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Review
Guillain-Barré syndrome in SARS-CoV-2 infection: an instant systematic review of the first six months of pandemic
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  1. Antonino Uncini1,
  2. Jean-Michel Vallat2,
  3. Bart C Jacobs3
  1. 1 Department of Neuroscience, Imaging and Clinical Sciences, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy
  2. 2 Department of Neurology, National Reference Center for “Rare Peripheral Neuropathies”, CHU Dupuytren, Limoges, France
  3. 3 Departments of Neurology and Immunology, Erasmus MC, Rotterdam, The Netherlands
  1. Correspondence to Professor Antonino Uncini, Department of Neuroscience, Imaging and Clinical Sciences, University “G. d’Annunzio” Chieti-Pescar, Chieti, Italy; uncini{at}unich.it

Abstract

A systematic review from 1 January to 30 June 2020 revealed 42 patients with Guillain-Barré syndrome (GBS) associated with SARS-CoV-2 infection. Single cases and small series were reported from 13 countries, the majority from Europe (79.4%) and especially from Italy (30.9%). SARS-CoV-2 infection was demonstrated by nasopharyngeal swab (85.7%) and serology (14.3%). Median time between COVID-19 and GBS onset in 36 patients was 11.5 days (IQR: 7.7–16). The most common clinical features were: limb weakness (76.2%), hypoareflexia (80.9 %), sensory disturbances (66.7 %) and facial palsy (38.1%). Dysautonomia occurred in 19%, respiratory failure in 33.3% and 40.5% of patients were admitted in intensive care unit. Most patients (71.4%) had the classical clinical presentation but virtually all GBS variants and subtypes were reported. Cerebrospinal fluid (CSF) albumin-cytological dissociation was found in 28/36 (77.8%) and PCR for SARS-CoV-2 was negative in 25/25 patients. Electrodiagnosis was demyelinating in 80.5% and levels 1 and 2 of Brighton criteria of diagnostic certainty, when applicable, were fulfilled in 94.5% patients. Antiganglioside antibodies were positive in only 1/22 patients. Treatments were intravenous immunoglobulin and/or plasma exchange (92.8%) with, at short-time follow-up, definite improvement or recovery in 62.1% of patients. One patient died. In conclusion, the most frequent phenotype of GBS in SARS-CoV-2 infection is the classical sensorimotor demyelinating GBS responding to the usual treatments. The time interval between infectious and neuropathic symptoms, absence of CSF pleocytosis and negative PCR support a postinfectious mechanism. The abundance of reports suggests a pathogenic link between SARS-CoV-2 infection and GBS but a case-control study is greatly needed.

  • Guillain-Barre syndrome
  • neurovirology
  • systematic reviews

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Footnotes

  • Contributors AU conceived the review, searched the literature and wrote the first draft. J-MV and BCJ checked the data and integrated the manuscript. All authors critically revised all the versions of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

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