Guillain-Barré syndrome after SARS-CoV-2 infection in an international prospective cohort study
Luijten LWG., Leonhard SE., van der Eijk AA., Doets AY., Appeltshauser L., Arends S., Attarian S., Benedetti L., Briani C., Casasnovas C., Castellani F., Dardiotis E., Echaniz-Laguna A., Garssen MPJ., Harbo T., Huizinga R., Humm AM., Jellema K., van der Kooi AJ., Kuitwaard K., Kuntzer T., Kusunoki S., Lascano AM., Martinez-Hernandez E., Rinaldi S., Samijn JPA., Scheidegger O., Tsouni P., Vicino A., Visser LH., Walgaard C., Wang Y., Wirtz PW., Ripellino P., Jacobs BC., Jacobs BC., Hughes RAC., Cornblath DR., Gorson KC., Hartung H-P., Kusunoki S., van Doorn PA., Willison HJ., van den Berg B., Verboon C., Roodbol J., Doets AY., Leonhard SE., Luijten LWG., de Koning LC., Mandarakas M., van Woerkom M., Arends S., Reisin RC., Reddel SW., Islam Z., Mohammad QD., van den Bergh P., Feasby TE., Wang Y., Harbo T., Péréon Y., Lehmann HC., Dardiotis E., Nobile-Orazio E., Shahrizaila N., Bateman K., Illa I., Querol L., Ripellino P., Hsieh S-T., Chavada G., Davidson A., Addington JM., Andersen H., Antonini G., Ajroud-Driss S., Attarian S., Badrising UA., Balducci C., Barroso FA., Bella IR., Benedetti L., Bertorini TE., Bhavaraju-Sanka R., Brannagan TH., Briani C., Bürmann J., Busby M., Butterworth S., Casasnovas C., Castellani F., Cavaletti G., Chao C-C., Chen S., Claeys KG., Conti ME., Cosgrove JS., Dalakas MC., Derejko MA., Dimachkie MM., de la Cour CD., Echaniz-Laguna A., Eftimov F., Faber KG., Fazio R., Fokke C., Fujioka T., Fulgenzi EA., Galassi G., García-Sobrino T., Garssen MPJ., Gentile F., Gijsbers CJ., Gilchrist JM., Job Gilhuis H., Goldstein JM., Goyal NA., Granit V., Grapperon A-M., Grisanti S., Gutiérrez-Gutiérrez G., Gutmann L., Hadden RDM., Holbech JV., Holt JKL., Htut M., Humm A., Hundsberger T., Jellema K., Pascual IJ., Jimeno Montero MC., Kaida K., Karafiath S., Katzberg HD., Khoshnoodi M., Kiers L., Kimpinski K., Kleyweg RP., Kokubun N., Kolb N., Kuitwaard K., Kuntzer T., Kuwabara S., Kuwahara M., Kwan JY., Ladha SS., Lassen LL., Lascano AM., Lawson V., Pan EL., Cejas LL., Magot A., Manji H., Marfia GA., Márquez-Infante C., Aguilar LM., Hernandez EM., Sanchez PM., Mataluni G., Mattiazzi MG., McDermott CJ., Meekins GD., Miller JAL., Monges MS., de la Tassa GM., Nascimbene C., Nedkova-Hristova V., Nowak RJ., Osei-Bonsu M., Pardo J., Pascuzzi RM., Pritchard J., Pulley M., Rinaldi S., Roberts RC., Rojas-Marcos I., Rudnicki SA., Sachs GM., Samijn JPA., Santoro L., Scheidegger O., Schenone A., Schwindling L., Sedano Tous MJ., Sheikh KA., Silvestri NJ., Sindrup SH., Sommer CL., Song Y., Stein B., Stino AM., Tan C-Y., Tankisi H., Tsouni P., Twydell PT., Van Damme P., van der Kooi AJ., van der Meulen W., van der Ree TC., van Dijk GW., van Koningsveld R., Varrato JD., Vermeij FH., Verschuuren JJGM., Vicino A., Visser LH., Vytopil M., Waheed W., Walgaard C., Wirtz PW., Xing C., Yamagishi Y., Zhou L., Zivkovic S.
Abstract In the wake of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, an increasing number of patients with neurological disorders, including Guillain-Barré syndrome (GBS), have been reported following this infection. It remains unclear, however, if these cases are coincidental or not, as most publications were case reports or small regional retrospective cohort studies. The International GBS Outcome Study is an ongoing prospective observational cohort study enrolling patients with GBS within 2 weeks from onset of weakness. Data from patients included in this study, between 30 January 2020 and 30 May 2020, were used to investigate clinical and laboratory signs of a preceding or concurrent SARS-CoV-2 infection and to describe the associated clinical phenotype and disease course. Patients were classified according to the SARS-CoV-2 case definitions of the European Centre for Disease Prevention and Control and laboratory recommendations of the World Health Organization. Forty-nine patients with GBS were included, of whom eight (16%) had a confirmed and three (6%) a probable SARS-CoV-2 infection. Nine of these 11 patients had no serological evidence of other recent preceding infections associated with GBS, whereas two had serological evidence of a recent Campylobacter jejuni infection. Patients with a confirmed or probable SARS-CoV-2 infection frequently had a sensorimotor variant 8/11 (73%) and facial palsy 7/11 (64%). The eight patients who underwent electrophysiological examination all had a demyelinating subtype, which was more prevalent than the other patients included in the same time window [14/30 (47%), P = 0.012] as well as historical region and age-matched control subjects included in the International GBS Outcome Study before the pandemic [23/44 (52%), P = 0.016]. The median time from the onset of infection to neurological symptoms was 16 days (interquartile range 12–22). Patients with SARS-CoV-2 infection shared uniform neurological features, similar to those previously described in other post-viral GBS patients. The frequency (22%) of a preceding SARS-CoV-2 infection in our study population was higher than estimates of the contemporaneous background prevalence of SARS-CoV-2, which may be a result of recruitment bias during the pandemic, but could also indicate that GBS may rarely follow a recent SARS-CoV-2 infection. Consistent with previous studies, we found no increase in patient recruitment during the pandemic for our ongoing International GBS Outcome Study compared to previous years, making a strong relationship of GBS with SARS-CoV-2 unlikely. A case-control study is required to determine if there is a causative link or not.