Guillain Barré Syndrome and its variants as a manifestation of COVID-19: A systematic review of case reports and case series

Abstract

Background The COVID-19 pandemic caused by SARS-COV-2 began in Wuhan, China in December 2019. Reports of COVID-19 with central (CNS) and peripheral nervous (PNS) system manifestations are emerging. In this systematic review, we compared and summarized the demographics, clinical features, Brighton criteria, immunological and laboratory findings with a focus on modified Erasmus GBS Outcome Score (mEGOS) in SARS-CoV-2 patients with GBS and its variants. Methods Based on PRISMA guidelines, we searched three databases (PubMed, Scopus, and Google Scholar) for studies on COVID-19 and GBS between December 1, 2019 to July 15, 2020. For descriptive analysis, we studied two groups with: 1) acute inflammatory demyelinating polyradiculoneuropathy (AIDP) variant, and 2) Non-AIDP/Other variants. We compared mEGOS scores for patients in both groups along with other key clinical features. Results Of the 50 GBS cases identified from 37 studies, 33 (66%) had acute inflammatory demyelinating polyradiculopolyneuropathy (AIDP) while 17 (34%) were of other (non-AIDP) variants. There mEGOS scores did not differ between AIDP patients and AMAN/AMSAN patients. Majority of the AIDP (66.7%) and AMAN/AMSAN (57.2%) patients belonged to Brighton level 1 indicating maximum diagnostic certainty. Conclusion To our knowledge, this is among the first reviews that includes GBS variants and the clinical prediction tool mEGOS for prognostication in COVID-19 patients. Further research is needed to assess whether IVIG is preferable over plasmapheresis in this population of GBS patients. It would also be crucial to follow these patients over time to identify the long-term disability as well as treatment outcomes.

Neurological manifestations as the predictors of severity and mortality in hospitalized individuals with COVID-19: a multicenter prospective clinical study

“…Another study with 1200 patients also reported the incidence of 0.4% for GBS [ 55 ]. Systematic review studies reported that the majority of cases with COVID-19 and GBS had acute inflammatory demyelinating polyradiculopolyneuropathy (AIDP) variant [ 56 , 57 ]. The facial nerve palsy that was observed in our participant was also found in about half of the prior reported cases [ 56 ].…”

Macrophages and Autoantibodies in Demyelinating Diseases

“…Although an association between a specific anti-ganglioside antibody and Zika virus-related GBS has not been demonstrated [21], peptide sharing was suggested among proteins of the Zika virus, cytomegalovirus, and the human peripheral nervous system [22,23]. Recently, a conflicting discussion on the association between SARS-CoV2 infection (i.e., and AIDP has become a topic of research [24][25][26].…”

“…Gliomedin, galactocerebroside, and ganglioside LM1 have also been suggested as target antigens in AIDP [65][66][67][68]. Although recent emerging infectious diseases, including Zika virus infection and COVID-19, are reported to be associated with AIDP rather than AMAN [20,26], causative autoantibodies associated with these viruses have not been detected to date. Regarding CIDP, sural nerve biopsy specimens from a patient with antibodies to LM1 ganglioside, which is abundant in myelin, revealed complement deposition on myelin and demyelination by macrophages [69].…”

The Other Side of SARS-CoV-2 Infection: Neurological Sequelae in Patients

“…The first case of COVID-19 initially associated with acute GBS was reported by Zhao et al ( 2020 ). To date, 50 GBS patients, or its variants, and COVID-19 have been reported (for review, see Katyal et al, 2020 ; Satarker and Nampoothiri, 2020 ; Sriwastava et al, 2020 ). The mean latency between infection and GBS symptoms ranged between 11 and 13 days (Sriwastava et al, 2020 ).…”