Impact of the COVID-19 Pandemic on the Frequency, Clinical Spectrum and Outcomes of Pediatric Guillain-Barré Syndrome in India

Abstract

Objective: To study impact of COVID-19 pandemic on frequency, clinical/electrophysiological profile and treatment outcomes in pediatric Guillain-Barré syndrome (GBS). Background: GBS is the most frequent cause of pediatric acute flaccid paralysis. The effect of the COVID-19 pandemic on pediatric GBS is unclear in the literature. Methods: We conducted an ambispective, multicentric, cohort study involving 12 of 27 centres in GBS Consortium, during two periods: pre-COVID-19 (March-August 2019) and during COVID-19 (March-August 2020). Children ≤12 years who satisfied National Institute of Neurological Diseases and Stroke criteria for GBS/variants were enrolled. Details pertaining to clinical/laboratory parameters, treatment and outcomes (modified Rankin Scale (mRS) at discharge, GBS Disability score at discharge and 3 months) were analysed. Results: We enrolled 33 children in 2019 and 10 in 2020. Children in 2020 were older (median 10.4 [interquartile range 6.75–11.25] years versus 5 (2.5–8.4) years; P = 0.022) and had more sensory symptoms (50% versus 18.2%; P = 0.043). The 2020 group had relatively favourable mRS at discharge (median 1 (1–3.5) versus 3 (2–4); P = 0.042) and GBS disability score at 3 months (median 0 (0–0.75) versus 2 (0–3); P = 0.009) compared to 2019. Multivariate analysis revealed bowel involvement ( P = 0.000) and ventilatory support ( P = 0.001) as independent predictors of disability. No child in 2020 had preceding/concurrent SARS-CoV2 infection. Conclusions: The COVID-19 pandemic led to a marked decline in pediatric GBS presenting to hospitals. Antecedent illnesses, clinical and electrophysiological profile of GBS remained largely unchanged from the pre-pandemic era.

COVID-19, Vaccine, and Guillain–Barré Syndrome: Association or Causation

“…[ 8 ] Similar findings were reported by an epidemiological study conducted in the United Kingdom. [ 3 ] These studies[ 3 5 ] also reported no significant differences between GBS patients triggered by COVID-19 and those without the infection. Demyelinating GBS is the most common subtype worldwide and was unsurprisingly the most common in this study as well.…”

“…[ 3 4 ] Experts have argued that an increase in GBS incidence might be masked by a decrease in GBS incidence due to other infectious triggers because of better hygiene, lockdown, and social distancing. [ 5 ] Studies from Japan and Brazil have reported a decreased incidence of infectious diseases during the lockdown because of these containment measures,[ 6 7 ] thereby indirectly reducing the occurrence of GBS. The “GBS consortium,” established in India with 26 centers,[ 5 ] found a reduction in the number of GBS cases during the COVID-19 pandemic compared with the same duration in the previous year in both adult[ 5 ] and pediatric groups.…”

“…[ 5 ] Studies from Japan and Brazil have reported a decreased incidence of infectious diseases during the lockdown because of these containment measures,[ 6 7 ] thereby indirectly reducing the occurrence of GBS. The “GBS consortium,” established in India with 26 centers,[ 5 ] found a reduction in the number of GBS cases during the COVID-19 pandemic compared with the same duration in the previous year in both adult[ 5 ] and pediatric groups. [ 8 ] Similar findings were reported by an epidemiological study conducted in the United Kingdom.…”

“…In our experience during the pandemic, the proportion of GBS patients receiving IVIg was significantly higher than that of those receiving plasma exchange (PLEX). [ 5 ] The reasons were probably manifold: logistical (greater physician and nursing workforce were working in COVID-19 designated facilities) and difficulty in conducting plasma exchanges within COVID-19 facilities and patient choice (considering they were without accompanying family members in the hospital).…”