Guillain-Barré syndrome after SARS-CoV-2 infection in an international prospective cohort study
Linda W.G. Luijten, Sonja E. Leonhard, Annemiek A. van der Eijk, Alex Y. Doets, Luise Appeltshauser, Samuel Arends, Shahram Attarian, Luana Benedetti, Chiara Briani, Carlos Casasnovas, Francesca Castellani, Efthimios Dardiotis, Andoni Echaniz‐Laguna, Marcel P.J. Garssen, Thomas Harbo, Ruth Huizinga, Andrea M. Humm, Korné Jellema, Anneke J. van der Kooi, Krista Kuitwaard, Thierry Küntzer, Susumu Kusunoki, Agustina M. Lascano, Eugenia Martínez‐Hernández, Simon Rinaldi, Johnny P.A. Samijn, Olivier Scheidegger, Pinelopi Tsouni, Alex Vicino, Leo H. Visser, Christa Walgaard, Yuzhong Wang, Paul W. Wirtz, Paolo Ripellino, Bart C. Jacobs, Bart C. Jacobs, Richard AC Hughes, David R. Cornblath, Kenneth C. Gorson, Hans‐Peter Hartung, Susumu Kusunoki, Pieter A. van Doorn, Hugh J. Willison, Bianca van den Berg, Christine Verboon, Joyce Roodbol, Alex Y. Doets, Sonja E. Leonhard, Linda W.G. Luijten, L.C. de Koning, Melissa R. Mandarakas, M. van Woerkom, Samuel Arends, Ricardo Reisin, Stephen W Reddel, Zhahirul Islam, Quazi Deen Mohammad, Peter Van den Bergh, T E Feasby, Yuzhong Wang, Thomas Harbo, Yann Péréon, Helmar C. Lehmann, Efthimios Dardiotis, Eduardo Nobile‐Orazio, Nortina Shahrizaila, Kathleen Bateman, Isabel Illa, Luís Querol, Paolo Ripellino, Sung‐Tsang Hsieh, Govindsinh Chavada, Amy Davidson, James M Addington, Henning Andersen, Giovanni Antonini, Senda Ajroud‐Driss, Shahram Attarian, Umesh A. Badrising, Claudia Balducci, Fábio Barroso, I.R. Bella, Luana Benedetti, Tulio E. Bertorini, Ratna Bhavaraju‐Sanka, Thomas H. Brannagan, Chiara Briani, Jan Bürmann, Mark Busby, Stephen Butterworth, Carlos Casasnovas, Francesca Castellani, Guido Cavaletti, Chi‐Chao Chao, Shan Chen, Kristl G. Claeys, M E Conti, Jeremy Cosgrove, Marinos C. Dalakas, Miroslawa A Derejko
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.