lifted around December 7, 2022. This study aimed to explore whether the relative frequency of GBS increased during the major outbreak in the absence of COVID-19-mandated social restrictions in China.MethodsGBS patients admitted to the First Hospital, Shanxi Medical University, from December 7, 2022 to February 20, 2023, and from June, 2017 to August, 2019 were included. The relative frequencies of GBS in hospitalized patients during different periods were compared. The patients with and without SARS-CoV-2 infection within six weeks prior to GBS onset formed the COVID-GBS group and non-COVID-GBS group, respectively.ResultsThe relative frequency of GBS among hospitalized patients during the major outbreak of COVID-19 (13/14,408) was significantly higher than that before the COVID-19 epidemic (29/160,669, P < 0.001). More COVID-GBS patients (11/13) presented AIDP subtype than non-COVID-GBS cases (10/27, P = 0.003). The mean interval between onset of infective symptoms and GBS was longer in COVID-GBS (21.54 ± 11.56 days) than in non-COVID-GBS (5.76 ± 3.18 days, P < 0.001).ConclusionsCOVID-19 significantly increased the incidence of GBS. Most COVID-GBS patients fell into the category of AIDP, responded well to IVIg, and had a favorable prognosis.

Superacute onset of Guillain-Barré syndrome after elective spinal surgery: A case report and literature review.

Guillain-Barré syndrome (GBS) epitomizes an acute peripheral neuropathy hallmarked by an autoimmune retort directed at the myelin sheath enwrapping peripheral nerves. While it is widely acknowledged that a majority of GBS patients boast a history of antecedent infections, the documentation of postoperative GBS occurrences is progressively mounting. Drawing upon an exhaustive compendium of recent case reports, the disease's inception spans a gamut from within 1 hour to 1.2 years. At this juncture, we proffer a singular case: an instance involving a 51-year-old gentleman who underwent lumbar spine surgery, only to encounter immediate debilitation of limb and respiratory musculature. Post elimination of variables linked to anesthetic agents, encephalon, and spinal cord pathologies, a potent suspicion of superacute GBS onset emerged. Subsequent to immunoglobulin therapy, plasmapheresis, and adjunctive support, the patient's ultimate demise became manifest. No progress was found to date. Given GBS's potential to instigate paralysis, respiratory collapse, and autonomic nervous system aberrations, alongside other pernicious sequelae, coupled with the exceptional rarity of the temporal onset in this particular instance, it undeniably proffers an imposing conundrum for anesthetists in the realm of differential diagnosis and therapeutic conduct. During the postoperative convalescence phase under anesthesia, should the patient evince deviant limb musculature vigor and compromised respiratory sinews, the prospect of GBS must not be consigned to oblivion. Precision in diagnosis conjoined with apt therapeutic measures could well be the harbinger of a divergent denouement for the afflicted patient.

Takotsubo cardiomyopathy in Guillain-Barré syndrome.

Takotsubo cardiomyopathy (TCM) is a serious autonomic complication of Guillain-Barré syndrome (GBS). However, the association between TCM and GBS has not been investigated in detail. We investigated the characteristics of GBS patients with TCM (GBS-TCM). Clinical features and anti-ganglioside antibody between the GBS-TCM patients and 62 classical GBS patients without TCM as control patients were compared. Eight GBS-TCM patients were identified, in whom TCM was diagnosed at a mean of 6.5 [range 3-42] days after the onset of GBS. The age at onset of GBS was elder in the GBS-TCM patients than in the control GBS patients (76.5 [56-87] vs. 52 [20-88] years, p < 0.01). Notably, cranial nerve deficits, particularly in the lower cranial nerves, were observed in all GBS-TCM patients (100% vs. 41.9%, p < 0.01). Additionally, the GBS-TCM patients showed a higher GBS disability score at nadir (5 [4-5] vs. 4 [1-5], p < 0.01), and lower Medical Research Council sum scores at admission and nadir (37 [30-44] vs. 48 [12-60] at admission, p < 0.05, and 20 [12-44] vs. 40 [0-60] at nadir, p < 0.05, respectively). Mechanical ventilation was more frequently required in the GBS-TCM patients (62.5% vs. 11.3%, p < 0.01). Three GBS-TCM patients were positive for anti-ganglioside antibodies. TCM occurred at a relatively early phase of GBS. The characteristics of GBS-TCM were the elder, lower cranial nerve involvements, severe limb weakness, and respiratory failure.

Clinical characteristics of Guillain–Barré syndrome in patients with primary Sjögren’s syndrome

To investigate the clinical characteristics of Guillain–Barré syndrome (GBS) in patients with primary Sjögren’s syndrome (SS). Records of patients with positive anti-SSA antibodies hospitalized in the Beijing Tiantan Hospital between December 2011 and May 2020 were retrieved. Patients who fulfilled the criteria for diagnosis of GBS and primary SS were included, and their clinical data were analyzed. Among the 785 patients with positive anti-SSA, 52 patients were identified in this study. They were 27 males and 25 females with median age of 59 years old. Besides anti-SSA antibodies, multiple autoantibodies were detected in these patients including antinuclear antibody, anti-Ro52, anti-mitochondrial M2, anti-thyroid peroxidase and anti-thyroglobulin autoantibodies. Preceding infection was reported in 42 patients. Hyporeflexia/areflexia and limbs weakness were the most common manifestation and 35 patients presented cranial nerve injuries. GBS disability score of 3, 4 and 5 was scaled in 28 (53.8%), 15 (28.8%) and 3 (5.8%) patients respectively. Forty-six patients received intravenous immunoglobulin (IVIG) monotherapy, 5 patients were treated by IVIG plus glucocorticoids, and 51 patients improved during hospitalization. The frequency of male gender among the patients with both GBS and primary SS suggests an independent onset of GBS and the co-existence of these autoimmune diseases in patients with multiple autoantibodies. Majority of patients with GBS and primary SS experience benign disease course.

Analysis of Post-COVID-19 Guillain-Barré Syndrome over a Period of One Year in the University Hospital of Split (Croatia).

The virus SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) is capable of attacking the nervous system in several ways and leading to neurological diseases such as GBS (Guillain-Barré syndrome) through the resulting neurotropism and immune response. The aim of this study is to show the relationship between Coronavirus disease (COVID-19) and GBS and to better understand the clinical symptoms to prevent poor outcomes. Data from 15 patients were extracted from the Department of Neurology, University Hospital of Split, Croatia, for the year 2021. The age of the patients ranged from 26 to 89 years, of whom 27% were women. Sixty seven percent of all GBS patients recovered from COVID-19 infection, whereas post-vaccinal polyradiculoneuritis was detected in 6%. Forty four percent of the patients who developed GBS had a severe form of COVID-19 infection. Forty percent of patients were treated with intravenous immunoglobulins (IVIG), followed by therapeutic plasma exchange (PLEX) in 27%. After the therapy, improvement was observed in 13 patients, while two patients died. The results suggest that SARS-CoV-2 triggers GBS because it follows a similar pattern of infection as the other viral and bacterial agents that contribute to the onset of GBS. There is no evidence that prior infection with COVID-19 worsens the clinical presentation of GBS.

Predictors of Treatment Outcome and Clinical Profile among Guillain- Barre Syndrome Patients in South India.

Guillain-Barre syndrome (GBS) is one of the principal causes of acute neuromuscular weakness and paralysis worldwide. Its clinic-epidemiological profile and factors influencing its treatment outcomes in developing countries are very minimally studied. The study aimed to find out the risk factors, clinical presentation, management, and predictors of treatment outcomes among GBS patients admitted in two tertiary care hospitals. Medical records of 121 inpatients with GBS confirmed based on the Brighton criteria over the recent five-year period from June 2017 to May 2022 were examined. Assessment of the severity of GBS was done using the Hughes functional grading scale. The mean age at onset was 36.8 ± 18.9 years. The majority of the patients [82 (67.8%)] were males. Antecedent illnesses within 1 month of onset of GBS were present among 34 (28.1%) patients. The majority of them developed respiratory tract illnesses [13 (38.2%)]. Recurrent history of GBS was observed among 4 (3.3%) patients. The median time gap between the onset of antecedent illnesses and the onset of GBS was 5 days (IQR 3, 10). The most common symptom among GBS patients was the weakness of the muscles of the extremities [117 (96.7%)]. The pattern of progression of weakness among 53 (45.3%) of these patients was from the lower to upper limbs. The most common sign noted was hypotonia [64(52.9%)]. Complications due to GBS were observed among 12 (9.9%) patients. The most common complication among them was respiratory distress in 11 (91.7%) patients, followed by autonomic dysfunctions in 8 (66.7%). Albuminocytological dissociation in cerebrospinal fluid was noted among 48 (39.7%) patients. The majority of patients in nerve conduction studies had acute inflammatory demyelinating polyneuropathy [61(50.4%)]. The majority of the GBS patients [68 (56.2%)] were treated using intravenous immunoglobulin (IVIG). 95 (78.5%) patients improved with treatment at the time of discharge. In multivariable analysis, the absence of antecedent illnesses (p =0.029), Brighton's diagnostic certainty levels 1 and 2 of GBS (p =0.024), and being on IVIG treatment (p =0.05) were associated with improvement in disease condition among the patients. Appropriate diagnosis of GBS using both clinical and laboratory evidence and providing appropriate treatment along with more supervision among GBS patients with a history of antecedent illnesses will help improve their prognosis at the time of discharge.

Guillain-Barré syndrome as clinical presentation of a recently acquired hepatitis C

About 40% of the Guillain-Barré syndrome (GBS) cases are associated with prodromal infections; occasionally, it has been associated to chronic hepatitis C or its reactivation. A 38-year-old man came to our attention after transaminase elevation occurred during recovery from GBS. All the possible causes of acute hepatitis were excluded except for the positivity of HCVRNA, and a diagnosis of new onset hepatitis C was made. Recalling patient history, we observed that (i) anti-HCV antibodies were negative and liver enzymes were normal 7 weeks before GBS onset; (ii) in the early stages of ICU admission, liver enzymes started to rise, but the elevation remained mild under steroid treatment; (iii) serum aminotransferase peak occurred 11 weeks after GBS onset; and (iv) HCV RNA was already significantly high when anti-HCV antibodies became positive, consistent with an acute hepatitis. Furthermore, anti-HCV seroconversion was likely delayed or blurred by steroids and immunoglobulin infusions. The interval of time between GBS onset and transaminase elevation compared with the patient clinical history allows us to establish a cause-effect relationship between the two diseases. All patients with GBS should be tested for hepatitis C, or its reactivation if already present, and followed up for an early diagnosis and treatment.

Neuropathic Tremor in Guillain-Barré Syndrome.

Neuropathic Tremor (NT) is a postural/kinetic tremor of the upper extremity, often encountered in patients with chronic neuropathies such as paraprotein-associated and hereditary neuropathies. To describe the clinical and electrophysiological features of NT in a previously underrecognized setting- during recovery from Guillain-Barré Syndrome (GBS). Patients with a documented diagnosis of GBS in the past, presenting with tremor were identified from review of clinical records. Participants underwent structured, videotaped neurological examination, and electrophysiological analysis using tri-axial accelerometry-surface electromyography. Tremor severity was assessed using the Fahn-Tolosa-Marin Tremor Rating Scale. We describe the clinical and electrophysiological features of 5 patients with GBS associated NT. Our cohort had a fine, fast, and slightly jerky postural tremor of frequency ranging from 8 to 10 Hz. Dystonic posturing and overflow movements were noted in 4/5 patients. Tremor appeared 3 months-5 years after the onset of GBS, when patients had regained near normal muscle strength and deep tendon jerks were well elicitable. Electrophysiological analysis of tremor strongly suggested the presence of a central oscillator in all patients. NT is not limited to chronic inflammatory or hereditary neuropathies and may occur in the recovery phase of GBS. The tremor is characterized by a high frequency, jerky postural tremor with dystonic posturing. Electrophysiological evaluation suggests the presence of a central oscillator, hypothetically the cerebellum driven by impaired sensorimotor feedback.

Clinical features and maternal and fetal outcomes in women with Guillain-Barré syndrome in pregnancy.

Guillain-Barre syndrome (GBS) is an acute inflammatory polyradiculoneuropathy rarely observed during pregnancy. In this retrospective study, we analyzed the characteristics of pregnant women with GBS (pGBS) diagnosed in French University Hospitals in the 2002-2022 period and compared them with a reference group of same-age non-pregnant women with GBS (npGBS) identified in the same institutions & timeframe. We identified 16 pGBS cases. Median age was 31years (28-36), and GBS developed in the 1st, 2nd, and 3rd trimester in 31%, 31% and 38% of cases respectively. A previous infection was identified in six cases (37%), GBS was demyelinating in nine cases (56%), and four patients (25%) needed respiratory assistance. Fifteen patients (94%) were treated with intravenous immunoglobulins, and neurological recovery was complete in all cases (100%). Unscheduled caesarean section was needed in five cases (31%), and two fetuses (12.5%) died because of cytomegalovirus (CMV) infection (1 case) and HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets) syndrome (1 case). In comparison with a reference group of 18 npGBS women with a median age of 30years (27-33), pGBS patients more frequently had CMV infection (31% vs 11%), had a prolonged delay between GBS onset and hospital admission (delay > 7days: 57% vs 12%), more often needed ICU admission (56% vs 33%) and respiratory assistance (25% vs 11%), and more often presented with treatment-related fluctuations (37% vs 0%). This study shows GBS during pregnancy is a severe maternal condition with significant fetal mortality.

Assessment of the relationship between COVID -19 and Guillain Barre syndrome: a single center pandemic experience

Background &amp; Objective: This study aimed to determine the relationship between COVID-19 infection/ vaccination and Guillain-Barré syndrome (GBS) and to compare clinical characteristics and functional outcomes between COVID-19-related and non-COVID-19 GBS patients. Method: The medical files of the patients who sought treatment with the diagnosis of GBS between March 2020 and July 2022 were retrospectively analyzed. The patients were divided into groups as COVID-19-related GBS (C-GBS) and non-COVID-19 GBS (NC-GBS). Demographic and clinical characteristics, neurological examination findings, treatment protocols, and outcomes, including functional status, ambulation level, independence in daily living activities, and anxiety-depression levels of the patients with GBS, were recorded. Results: A total of 25 patients were included in the study. GBS was found to be associated with COVID-19 in 9 (36%) patients. Among them, 5 (20%) patients developed GBS after COVID-19 infection and 4 (16%) after the COVID-19 vaccine. The latency between COVID-19 infection and the onset of GBS ranged from 7 to 60 days, and the latency between vaccination and the onset of GBS ranged from 3 to 60 days. The clinical presentation and features, disease severity, and electrodiagnostic patterns of C-GBS patients were similar to NC-GBS patients. Also, there was no significant difference between patients with C-GBS and NC-GBS regarding functional status, ambulation level, functional independence in daily activities, and anxiety-depression levels. Conclusion: GBS is not uncommon in COVID-19. In this study, 20% of GBS cases admitted to our hospital during the pandemic seem to be associated with COVID-19 infection and 16% with COVID-19 vaccination. However, clinical features and functional outcomes of C-GBS and NC-GBS cases are similar.

Before blaming SARS-CoV-2 for GBS, other causes should be ruled out.

We read with interest the article by Parikh et al.[1] about a 2.5-year-old female patient who developed progressive, flaccid quadriparesis that resulted in being unable to stand or walk. Work-up revealed positive IgG-antibodies against SARS-CoV-2, demyelinating neuropathy, and dissociation cyto-albumin.[1] Guillain–Barre syndrome (GBS) was diagnosed and intravenous immunoglobulins (IVIG) were given with little benefit.[1] The study is appealing but raises concerns. We disagree with the diagnosis of acute SARS-CoV-2 infection.[1] The patient tested negative for SARS-CoV-2 in the PCR and the rapid antigen test (RAT).[1] Only neutralizing IgG antibodies were elevated.[1] Given that neutralizing antibodies can persist for months,[2] it cannot be ruled out that SARS-CoV-2 infection may have occurred already weeks or months before the onset of GBS, suggesting a causal relationship between SARS-CoV-2 and GBS rather unlikely. Further arguments against acute SARS-CoV-2 infection are that the history was negative for pulmonary or gastrointestinal infections shortly before the onset of GBS,[1] the lymphocyte count was normal, and no other stigmata of COVID-19 were present.[1] Acute SARS-CoV-2 infections are often associated with lymphopenia.[3] We disagree with the interpretation of nerve conduction studies as “demyelinating.” According to Table 1, nerve conduction velocities in the median, ulnar, peroneal, and tibial nerves were within normal limits.[1] The findings in Table 1 are more suggestive of an axonal lesion;[1] therefore, the diagnosis should be acute, motor, axonal neuropathy (AMAN) rather than acute, inflammatory demyelinating polyneuropathy (AIDP). We disagree with the statement in the discussion that there were no abnormalities on follow-up.[1] No results of follow-up investigations were given in the case description.[1] The patient was discharged with severe paraparesis (muscular research council [MRC] 2/5 respectively 3/5).[1] We should know the period in which neurological abnormalities have completely disappeared. Because muscle strength in the lower limbs hardly improved (MRC 2/5 bilaterally at onset, MRC 2/5 respectively 3/5 at discharge), IVIGs can be rated as rather ineffective. We should know if ever plasmapheresis was considered. Additionally, GBS patients who do not respond to treatment should be evaluated for nodopathy.[4] and it should be borne in mind that about one-third of GBS patients have no causative agent. Because the patient had difficulty sitting down,[1] involvement of the axial muscles cannot be ruled out. Because respiratory muscles are often affected along with the axial muscles, we should be informed if there was any evidence of muscular respiratory insufficiency. Were oxygen saturation and lung function tests within normal limits? The results of the virus panels are missing.[1] We should know which viral infections have been ruled out. Given that GBS is often triggered by previous viral infections,[5] ruling them all out is imperative. Even in the absence of a gastrointestinal infection, the patient must be tested for antibodies to Campylobacter jejuni and Mycoplasma pneumoniae.[5] Overall, the interesting study has limitations that challenge the results and their interpretation. Diagnosing COVID-19 requires a positive PCR. A causal connection between SARS-CoV-2 and GBS can only be established if a temporal connection between the infection and the onset of neurological compromise can be demonstrated. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Ethics approval Ethics approval was in accordance with ethical guidelines. The study was approved by the institutional review board. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Особливості маніфестації неврологічних симптомів гострих полінейропатій та їх диференційна діагностика в дітей при коронавірусній хворобі (COVID-19)

The relevance of the problem of diagnosis and treatment of polyneuropathy in children is due to the diverse clinical manifestations of this pathology, which are often acute and can lead to severe, life-threatening complications. Guillain-Barré syndrome (GBS) refers to acute or subacute, often post-infectious, immune-mediated polyneuropathies accompanied by axonal damage to nerve trunks and peripheral nerves. The present study is devoted to the assessment of neurological symptoms in the acute course of GBS, including its differential diagnosis with musculoskeletal lesions in coronavirus disease (COVID-19) in childhood. Purpose - to determine the features of the debut and characterize the neurological symptoms of acute polyneuropathies in children, including GBS in COVID-19. Materials and methods. We examined 10 children with confirmed GBS. Clinical-anamnestic, general clinical, clinical-neurological, clinical-instrumental and clinical-laboratory methods of examination were used. Results. In 1 of the examined patients aged 6 years, GBS developed in the acute period of COVID-19 and manifested as acute flaccid paresis in the distal, and after 4 days - severe weakness of the thigh muscles in combination with leg pain. In 8 of the examined patients, the debut of GBS occurred within 7-21 days after an acute respiratory viral infection. Of these, 6 children had the acute phase of COVID-19 14-21 days before the onset of GBS, which was confirmed by the results of an oropharyngeal PCR-test. The acute phase of COVID-19 in these patients was manifested by fever up to 38.0º, ague, hyposmia, lasting from 3 to 5 days. Severe pain in the legs was noted in all patients with GBS. The absence of elevated levels of creatine phosphokinase, alanine aminotransferase, aspartate aminotransferase according to biochemical blood tests in patients and the absence of myoglobin in the urine excluded rhabdomyolysis of skeletal muscles. Electroneuromyography (ENMG) confirmed the neural type of lesion in the legs. Conclusions. In most patients, the debut of GBS occurred 3 weeks after the acute phase of COVID-19. Pain syndrome and symmetrical flaccid paresis were the leading symptoms of the course of GBS in children. Reduced excitation conduction velocity along the motor fibres of the tibial and peroneal nerves, according to the results of ENMG, allowed confirming the diagnosis of GBS. Differential diagnosis of GBS with musculoskeletal lesions, in particular, the exclusion of the diagnosis of rhabdomyolysis in COVID-19 in children, allowed for timely prescription of adequate therapy. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

SARS‐CoV‐2‐related polyradiculitis must be preceded by PCR‐confirmed COVID‐19

We read with interest the article by Pourbahtyaran et al. about a prospective study on seven pediatric patients with SARS-CoV-2-associated Guillain Barre syndrome (GBS) recruited between March 2020 and August 2021 in a single Iranian center.1 These patients were compared with 15 GBS patients who were negative for SARS-CoV-2 mRNA as well as antibodies recruited during the same period.1 It was found that the prevalence of GBS did not increase during the pandemic compared with previous years but that the outcome of SARS-CoV-2-related GBS was worse compared with non-COVID-related GBS.1 The study is appealing but carries limitations that raise concerns and should be discussed. The main limitation of the study is that SARS-CoV-2 infection was diagnosed in six patients with SARS-CoV-2-related GBS only by determination of antibodies against SARS-CoV-2.1 It was not communicated whether these antibodies were of the IgG or IgM subtype.1 It was also not discussed that these antibodies can persist for months, why establishing a causal relationship between SARS-CoV-2 infection and GBS is not reliable in these six patients. They should be excluded from the evaluation. Given the fact that the latency between the onset of infection and the onset of neurological manifestations ranged between 2 and 30 days, it is surprising that only one-seventh of patients was PCR-positive for SARS-CoV-2.1 A second limitation of the study is that no information about the cerebrospinal fluid (CSF) findings was provided.1 GBS is usually diagnosed according to the Brighton criteria2 and for level 1 diagnosis of GBS it is mandatory that patients have typical CSF findings. We should be told how many of the seven patients with SARS-CoV-2-related GBS had dissociation-cyto-albuminique and how many did not show this abnormality. Furthermore, CSF can be examined for cytokines, chemokines, glial factors, and 14-3-3, which have been shown elevated in patients with neuro-COVID.3 We disagree with the conclusion that the prevalence of GBS did not increase during the pandemic. First, the number of patients is too small to draw such conclusions. Strictly speaking, only a single patient had SARS-CoV-2-related GBS. In the remaining patients, the acute SARS-CoV-2 infection remained unconfirmed. Second, the pandemic is ongoing and thus lasts more than 3 years. To compare prepandemic prevalences with those during the pandemic patients from the entire pandemic period should be recruited. Third, the pre-COVID period with which COVID patients were compared with is not mentioned. Because GBS prevalences may have undulated in the pre-COVID era, it is crucial to know the exact time of recruitment. Regarding the 15 years old female with lupus erythematosus, we should know about her long-term immunosuppressive treatment. Immuno-suppressed patients are more susceptible to infectious diseases, and since she was SARS-CoV-2 negative, another pathogen is more likely to be the cause. Overall, the interesting study has limitations that call the results and their interpretation into question. SARS-CoV-2-related GBS should only be diagnosed in patients with a PCR-confirmed SARS-CoV-2 infection time linked with the onset of GBS. JF: design, literature search, discussion, first draft, critical comments, final approval. None. No funding was received. The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors. All data are available from the corresponding author.

Guillain-Barré syndrome in remission of Ulcerative colitis: a case report

This case report provides a unique instance of a patient who developed Guillain-Barré syndrome (GBS) during the remission phase of ulcerative colitis (UC). GBS is a rare but severe autoimmune disorder affecting the peripheral nervous system, while UC is a chronic inflammatory bowel disease. The co-occurrence of GBS and UC is rare, and its underlying mechanisms are not well understood. The patient's medical history and the course of their treatment are discussed in detail to provide a comprehensive understanding of the condition.The onset of GBS in this case report was characterized by lower extremity weakness and numbness of the upper extremities, which is consistent with the typical symptoms of GBS. The electromyography (EMG) results showed low limb nerve conduction and velocity with low amplitude, which supports the diagnosis of GBS. The treatment involved intravenous (IV) methylprednisolone, which is a commonly used steroid in the management of GBS. The patient showed improvement in his symptoms, with the weakness and numbness disappearing and muscle strength recovering, which is in line with the expected outcome of treatment with steroids.This case report provides valuable insight into the complex interplay between GBS and UC, and the potential impact of autoimmune diseases on each other. The findings of this report will contribute to the existing literature on GBS and UC, and help healthcare professionals to make informed decisions regarding the diagnosis and management of these complex conditions. The report concludes with a discussion of the implications of the case and the need for further research to better understand the relationship between GBS and UC.

Guillain-Barré syndrome in patients dying with COVID-19 in Italy: a retrospective study.

We presented a four-case series of COVID-19 related deaths occurred in patients with Guillain-Barré syndrome (GBS) between February 2020 and January 2022 in Italy. They were extracted from 8,436 medical charts of COVID-19 patients dying. All cases, ranged 48-73 years, showed classical GBS clinical onset - limb weakness, sensory deficits, hypoareflexia - and three of them were admitted in intensive care unit (ICU) for ventilator support. The cerebrospinal fluid showing albumin-cytological dissociation was performed in two cases. Nerve conduction studies supported the diagnosis in all cases. Interstitial pneumonia was documented by chest X-rays or CT scans in all cases: they were treated with intravenous immunoglobulin (IVIg) and the drugs used for COVID-19 infection. Although the mechanism of GBS onset is still unclear in COVID-19, fatal cases may be more frequent than other virus-related GBS, so that strictly monitoring in high-risk patients could dramatically decrease the mortality of GBS.

Guillain-Barré syndrome associated with SARS-CoV-2 vaccination: how is it different? a systematic review and individual participant data meta-analysis.

An association between Guillain-Barré syndrome (GBS) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccination has been reported. We aimed to summarize the clinical features of GBS associated with SARS-CoV-2 vaccination and determine the contrasting features from coronavirus disease-19 (COVID-19) associated GBS and GBS following other causes. We performed PubMed search for articles published between 1 December 2020 and 27 January 2022 using search terms related to "SARS-CoV-2 vaccination" and "GBS". Reference searching of the eligible studies was performed. Sociodemographic and vaccination data, clinical and laboratory features, and outcomes were extracted. We compared these findings with post-COVID-19 GBS and International GBS Outcome Study (IGOS) (GBS from other causes) cohorts. We included 100 patients in the analysis. Mean age was 56.88 years, and 53% were males. Six-eight received non-replicating virus vector and 30 took messenger RNA (mRNA) vaccines. The median interval between the vaccination and the GBS onset was 11 days. Limb weakness, facial palsy, sensory symptoms, dysautonomia, and respiratory insufficiency were seen in 78.65%, 53.3%, 77.4%, 23.5%, and 25%, respectively. The commonest clinical and electrodiagnostic subtype were sensory-motor variant (68%) and acute inflammatory demyelinating polyneuropathy (61.4%), respectively. And 43.9% had poor outcome (GBS outcome score ≥3). Pain was common with virus vector than mRNA vaccine, and the latter had severe disease at presentation (Hughes grade ≥3). Sensory phenomenon and facial weakness were common in vaccination cohort than post-COVID-19 and IGOS. There are distinct differences between GBS associated with SARS-CoV-2 vaccination and GBS due to other causes. Facial weakness and sensory symptoms were commonly seen in the former and outcomes poor.

Concomitant Guillain-Barré Syndrome and COVID-19: A Meta-Analysis of Cases.

Background and Objectives: Recent findings demonstrate that the transmigration of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) to the nervous system implicates severe neurotropic pathologies, including the onset of the rare disease called Guillain-Barré syndrome (GBS) which is characterized by immune-mediated polyneuropathy. This study aimed to identify the predisposing factors and the clinical features of coronavirus disease 2019 (COVID-19)-induced GBS. Materials and Methods: We have performed an analysis of 147 cases. A systematic review of the published research work was performed per the PRISMA statement to obtain individual participant data (IPD) for the meta-analysis. The search was conducted through PubMed, using the combined search terms "Guillain-Barré syndrome" and "COVID-19". All case reports and series in the English language with accessed full text were included in the search. Results: A systematic database search led to the retrieval of 112 peer-reviewed articles published between 1 April 2020, and 8 February 2022. The articles comprised 16 case series and 96 case reports containing IPD for 147 patients. Our findings showed that 77.6% of all cases were 40 years or older. Males comprised most of the cases (65.3%; n = 96). The intensive care unit (ICU) admission was 44.9%, and the need for mechanical ventilation (MV) was 38.1%. The patients presented with hyporeflexia or areflexia (84.4%; n = 124), lower limb strength and sensation impairment (93.2%; n = 138), upper limb strength and sensation impairment (85.7; n = 126), and somatic sensation impairment (72.8%; n = 107). The patients presented with increased cerebral spinal fluid (CSF) protein levels (92%; n = 92) and the presence of CSF albuminocytological dissociation (83.5%; n = 71). The most common variant of GBS observed was acute inflammatory demyelinating polyneuropathy (AIDP). We found that predisposing factors concomitant with COVID-19 and GBS were male gender and older age. Among the cases, patient mortality was 10.9%. Conclusions: A gap of knowledge exists regarding the complete spectrum of clinical characteristics of COVID-19-related GBS. Recent findings suggest that SARS-CoV-2 triggers GBS, as it follows a similar para-infectious pattern as the other viral agents contributing to the onset of GBS.

Neuro-immunological complications post COVID-19 vaccination: two case reports

Purpose: To add to the growing literature regarding the possible link between the onset of Guillain Barre syndrome (GBS) and Bickerstaff brainstem encephalitis (BBE) and the coronavirus disease (COVID-19) vaccines. Case reports: The first patient is a 38-year-old man that presented muscle weakness and an unsteady gait for a duration of one week. Initially, he developed an unsteady gait, then gradually worsening generalized muscle fatigue and ascending weakness in all limbs. He tested positive for GM1 and GQ1D antibodies, and magnetic resonance imaging (MRI) of the lumbar spine with contrast and nerve conduction study (NCS) results were both suggestive of acute motor axonal neuropathy (AMAN). The second patient is a 54-year-old man that developed generalized fatigue and subjective fever associated with headache and blurry vision followed by bulbar dysfunction. During hospitalization, his consciousness level started to be affected and he developed ataxia with ophthalmoparesis. A diagnosis of BBE was made based on clinical, imaging, and cerebrospinal fluid (CSF) findings. Conclusion: Since temporal relationships do not signify causation, we cannot draw any conclusions regarding the association between COVID-19 vaccines and these neurological disorders. However, it is vital that new cases are reported so that the knowledge base is built upon, and to increase healthcare workers’ vigilance for early signs of GBS or BBE.

COVID-19 and Guillain-Barré syndrome: A single-center prospective case series with a 1-year follow-up.

Single reports of Guillain-Barré syndrome (GBS) have been reported worldwide during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. While case reports are likely to be biased toward uncommon clinical presentations, systematic assessment of prospective series can highlight the true clinical features and spectrum. In this prospective, observational study, we included all consecutive patients who developed GBS. In patients with SARS-CoV-2 infection as antecedent, the time-gap between the infection and GBS onset had to be ≤30 days. The referral was a neurological University Research Hospital, in the Italian Region more severely involved by the pandemic, and hospitalizing both COVID+ and non-COVID neurological diseases. Clinical, laboratory, cerebrospinal fluid, and electromyographic features of GBS diagnosed between March 2020 and March 2021 were compared to a retrospective series of GBS diagnosed between February 2019 and February 2020 (control population). Nasopharyngeal swab was still positive at GBS onset in 50% of patients. Mild-to-moderate COVID-related pneumonia, as assessed by X-ray (6 patients) or X-ray plus computerized tomography (2 patients) co-occurred in 6 of 10 patients. GBS diagnosed during the pandemic period, including 10 COVID-GBS and 10 non–COVID-GBS, had higher disability on admission (P = .032) compared to the GBS diagnosed between February 2019 and 2020, possibly related to later hospital referral in the pandemic context. Compared to non–COVID-GBS (n = 10) prospectively diagnosed in the same period (March 2020–2021), post–COVID-GBS (n = 10) had a higher disability score on admission (P = .028), lower sum Medical Research Council score (P = .022) and lymphopenia (P = .025), while there were no differences in GBS subtype/variant, severity of peripheral involvement, prognosis and response to treatment. Cerebrospinal fluid search for SARS-CoV-2 RNA and antiganglioside antibodies were negative in all COVID+ patients. Temporal clustering of cases, coinciding with the waves of the pandemic, and concomitant reduction of the incidence of COVID-negative GBSs may indicate a role for SARS-CoV-2 infection in the development of GBS, although the association may simply be related to a bystander effect of systemic inflammation; lack of prevalence of specific GBS subtypes in post–COVID-GBS also support this view. GBS features and prognosis are not substantially different compared to non–COVID-GBS.