Document Type : Original Article
Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
Isfahan Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Department of Neurology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
Department of Neurology, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
Background: Few studies have reported the association of Guillain-Barre syndrome (GBS) and coronavirus disease-2019 (COVID-19) infection. In this study, we reported GBS in six patients infected with COVID-19 and reviewed all existing literature about GBS in association with COVID-19.
Methods: This study was performed in three referral centers of COVID-19 in Iran, and six patients with the diagnosis of GBS were enrolled. Patients enrolled in the study with acute progressive weakness according to the demyelinating or axonal variant of GBS, according to Uncini's criteria.
Results: Four of our patients had axonal polyneuropathy, two patients had demyelinating polyneuropathy, and one patient required mechanical ventilation. All our patients had a favorable response to treatment. In one patient, the GBS symptoms recurred four months after the first episode.
Conclusion: Limited case reports suggest a possible association between GBS and COVID-19. Such associations may be an incidental concurrence or a real cause-and-effect linkage; however, more patients with epidemiological studies are necessary to support a causal relationship.
- Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol 2020; 77(6): 683-90.
- Helms J, Kremer S, Merdji H, Clere-Jehl R, Schenck M, Kummerlen C, et al. Neurologic features in severe SARS-CoV-2 infection. N Engl J Med 2020; 382(23): 2268-70.
- Willison HJ, Jacobs BC, van Doorn PA. Guillain-Barre syndrome. Lancet 2016; 388(10045): 717-27.
- Cao-Lormeau VM, Blake A, Mons S, Lastere S, Roche C, Vanhomwegen J, et al. Guillain-Barre syndrome outbreak associated with Zika virus infection in French Polynesia: A case-control study. Lancet 2016; 387(10027): 1531-9.
- Sedaghat Z, Karimi N. Guillain Barre syndrome associated with COVID-19 infection: A case report. J Clin Neurosci 2020; 76: 233-5.
- Alberti P, Beretta S, Piatti M, Karantzoulis A, Piatti ML, Santoro P, et al. Guillain-Barre syndrome related to COVID-19 infection. Neurol Neuroimmunol Neuroinflamm 2020; 7(4): e741.
- Ottaviani D, Boso F, Tranquillini E, Gapeni I, Pedrotti G, Cozzio S, et al. Early Guillain-Barre syndrome in coronavirus disease 2019 (COVID-19): A case report from an Italian COVID-hospital. Neurol Sci 2020; 41(6): 1351-4.
- Scheidl E, Canseco DD, Hadji-Naumov A, Bereznai B. Guillain-Barre syndrome during SARS-CoV-2 pandemic: A case report and review of recent literature. J Peripher Nerv Syst 2020; 25(2): 204-7.
- Toscano G, Palmerini F, Ravaglia S, Ruiz L, Invernizzi P, Cuzzoni MG, et al. Guillain-Barre syndrome associated with SARS-CoV-2. N Engl J Med 2020; 382(26): 2574-6.
- Uncini A, Kuwabara S. The electrodiagnosis of Guillain-Barre syndrome subtypes: Where do we stand? Clin Neurophysiol 2018; 129(12): 2586-93.
- Kim JE, Heo JH, Kim HO, Song SH, Park SS, Park TH, et al. Neurological complications during treatment of middle east respiratory syndrome. J Clin Neurol 2017; 13(3): 227-33.
- Carod-Artal FJ. Neurological complications of coronavirus and COVID-19. Rev Neurol 2020; 70(9): 311-22.
- Whittaker A, Anson M, Harky A. Neurological Manifestations of COVID-19: A systematic review and current update. Acta Neurol Scand 2020; 142(1): 14-22.
- Coen M, Jeanson G, Culebras Almeida LA, Hubers A, Stierlin F, Najjar I, et al. Guillain-Barre syndrome as a complication of SARS-CoV-2 infection. Brain Behav Immun 2020; 87: 111-2.
- Camdessanche JP, Morel J, Pozzetto B, Paul S, Tholance Y, Botelho-Nevers E. COVID-19 may induce Guillain-Barre syndrome. Rev Neurol (Paris) 2020; 176(6): 516-8.
- Padroni M, Mastrangelo V, Asioli GM, Pavolucci L, Abu-Rumeileh S, Piscaglia MG, et al. Guillain-Barre syndrome following COVID-19: New infection, old complication? J Neurol 2020; 267(7): 1877-9.
- Virani A, Rabold E, Hanson T, Haag A, Elrufay R, Cheema T, et al. Guillain-Barre syndrome associated with SARS-CoV-2 infection. IDCases 2020; 20: e00771.
- Su XW, Palka SV, Rao RR, Chen FS, Brackney CR, Cambi F. SARS-CoV-2-associated Guillain-Barre syndrome with dysautonomia. Muscle Nerve 2020; 62(2): E48-9.
- Zhao H, Shen D, Zhou H, Liu J, Chen S. Guillain-Barre syndrome associated with SARS-CoV-2 infection: Causality or coincidence? Lancet Neurol 2020; 19(5): 383-4.
- El Otmani H, El Moutawakil B, Rafai MA, El Benna N, El Kettani C, Soussi M, et al. Covid-19 and Guillain-Barre syndrome: More than a coincidence! Rev Neurol (Paris) 2020; 176(6): 518-9.