Guillain-Barré syndrome

Shahrizaila, Nortina; Lehmann, Helmar C.; Kuwabara, Satoshi

doi:10.1016/s0140-6736(21)00517-1

Cited by 322 publications

(432 citation statements)

References 147 publications

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“…GBS is an acquired, rapidly progressive autoimmune disorder of the peripheral nerve roots involving myelin, axons, or both, resulting in an acute, monophasic paralyzing illness. [ 20 ] Systemic viral infections, including COVID-19 [ [20] , [21] , [22] ], have been associated with the loss of immune tolerance leading to GBS. While vaccines have also been empirically linked to GBS, epidemiological evidence from different vaccine types and genetic backgrounds suggests that a causal association is spurious [ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…In our cohort, we identified only three cases of GBS, all with clinical, laboratory, and electrophysiological confirmation. Interestingly, although COVID-19 has been epidemiologically linked to GBS [ [20] , [21] , [22] ], none of the three cases tested positive for SARS-CoV-2 during the presentation of GBS. Interestingly, all three had suspected or confirmed acute gastrointestinal infections with clinical onset after receiving the vaccine, suggesting that concomitant infections may result in increased susceptibility (if not entirely responsible) for peripheral nerve damage.…”

Section: Discussionmentioning

confidence: 99%

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Neurologic adverse events among 704,003 first-dose recipients of the BNT162b2 mRNA COVID-19 vaccine in Mexico: A nationwide descriptive study

García‐Grimshaw

Ceballos‐Liceaga

Hernández-Vanegas

et al. 2021

Clinical Immunology

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mRNA vaccines against SARS-CoV-2 are remarkably effective. Limited information exists about the incidence of adverse events following immunization (AEFI) with their use. We conducted a prospective observational study including data from 704,003 first-doses recipients; 6536 AEFI were reported, of whom 65.1% had at least one neurologic AEFI ( non-serious 99.6%). Thirty-three serious events were reported; 17 (51.5%) were neurologic (observed frequency, 2.4/100,000 doses). At the time of writing this report, 16/17 cases had been discharged without deaths. Our data suggest that the BNT162b2 mRNA COVID-19 vaccine is safe; its individual and societal benefits outweigh the low percentage of serious neurologic AEFI. This information should help to dissipate hesitancy towards this new vaccine platform.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Neurologic adverse events among 704,003 first-dose recipients of the BNT162b2 mRNA COVID-19 vaccine in Mexico: A nationwide descriptive study

García‐Grimshaw

Ceballos‐Liceaga

Hernández-Vanegas

et al. 2021

Clinical Immunology

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“…GBS usually develops within 4 weeks following the occurrence of antecedent events [ 8 , 9 ]. Bacterial or viral infection is the most common antecedent event; however, GBS has also been reported to occur after vaccination, surgery, or the administration of immune checkpoint inhibitors [ 10 ]. Several pathogens, including Campylobacter jejuni , Mycoplasma pneumoniae , cytomegalovirus, Epstein–Barr virus, hepatitis A virus, influenza A virus, and influenza B virus, have been suggested to be associated with the development of GBS [ 8 , 9 ].…”

Section: Antecedent Infection and Gbsmentioning

confidence: 99%

Emerging Infection, Vaccination, and Guillain–Barré Syndrome: A Review

2021

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Guillain–Barré syndrome (GBS) is an autoimmune disorder of the peripheral nervous system that typically develops within 4 weeks after infection. In addition to conventional infectious diseases with which we are familiar, emerging infectious diseases, such as Zika virus infection and coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have also been suggested to be associated with GBS. GBS is mainly categorized into a demyelinating subtype known as acute inflammatory demyelinating polyneuropathy (AIDP) and an axonal subtype known as acute motor axonal neuropathy (AMAN). Most patients who develop GBS after Zika virus infection or COVID-19 have AIDP. The concept of molecular mimicry between pathogens and human peripheral nerve components was established through studies of AMAN with anti-ganglioside GM1 antibodies occurring after Campylobacter jejuni infection. Although such mimicry between specific pathogens and myelin or Schwann cell components has not been clearly demonstrated in AIDP, a similarity of Zika virus and SARS-CoV-2 proteins to human proteins has been suggested. With the development of global commerce and travel, emerging infectious diseases will continue to threaten public health. From this viewpoint, the development of vaccines and antiviral drugs is important to prepare for and control emerging infectious diseases. Although a decrease in the number of patients after the 2015–2016 Zika epidemic increased the difficulty in conducting phase 3 trials for Zika virus vaccines, the efficacy and safety of new vaccines have recently been demonstrated for COVID-19. In general, vaccines can decrease the risk of infectious disease by stimulating the immune system, and discussions regarding an increased risk of autoimmune disorders, such as GBS, have been ongoing for many years. However, the risk of GBS is not considered a legitimate reason to limit the administration of currently available vaccines, as only a trivial association or no association with GBS has been demonstrated.

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“…Prototypic GBS usually arises two to four weeks after an infection [9][10][11]. We would like to stress that a rather rapid, often parainfectious temporal evolution of COVID-19 and severe symptoms of GBS could be a specific feature of COVID-19 related GBS [4].…”

mentioning

confidence: 98%

Could symptom overlap of COVID-19 and Guillain–Barré syndrome mask an epidemiological association?

et al. 2021

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Dear Sirs, Whether COVID-19 can trigger Guillain-Barré syndrome (GBS) is currently controversially discussed. Recent studies in this and other journals [2-4] indicate an association. However others did not find any epidemiological evidence so far [1]. In this latter study, no significant association between COVID-19 and GBS was found. In 47 patients with GBS (of those 13 patients with definite, 12 with probable, and 22 patients without COVID-19) there was no atypical pattern in incidence, clinical presentation or response to established therapies in COVID-19 associated GBS [1]. Uniquely, a higher rate of assisted ventilation requirement was observed in GBS subsequent to COVID-19 [1]. Notably, several case series already conveyed a rapid sequence and even significant overlap of COVID-19 pneumonia and GBS [4-6]. We also observed such a rapid temporal sequence in three patients consecutively treated in our department between October 2020 and January 2021: The first patient, a 76-year-old male, presented with a reduction of his general condition and dyspnoea. Thoracic CT revealed pneumonic infiltrates typical for COVID-19. PCR analysis for SARS-CoV-2 were equivocal. Four days after hospitalization, the patient showed a rapidly evolving flaccid tetraparesis with general areflexia and phrenicobulbar involvement with consecutive requirement of intensive care. Cerebrospinal fluid (CSF) showed albuminocytologic dissociation and IgM autoantibodies against sulfatide were detected in serum (Table 1). Nerve conduction studies (NCS) revealed an axonal-demyelinating sensorimotor polyradiculoneuropathy. Intravenous immunoglobulin (IVIg) led to

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Guillain-Barré syndrome

Cited by 322 publications

References 147 publications

Neurologic adverse events among 704,003 first-dose recipients of the BNT162b2 mRNA COVID-19 vaccine in Mexico: A nationwide descriptive study

Neurologic adverse events among 704,003 first-dose recipients of the BNT162b2 mRNA COVID-19 vaccine in Mexico: A nationwide descriptive study

Emerging Infection, Vaccination, and Guillain–Barré Syndrome: A Review

Could symptom overlap of COVID-19 and Guillain–Barré syndrome mask an epidemiological association?

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