Guillain-Barré syndrome after SARS-CoV-2 infection in an international prospective cohort study

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 o...

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Published in:	Brain (London, England : 1878) Vol. 144; no. 11; p. 3392
Main Authors:	Luijten, Linda W G, Leonhard, Sonja E, van der Eijk, Annemiek A, Doets, Alex Y, Appeltshauser, Luise, Arends, Samuel, Attarian, Shahram, Benedetti, Luana, Briani, Chiara, Casasnovas, Carlos, Castellani, Francesca, Dardiotis, Efthimios, Echaniz-Laguna, Andoni, Garssen, Marcel P J, Harbo, Thomas, Huizinga, Ruth, Humm, Andrea M, Jellema, Korné, van der Kooi, Anneke J, Kuitwaard, Krista, Kuntzer, Thierry, Kusunoki, Susumu, Lascano, Agustina M, Martinez-Hernandez, Eugenia, Rinaldi, Simon, Samijn, Johnny P A, Scheidegger, Olivier, Tsouni, Pinelopi, Vicino, Alex, Visser, Leo H, Walgaard, Christa, Wang, Yuzhong, Wirtz, Paul W, Ripellino, Paolo, Jacobs, Bart C
Format:	Journal Article
Language:	English
Published:	England 16.12.2021
Subjects:	Adult Aged Cohort Studies COVID-19 - complications Female Guillain-Barre Syndrome - epidemiology Guillain-Barre Syndrome - virology Humans Male Middle Aged Prospective Studies SARS-CoV-2 COVID-19 Guillain-Barré SARS-CoV-2 syndrome preceding infections clinical phenotype
ISSN:	1460-2156, 1460-2156
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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.
AbstractList	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.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. 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.
Author	Scheidegger, Olivier Humm, Andrea M Attarian, Shahram Appeltshauser, Luise Garssen, Marcel P J Kusunoki, Susumu Samijn, Johnny P A van der Kooi, Anneke J Tsouni, Pinelopi Huizinga, Ruth Casasnovas, Carlos Castellani, Francesca Vicino, Alex Harbo, Thomas Jellema, Korné Rinaldi, Simon Doets, Alex Y Luijten, Linda W G Arends, Samuel Leonhard, Sonja E Briani, Chiara Ripellino, Paolo Visser, Leo H Benedetti, Luana Lascano, Agustina M Kuitwaard, Krista Martinez-Hernandez, Eugenia Jacobs, Bart C Wang, Yuzhong Echaniz-Laguna, Andoni van der Eijk, Annemiek A Kuntzer, Thierry Wirtz, Paul W Walgaard, Christa Dardiotis, Efthimios
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BackLink	https://www.ncbi.nlm.nih.gov/pubmed/34553216$$D View this record in MEDLINE/PubMed
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ContentType	Journal Article
Contributor	Cavaletti, Guido Holbech, Jakob V Bateman, Kathleen Faber, Karin G Cosgrove, Jeremy S Bella, Isabelita R Doets, Alex Y Hadden, Robert D M Shahrizaila, Nortina Jimeno Montero, Maria C Hundsberger, Thomas Benedetti, Luana Balducci, Claudia Grapperon, Aude-Marie Wang, Yuzhong Hughes, Richard A C Badrising, Umesh A Péréon, Yann Davidson, Amy van den Bergh, Peter Dardiotis, Efthimios Gijsbers, Cees J Brannagan, Thomas H Granit, Volkan Bürmann, Jan García-Sobrino, Tania Kusunoki, Susumu Feasby, Tom E Castellani, Francesca Fazio, Raffaella Gilchrist, James M Antonini, Giovanni Conti, Maria Eugenia Dimachkie, Mazen M Galassi, Giuliana Fulgenzi, Ernesto A Willison, Hugh J de Koning, Laura C Luijten, Linda W G Bertorini, Tulio E Briani, Chiara Karafiath, Summer Job Gilhuis, H Chao, Chi-Chao Fokke, Chris Addington, James M Echaniz-Laguna, Andoni Lehmann, Helmar C Bhavaraju-Sanka, Ratna Holt, James K L van Doorn, Pieter A Barroso, Fabio A Dalakas, Marinos C Attarian, Shahram Eftimov, Filip Claeys, Kristl G Garssen, Marcel P J Roodbol, Joyce Gentile, Fran
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