Anti-pan-neurofascin IgM in COVID-19-related Guillain-Barré syndrome: Evidence for a nodo-paranodopathy

Tard, Céline; Maurage, Claude‐Alain; Paula, André Maues De; Cassim, F.; Delval, Arnaud; Kuchcinski, Grégory; Davion, Jean‐Baptiste; Defebvre, Luc; Bouchiba, M.; Jourdain, M.; Boucraut, José

doi:10.1016/j.neucli.2020.09.007

Cited by 10 publications

(13 citation statements)

References 10 publications

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“…112,113 One case was reported with positive NF-155 and NF-186 antibodies, which are structural proteins in the node of Ranvier. 22 The possible role of host immunogenetic background in the development of GBS and its variants has been related to human leukocyte antigen (HLA) polymorphism in different populations, this observation might explain the increased reporting of COVID-19 related GBS in the Italy, as one-third of the cases identified in our review were Italian. 114,115 The role of HLA polymorphism in COVID-19 related GBS has been emphasized in one of the cases reported by Gigli et al, 36 in which SARS-CoV2 antibodies were detected in the CSF.…”

Section: Le Journal Canadien Des Sciences Neurologiquesmentioning

confidence: 84%

Guillain Barre Syndrome as a Complication of COVID-19: A Systematic Review

Aladawi

Elfil

Abu-Esheh

et al. 2021

Can. J. Neurol. Sci.

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Background: 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. Methods: 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. Results: 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. Conclusions: 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.

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Section: Le Journal Canadien Des Sciences Neurologiquesmentioning

confidence: 84%

Guillain Barre Syndrome as a Complication of COVID-19: A Systematic Review

Aladawi

Elfil

Abu-Esheh

et al. 2021

Can. J. Neurol. Sci.

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“…After review of the 242 documents, we identified 430 patients with COVID-19 diagnosed based on PCR or serologic testing who had acute neurological symptoms prompting CSF testing [ [5] , [6] , [7] , [8] , [9] , [10] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , …”

Section: Resultsmentioning

confidence: 99%

“…It is important to note that CSF results can change over the course of a patient's illness. This is evident in the results from some of the patients included in this review who had more than one lumbar puncture performed [10,14,25,45,51,53,74,135]. Although we documented the number of days between onset of symptoms of COVID-19 and development of neurological symptoms in Supplementary Tables 1 and 2, we did not indicate the number of days after onset of neurological symptoms that CSF was obtained.…”

Section: Discussionmentioning

confidence: 97%

“…Khodamoradi et al also documented a marked increase in CSF protein on serial lumbar punctures (the text notes the initial CSF protein was 0.2 mg/dL, but we assume this was meant to be 20 mg/dL, then the subsequent CSF protein was 685 mg/dL (confirmed via personal communication with the authors) and a third CSF protein was normal) in a patient who presented with headache and was found to have a positive CSF SARS-CoV-2 PCR (discussed further below)." [184,249] CSF protein also increased between taps, but not as dramatically, for 11 other patients who had serial CSF protein values reported [10,14,45,51,74,78,135,180,205,220,233]. However, it decreased between taps for a patient with multifocal strokes (314 mg/dL➔normal), a patient with multifocal intracranial and spinal cord hyperintense lesions (281 mg/dL➔111 mg/dL) and much less notably so for a patient with leukoencephalopathy (22 mg/dL➔19 mg/ dL) [170,188,245].…”

Section: Csf Proteinmentioning

confidence: 99%

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Cerebrospinal fluid in COVID-19: A systematic review of the literature

Lewis

Frontera

Placantonakis

et al. 2021

Journal of the Neurological Sciences

141

152

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We sought to review the literature on cerebrospinal fluid (CSF) testing in patients with COVID-19 for evidence of viral neuroinvasion by SARS-CoV-2. Methods: We performed a systematic review of Medline and Embase between December 1, 2019 and November 18, 2020 to identify case reports or series of patients who had COVID-19 diagnosed based on positive SARS-CoV-2 polymerase chain reaction (PCR) or serologic testing and had CSF testing due to a neurologic symptom. Results: We identified 242 relevant documents which included 430 patients with COVID-19 who had acute neurological symptoms prompting CSF testing. Of those, 321 (75%) patients had symptoms that localized to the central nervous system (CNS). Of 304 patients whose CSF was tested for SARS-CoV-2 PCR, there were 17 (6%) whose test was positive, all of whom had symptoms that localized to the central nervous system (CNS). The majority (13/17, 76%) of these patients were admitted to the hospital because of neurological symptoms. Of 58 patients whose CSF was tested for SARS-CoV-2 antibody, 7 (12%) had positive antibodies with evidence of intrathecal synthesis, all of whom had symptoms that localized to the CNS. Of 132 patients who had oligoclonal bands evaluated, 3 (2%) had evidence of intrathecal antibody synthesis. Of 77 patients tested for autoimmune antibodies in the CSF, 4 (5%) had positive findings. Conclusion: Detection of SARS-CoV-2 in CSF via PCR or evaluation for intrathecal antibody synthesis appears to be rare. Most neurological complications associated with SARS-CoV-2 are unlikely to be related to direct viral neuroinvasion.

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“…More recently, a systematic literature review on CSF testing in patients with COVID-19 found that 17 out of 304 reviewed cases had a positive SARS-CoV-2 PCR in the CSF. 17 [ 57,67,[76][77][78][79]98] [67, [80][81][82]97] [ [83][84][85] [ 65,71,82,[85][86][87][88][89][90][91][92][93][94][95][96] [ No. of patients % (n/total) 59 24 In situ hybridization localized the RNA to inside the sarcolemma.…”

Section: Pathophysiological Insights Into Pns Involvementmentioning

confidence: 99%

COVID‐19 and the peripheral nervous system. A 2‐year review from the pandemic to the vaccine era

Taga

Lauria

2022

J Peripheral Nervous Sys

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Increasing literature has linked COVID‐19 to peripheral nervous system (PNS) diseases. In addition, as we move from the pandemic to the vaccination era, literature interest is shifting towards the potential association between COVID‐19 vaccines and PNS manifestations. We reviewed published literature on COVID‐19, COVID‐19 vaccines and PNS manifestations between 1 January 2020 and 1 December 2021. For Guillain‐Barré syndrome (GBS), isolated cranial neuropathy (ICN) and myositis associated with COVID‐19, the demographic, clinical, laboratory, electrophysiological and imaging features were included in a narrative synthesis. We identified 169 studies on COVID‐19‐associated complications, including 63 papers (92 patients) on GBS, 29 papers (37 patients) on ICN and 11 papers (18 patients) on myositis. Additional clinical phenotypes included chronic inflammatory demyelinating polyneuropathy, vasculitic neuropathies, neuralgic amyotrophy, critical care‐related complications, and myasthenia gravis. PNS complications secondary to COVID‐19 vaccines have been reported during randomized clinical trials, in real‐world case reports, and during large‐scale surveillance programs. These mainly include cases of GBS, Bell's palsy, and cases of neuralgic amyotrophy. Based on our extensive review of the literature, any conclusion about a pathophysiological correlation between COVID‐19 and PNS disorders remains premature, and solely supported by their temporal association, while epidemiological and pathological data are insufficient. The occurrence of PNS complications after COVID‐19 vaccines seems limited to a possible higher risk of facial nerve palsy and GBS, to a degree that widespread access to the ongoing vaccination campaign should not be discouraged, while awaiting for more definitive data from large‐scale surveillance studies.

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Anti-pan-neurofascin IgM in COVID-19-related Guillain-Barré syndrome: Evidence for a nodo-paranodopathy

Cited by 10 publications

References 10 publications

Guillain Barre Syndrome as a Complication of COVID-19: A Systematic Review

Guillain Barre Syndrome as a Complication of COVID-19: A Systematic Review

Cerebrospinal fluid in COVID-19: A systematic review of the literature

COVID‐19 and the peripheral nervous system. A 2‐year review from the pandemic to the vaccine era

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