Association of Guillain-Barre syndrome with COVID-19 infection: An updated systematic review

Abstract

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Commentary: The spectrum of neurological manifestations related to COVID-19 and vaccinations

“…There was a pressing need in the beginning to understand the systemic manifestations but along the way it became clear that SARS-CoV-2 was also a neurovirulent virus. This has been evident through the several publications of para- and post- infectious neurological sequelae ( Jeanneret et al, 2021 ; Moreno-Escobar et al, 2021 ; Papri et al, 2021 ; Sheikh et al, 2021 ). SARS-CoV-2 affects both the central and peripheral nervous system with the latter being more likely affected during acute viral illness ( Sheikh et al, 2021 ).…”

“…Several mechanisms for viral involvement have been proposed, including development of a cytokine storm leading to fever, production of antibodies targeting myelin, fibrinogen, transthyretin, or albumin resulting in extensive damage. Interestingly, the ganglioside antibodies associated in AIDP were not significantly identified ( Papri et al, 2021 ; Sheikh et al, 2021 ).…”

Dimensions of SARS-CoV-2 associated Guillain-Barré syndrome

“…With interest we read the systematic review by Shaikh et al about 94 patients with SARS-CoV-2 associated Guillain-Barré syndrome (SC2-GBS) collected from various databases by searching the appropriate literature between 1.1.2020 and 15.9.2020 (Sheikh et al, 2021). Salient observation revealed that mean age was 56 ± 16y, that 65% were males, that paresthesia was the most common symptom present in 49%, that the diagnosis was confirmed by reverse transcriptase polymerase chain reaction (RT-PCR) in 69%, and that 78% received intravenous immunoglobulins (IVIG) (Sheikh et al, 2021). It was concluded that GBS is recognised as one of the many presentations of COVID-19 (Sheikh et al, 2021).…”

“…Salient observation revealed that mean age was 56 ± 16y, that 65% were males, that paresthesia was the most common symptom present in 49%, that the diagnosis was confirmed by reverse transcriptase polymerase chain reaction (RT-PCR) in 69%, and that 78% received intravenous immunoglobulins (IVIG) (Sheikh et al, 2021). It was concluded that GBS is recognised as one of the many presentations of COVID-19 (Sheikh et al, 2021). The study is appealing but has a number of limitations and raises comments and concerns.…”

“…A first limitation of the study is that manifestations of COVID-19 are mixed up with manifestations of GBS. It is unclear, for example, if respiratory symptoms in the 68 patients listed in Table 3 were due to neuromuscular respiratory insufficiency from the GBS or due to COVID-19 pneumonia (Sheikh et al, 2021). It should be made clear in how many patients with respiratory insufficiency listed in Table 4, respiratory insufficiency can be attributed to COVID-19-related acute lung injury/acute respiratory distress syndrome (ALI/ARDS), in how many to GBS-related neuromuscular respiratory failure, and in how many to both etiologies.…”