Article Text

Original research
Guillain-Barré syndrome and COVID-19: an observational multicentre study from two Italian hotspot regions
  1. Massimiliano Filosto1,
  2. Stefano Cotti Piccinelli2,
  3. Stefano Gazzina3,
  4. Camillo Foresti4,
  5. Barbara Frigeni4,
  6. Maria Cristina Servalli4,
  7. Maria Sessa4,
  8. Giuseppe Cosentino5,
  9. Enrico Marchioni6,
  10. Sabrina Ravaglia5,
  11. Chiara Briani7,
  12. Francesca Castellani7,
  13. Gabriella Zara7,
  14. Francesca Bianchi8,
  15. Ubaldo Del Carro8,
  16. Raffaella Fazio8,
  17. Massimo Filippi8,
  18. Eugenio Magni9,
  19. Giuseppe Natalini10,
  20. Francesco Palmerini9,
  21. Anna Maria Perotti9,
  22. Andrea Bellomo11,
  23. Maurizio Osio12,
  24. Giuseppe Scopelliti11,
  25. Marinella Carpo13,
  26. Andrea Rasera14,
  27. Giovanna Squintani14,
  28. Pietro Emiliano Doneddu15,
  29. Valeria Bertasi16,
  30. Maria Sofia Cotelli16,
  31. Laura Bertolasi17,
  32. Gian Maria Fabrizi17,
  33. Sergio Ferrari17,
  34. Federico Ranieri17,
  35. Francesca Caprioli18,
  36. Elena Grappa19,
  37. Laura Broglio3,
  38. Giovanni De Maria3,
  39. Ugo Leggio3,
  40. Loris Poli20,
  41. Frank Rasulo21,
  42. Nicola Latronico21,
  43. Eduardo Nobile-Orazio15,
  44. Alessandro Padovani2,
  45. Antonino Uncini22
  1. 1 Department of Clinical and Experimental Sciences, University of Brescia; Unit of Neurology, ASST Spedali Civili; NeMO-Brescia Clinical Center for Neuromuscular Diseases, Brescia, Italy
  2. 2 Department of Clinical and Experimental Sciences, University of Brescia; Unit of Neurology, ASST Spedali Civili, Brescia, Italy
  3. 3 Unit of Neurophysiopathology, ASST Spedali Civili, Brescia, Italy
  4. 4 Unit of Neurology and Neurophysiology, ASST PG23, Bergamo, Italy
  5. 5 IRCCS Mondino Foundation, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
  6. 6 IRCCS Mondino Foundation, Neurooncology and Neuroinflammation Unit, Pavia, Italy
  7. 7 Neurology Unit, Azienda Ospedale-Università di Padova, Padova, Italy
  8. 8 Neurology and Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Vita Salute SanRaffaele University, Milano, Italy
  9. 9 Unit of Neurology, Fondazione Poliambulanza, Brescia, Italy
  10. 10 Unit of Intensive Care and Anesthesiology, Fondazione Poliambulanza, Brescia, Italy
  11. 11 ‘‘Luigi Sacco” Department of Biomedical and Clinical Sciences, University of Milano, Milano, Italy
  12. 12 Unit of Neurology, ASST Fatebenefratelli Sacco, Milano, Italy
  13. 13 Unit of Neurology, ASST Bergamo Ovest, Treviglio, Italy
  14. 14 Unit of Neurology, AOUI Verona, Verona, Italy
  15. 15 Department of Neurology, Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Clinical and Research Institute; Department of Medical Biotechnology and Translational Medicine,Milan University, Milano, Italy
  16. 16 Unit of Neurology, ASST Valcamonica, Esine (Bs), Italy
  17. 17 Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
  18. 18 Unit of Neurology, ASST Cremona, Cremona, Italy
  19. 19 Intensive Care Unit, ASST Cremona, Cremona, Italy
  20. 20 Unit of Neurology, ASST Spedali Civili, Brescia, Italy
  21. 21 Department of Anesthesia, Critical Care and Emergency, ASST Spedali Civili;Department of Medical and Surgical Specialties, Radiological Sciences and Public Health,University of Brescia, Brescia, Italy
  22. 22 Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti-Pescara, Italy
  1. Correspondence to Prof. Massimiliano Filosto, Department of Clinical and Experimental Sciences, University of Brescia; Unit of Neurology, ASST Spedali Civili; NeMO-Brescia Clinical Center for Neuromuscular Diseases, Brescia, Italy; massimiliano.filosto{at}


Objective Single cases and small series of Guillain-Barré syndrome (GBS) have been reported during the SARS-CoV-2 outbreak worldwide. We evaluated incidence and clinical features of GBS in a cohort of patients from two regions of northern Italy with the highest number of patients with COVID-19.

Methods GBS cases diagnosed in 12 referral hospitals from Lombardy and Veneto in March and April 2020 were retrospectively collected. As a control population, GBS diagnosed in March and April 2019 in the same hospitals were considered.

Results Incidence of GBS in March and April 2020 was 0.202/100 000/month (estimated rate 2.43/100 000/year) vs 0.077/100 000/month (estimated rate 0.93/100 000/year) in the same months of 2019 with a 2.6-fold increase. Estimated incidence of GBS in COVID-19-positive patients was 47.9/100 000 and in the COVID-19-positive hospitalised patients was 236/100 000. COVID-19-positive patients with GBS, when compared with COVID-19-negative subjects, showed lower MRC sum score (26.3±18.3 vs 41.4±14.8, p=0.006), higher frequency of demyelinating subtype (76.6% vs 35.3%, p=0.011), more frequent low blood pressure (50% vs 11.8%, p=0.017) and higher rate of admission to intensive care unit (66.6% vs 17.6%, p=0.002).

Conclusions This study shows an increased incidence of GBS during the COVID-19 outbreak in northern Italy, supporting a pathogenic link. COVID-19-associated GBS is predominantly demyelinating and seems to be more severe than non-COVID-19 GBS, although it is likely that in some patients the systemic impairment due to COVID-19 might have contributed to the severity of the whole clinical picture.

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • AP and AU contributed equally to the study and share senior authorship.

  • Contributors Conception and design of the study: MF, SCP, AP and AU. Drafting the manuscript and tables: SCP and MF. Statistical analysis: SG and SCP. Acquisition and analysis of clinical and neurophysiological data: MF, SCP, SG, CF, BF, MCS, MS, GC, EM, SR, CB, FCas, GZ, FB, UDC, RF, MFili, EM, GN, FP, AMP, AB, MO, GS, MC, AR, GS, PED, VB, MSC, LBe, GMF, SF, FR, FCap, EG, LBr, GDM, UL, LP, FR, NL and EN-O. Interpretation of electrophysiological data: AU. Critical revision of the article: NL, EN-O, AP and AU. Responsible for the overall content: MF, SCP, AP and AU. All authors discussed the results and contributed to the final 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.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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