Electrophysiological features of acute inflammatory demyelinating polyneuropathy associated with SARS-CoV-2 infection

Uncini, Antonino; Foresti, Camillo; Frigeni, Barbara; Benedetta, Storti; Servalli, Maria Cristina; Gazzina, Stefano; Cosentino, Giuseppe; Bianchi, Francesca; Del Carro, Ubaldo; Alfonsi, Enrico; Piccinelli, Stefano Cotti; De Maria, Giovanni; Padovani, Alessandro; Filosto, Massimiliano; Ippoliti, Luigi

Objective To assess whether patients with acute inflammatory demyelinating polyneuropathy (AIDP) associated with SARS-CoV-2 show characteristic electrophysiological features. Methods Clinical and electrophysiological findings of 24 patients with SARS-CoV-2 infection and AIDP (S-AIDP) and of 48 control AIDP (C-AIDP) without SARS-CoV-2 infection were compared. Results S-AIDP patients more frequently developed respiratory failure (83.3% vs 25%, P=0.000) and required intensive care unit (ICU) hospitalization (58.3% vs 31.3%, P=0.000). In C-AIDP, distal motor latencies (DMLs) were more frequently prolonged (70.9% vs 26.2%, P=0.000) whereas in S-AIDP distal compound muscle action potential (dCMAP) durations were more frequently increased (49.5% vs 32.4%, P=0.002) and F waves were more often absent (45.6% vs 31.8%, P=0.011). Presence of nerves with increased dCMAP duration and normal or slightly prolonged DML was elevenfold higher in S-AIDP (31.1% vs 2.8%, P=0.000);11 S-AIDP patients showed this pattern in 2 nerves. Conclusion Increased dCMAP duration, thought to be a marker of acquired demyelination, can also be oserved in critical illness myopathy. In S-AIDP patients, an increased dCMAP duration dissociated from prolonged DML, suggests additional muscle fiber conduction slowing, possibly due to a COVID-19-related hyperinflammatory state. Absent F waves, at least in some S-AIDP patients, may reflect α-motor neuron hypoexcitability because of immobilization during the ICU stay. These features should be considered in the electrodiagnosis of SARS-CoV-2 patients with weakness, to avoid misdiagnosis.