Guillain-Barré syndrome spectrum associated with COVID-19: an up-to-date systematic review of 73 cases

Abstract

Since coronavirus disease-2019 (COVID-19) outbreak in January 2020, several pieces of evidence suggested an association between the spectrum of Guillain-Barré syndrome (GBS) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Most findings were reported in the form of case reports or case series, whereas a comprehensive overview is still lacking. We conducted a systematic review and searched for all published cases until July 20th 2020. We included 73 patients reported in 52 publications. A broad age range was affected (mean 55, min 11-max 94 years) with male predominance (68.5%). Most patients showed respiratory and/or systemic symptoms, and developed GBS manifestations after COVID-19. However, asymptomatic cases for COVID-19 were also described. The distributions of clinical variants and electrophysiological subtypes resemble those of classic GBS, with a higher prevalence of the classic sensorimotor form and the acute inflammatory demyelinating polyneuropathy, although rare variants like Miller Fisher syndrome were also reported. Cerebrospinal fluid (CSF) albuminocytological dissociation was present in around 71% cases, and CSF SARS-CoV-2 RNA was absent in all tested cases. More than 70% of patients showed a good prognosis, mostly after treatment with intravenous immunoglobulin. Patients with less favorable outcome were associated with a significantly older age in accordance with previous findings regarding both classic GBS and COVID-19. COVID-19-associated GBS seems to share most features of classic post-infectious GBS and possibly the same immune-mediated pathogenetic mechanisms. Nevertheless, more extensive epidemiological studies are needed to clarify these issues.

Keywords: Autoimmune; COVID-19; Coronavirus; Guillain–Barré syndrome; Miller Fisher syndrome; Neuroimmunology; Neurology; Polyradiculopathy; SARS-CoV-2.

Fig. 1

Temporal and spatial distribution of reported cases with COVID-19-associated Guillain–Barré syndrome in literature from 1st January until 20th July 2020. The x-axis shows the number of described patients. The y-axis illustrates the countries of provenience of the cases. In each line, different colours represent the months of April, May, June, and July (* until 20th July) 2020, in which the cases were published. Abbreviations: UK, United Kingdom, USA, United States of America