More Evidence Supports COVID-19/Guillain-Barré Link

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APRIL 20, 2020 -- Five more cases of Guillain–Barré syndrome (GBS) in association with COVID-19 have been identified, further supporting a link between the virus and neurologic complications, including GBS.

The account, from Italian researchers, comes a little more than 2 weeks following the first reported case of COVID-19 presenting as GBS.

The article, with lead author Gianpaolo Toscano, MD, IRCCS C. Mondino Foundation, Pavia, Italy, was published online April 17 in the New England Journal of Medicine

The five GBS cases occurred in three hospitals in Italy from February 28 through March 21. There were an estimated 1000 to 1200 COVID-19 admissions during this time.

The onset of GBS in the five patients occurred 5 to 10 days after initial COVID-19 diagnosis.

Three of the patients developed a demyelinating form of GBS; the other two had findings generally consistent with an axonal variant. All five patients received intravenous immune globulin treatment.

Four weeks following treatment, two patients were on a ventilator in the intensive care unit, and the other two, with flaccid paraplegia and minimal upper limb movement, were undergoing physical therapy. The fifth patient was discharged and was walking independently.

Although apparently still a rare occurrence, these additional cases may help raise awareness of GBS as a potential complication of COVID-19 among frontline clinicians.

Given the small number of cases in this observational series, it is unclear whether severe neurologic deficits and axonal involvement are typical features of COVID-19-associated GBS, the authors note.

Furthermore, it was not possible to determine whether any respiratory challenges associated with COVID-19 were independent of any muscle weakness caused by GBS.

However, the authors note that such an effect "might be considered if findings on chest imaging are not commensurate with the severity of respiratory insufficiency.

Guillane-Barré syndrome with Covid-19 should be distinguished from critical illness neuropathy and myopathy, which tend to appear later in the course of critical illness than Guillain-Barré syndrome," the authors write.

Medscape Medical News

Sources

New Engl J Med. Published online April 17, 2020. Full text

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