COVID‐19‐Associated Guillain‐Barre Syndrome: The Early Pandemic Experience.

Caress, James B.; Castoro, Ryan J.; Simmons, Zachary; Scelsa, Stephen N.; Lewis, Richard A.; Ahlawat, Aditi; Nayaranaswami, Pushpa

Guillain‐Barre Syndrome (GBS) is an inflammatory polyradiculoneuropathy associated with numerous viral infections. Recently, there have been many case reports describing the association between COVID‐19 and GBS but much remains unknown about the strength of the association and the features of GBS in this setting. We reviewed 37 published cases of GBS associated with COVID‐19 to summarize this information for clinicians and to determine whether a specific clinical or electrodiagnostic (EDX) pattern is emerging. The mean age (59y), gender (65% male) and COVID‐19 features appear to reflect those of hospitalized COVID‐19 patients early in the pandemic. The mean time from COVID‐19 symptoms to GBS symptoms was 11 days. The clinical presentation and severity of these GBS cases was similar to those with non‐COVID‐19 GBS. The EDX pattern was considered demyelinating in approximately one half of the cases. Cerebrospinal fluid, when assessed, demonstrated albuminocytologic dissociation in 76% of patients and was negative for SARS‐CoV‐2 in all. Serum anti‐ganglioside antibodies were absent in 15 of 17 patients tested. Most patients were treated with a single course of intravenous immunoglobulin, and improvement was noted within 8 weeks in most. In summary, GBS associated COVID‐19 appears to be an uncommon condition with similar clinical and EDX patterns to GBS prior to the pandemic. Future studies should compare patients with COVID‐19 associated GBS to those with contemporaneous non‐COVID‐19 GBS and determine if the incidence of GBS is elevated in those with COVID‐19.