Facial Diplegia: A Rare, Atypical Variant of Guillain-Barré Syndrome and Ad26.COV2.S Vaccine

Jain, Esha; Pandav, Krunal; Regmi, Pratima; Michel, George; Altshuler, Ida

doi:10.7759/cureus.16612

Cited by 17 publications

(11 citation statements)

References 9 publications

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“…Thirty-four articles, comprising 57 patients, were included in this study [ 4 , 11 , 12 , 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 ]. The search and selection process are detailed in Figure 1 .…”

Section: Resultsmentioning

confidence: 99%

Prognosis of Guillain–Barré Syndrome Linked to COVID-19 Vaccination

et al. 2022

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There have been increasing reports of Guillain–Barré syndrome (GBS), a rare but debilitating neurological disease, occurring post-COVID-19 vaccination. However, the outcomes and relationships between patient demographics and clinical outcomes of post-COVID-19 vaccination GBS remain unclear. To bridge this gap, our study investigates the outcomes and clinical factors associated with poorer GBS outcomes following COVID-19 vaccination. We conducted a review and pooled analysis of detailed data extracted from 57 published cases with the relevant search strategies and criteria. The groups compared included male versus female patients, 1st dose versus 2nd dose and early onset versus late onset of GBS. Multivariate regression analysis was performed to compare the vaccine type, clinical severity and post-treatment outcomes between these groups of patients. Our results highlight for the first time that females were significantly more likely to have severe clinical presentation and poorer outcomes compared to males. Additionally, viral vector vaccines were the predominant vaccine type administered in early-onset post-COVID-19-vaccination GBS and GBS occurring after the 1st vaccination dose. It was also shown that reported cases of post-vaccination GBS generally displayed a positive response to conventional treatment and had favourable post-treatment outcomes. Through this study, we have established important links and provided assuring evidence for treatment response and post-treatment outcomes of GBS occurring post-COVID-19 vaccination. While the COVID-19 vaccination brings about much greater benefits than risks, our findings provide further impetus for greater vigilance in certain patient groups and more studies to explore the mechanisms behind these links.

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Section: Resultsmentioning

confidence: 99%

Prognosis of Guillain–Barré Syndrome Linked to COVID-19 Vaccination

et al. 2022

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“…For example, one article reported five BFWdp cases, ref [ 7 ], but we excluded three of them because of symptoms in the limbs: right hip flexion weakness, sensory ataxia, and bilateral hip flexion weakness. Finally, 18 cases from seven articles were analyzed in this review [ 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. A flow diagram illustrating the full enrollment process is shown in Figure 1 .…”

Section: Resultsmentioning

confidence: 99%

Bilateral Facial Weakness with Distal Paresthesia Following COVID-19 Vaccination: A Scoping Review for an Atypical Variant of Guillain–Barré Syndrome

Kim

Yoon

et al. 2022

Brain Sciences

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Background and Purpose: Recent population-based studies from the US and UK have identified an increase in the occurrence of Guillain–Barré syndrome (GBS) following coronavirus disease 2019 (COVID-19) vaccination. However, the localized variant of GBS might be underestimated due to its rarity and atypical features. We aimed to identify and characterize bilateral facial weakness with distal paresthesia (BFWdp) as a GBS variant following COVID-19 vaccination. Materials and Methods: Relevant studies published during the COVID-19 pandemic were searched and identified in the MEDLINE, Embase, and other databases. Results: This review found that 18 BFWdp cases presented characteristics similar to previous BFWdp cases as defined in the literature: male dominance, frequent albuminocytological dissociation, and acute inflammatory demyelinating neuropathy pattern. In contrast, facial nerve enhancement on brain MRI and antiganglioside antibody positivity were often observed in BFWdp following COVID-19 vaccination. Conclusions: The mechanism of BFWdp following COVID-19 vaccination appears to be somewhat different from that of sporadic BFWdp. Neurological syndromes with rare incidence and difficulty in diagnosis should be considered adverse events of COVID-19 vaccination.

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“…Similarly, a temporal association between GBS and SARS-CoV-2 vaccinations has been described in the recent literature [ 12 ]. To date, there has only been 1 published case of GBS after Ad26.COV2.S vaccine in the United States [ 13 ]. We report a case of GBS that occurred 14 days after Ad26.…”

Section: Discussionmentioning

confidence: 99%

“…In the present case report, the patient had subtle sensorimotor improvements after IVIG and plasma exchange for a brief duration before recurrence. In Contrast, in the case of atypical GBS after Ad26.COV2.S reported by Jain and colleagues, successful treatment with IVIG and plasma exchange was demonstrated over 14 days [ 13 ]. Immunomodulatory therapy is the mainstay of treatment and usually contributes to a favorable prognosis.…”

Section: Discussionmentioning

confidence: 99%

Guillain-Barré Syndrome After Ad26.COV2.S Vaccination

et al. 2022

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Patient: Male, 66-year-old Final Diagnosis: Guillain-Barré syndrome Symptoms: Paresthesia • weakness Medication: — Clinical Procedure: — Specialty: Immunology • Infectious Diseases • Neurology • Rehabilitation Objective: Unknown etiology Background: Since December 2020, multiple vaccines have mobilized mass immunization campaigns capable of mitigating the current SARS-COV-2 pandemic. Ad26.COV2.S (Johnson & Johnson/Janssen) is a recombinant, replication-incompetent vector vaccine encoding the SARS-CoV-2 spike (s) protein and is especially protective against severe-critical disease. It is a single-dose injection; adverse effects after vaccine administration are usually mild and self-limited, including pain at the injection site, headache, fatigue, muscle aches, and nausea. Severe adverse events involving hospitalization and death after Ad26.COV2.S rarely occur. However, not unlike previous viral vector vaccines, ongoing clinical trials may unveil rare complications of Ad26.COV2.S. Guillain-Barré syndrome (GBS) is an autoimmune demyelinating polyneuropathy that can potentially manifest severe neurological symptoms after vaccination. Case Report: This report describes a case of classic GBS features that manifested 14 days after a single Ad26.COV2.S vaccine injection. The patient developed flaccid paralysis with treatment-related fluctuations. Our findings warrant further investigation into the potential relationship between SARS-CoV-2 vaccinations and the development of GBS. Conclusions: A temporal association between the Ad26.COV2.S (Johnson & Johnson/Janssen) vaccine and the onset of GBS was demonstrated in this case report. A feasible underlying pathogenic mechanism involves the cross-reactivity of antibodies stimulated by adenovirus vaccine components and peripheral nerve glycoproteins. However, there is currently insufficient evidence to support a causal relationship between Ad26.COV2.S and the development of GBS. Further evidence gathered from clinician surveillance and clinical trials are needed to draw these conclusions.

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Facial Diplegia: A Rare, Atypical Variant of Guillain-Barré Syndrome and Ad26.COV2.S Vaccine

Cited by 17 publications

References 9 publications

Prognosis of Guillain–Barré Syndrome Linked to COVID-19 Vaccination

Prognosis of Guillain–Barré Syndrome Linked to COVID-19 Vaccination

Bilateral Facial Weakness with Distal Paresthesia Following COVID-19 Vaccination: A Scoping Review for an Atypical Variant of Guillain–Barré Syndrome

Guillain-Barré Syndrome After Ad26.COV2.S Vaccination

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