Q&A: Guillain-Barre syndrome in patients with COVID-19 requires more research
Recent research from Spain and the United States described Guillain-Barre syndrome — in both novel and recurrent forms — in patients with COVID-19, adding to the growing body of literature on the neurological manifestations of the disease.
In the first report, researchers from Spain identified 11 cases of Guillain-Barre syndrome (GBS) among 71,904 patients with COVID-19 across 61 EDs during a “2-month pandemic peak.” They reported a higher relative frequency of GBS in patients with vs. without COVID-19 (0.15% vs. 0.02%; OR = 6.30; 95% CI, 3.18-12.5) and a higher standardized incidence of the syndrome (9.44 vs. 0.69 cases per 100,000 inhabitants-years; OR = 13.5; 95% CI, 9.87-18.4). Patients with COVID-19 who developed GBS were more frequently admitted to intensive care, but mortality did not increase in these patients compared with control groups.
The researchers noted that additional cases and case series on the clinical characteristics of GBS in patients with COVID-19 were published as they prepared their manuscript. The results in those reports were “mainly consistent” with their findings, they wrote, and concluded that — when taken together — this group of research suggested “a potential role of SARS-CoV-2 as an additional viral infection causative of GBS.”
The second report involved the first known instance of COVID-19 leading to a recurrence of GBS, according to a press release from Rutgers University in New Jersey. The patient, a man aged 54 years, had developed GBS on two prior occasions and experienced a third occurrence after testing positive for COVID-19.
“The patient came to the [ED] with complaints of progressive difficulty swallowing, then had a fever for three days, followed by weakness in the arms, legs and face,” Erin McDonnell, a medical student at Rutgers Robert Wood Johnson Medical School, said in the press release. “His symptoms were worse this time than in previous episodes. He has since recovered.”
Healio Neurology spoke with McDonnell to learn more about the case at Rutgers University and the connection between GBS and COVID-19.
Q: To your knowledge, this is the first-ever report of COVID-19 as a trigger for recurrent GBS, correct?
A: Correct. To our knowledge, this is the first case describing a patient with recurrent GBS secondary to a COVID-19 infection. Abu-Rumeileh and colleagues documented more than 70 cases of patients with GBS secondary to COVID-19, our case represents a patient who had GBS in the past. About 3% to 5% of patients with GBS will have later recurrent episodes. There are other case studies describing COVID-19 as a trigger for chronic demyelinating polyneuropathy disorders, which is a relapsing-remitting demyelinating disorder.
Q: Should all patients who have had GBS in the past be concerned about a recurrence if they get COVID-19?
A: Patients who have had GBS in the past may be at risk for GBS recurrence secondary to COVID-19. Statistics demonstrate that, of patients who had GBS in the past, about 5% of them experience recurrent symptoms, but this was before COVID-19. We are still learning more about COVID-19 and its interaction with our own immune system.
Q: Does this development tell us anything about the underlying mechanisms behind GBS?
A: The mechanism behind GBS is based on an autoimmune concept called "molecular mimicry." The immune system mistakenly attacks the patient's healthy cells, resulting in nerve damage. More research is needed to better understand common antigens between the novel coronavirus and specific neuronal tissue.
Q: H ow might this impact the management of COVID-19 ?
A: We recommend close observation for patients with COVID-19 who present to clinicians with neurological and demyelinating symptoms. In addition, we advise clinicians to obtain a thorough history, if possible, to assess whether the patient had GBS in the past.
References:
- Abu-Rumeileh S, et al. J. Neurol. 2020;doi: 10.1007/s00415-020-10124-x.
- Fragiel M, et al. Ann Neurol. 2020;doi:10.1002/ana.25987.
- Rutgers Today. Rutgers reports first instance of COVID-19 triggering recurrent Guillain-Barre syndrome. Available at: https://www.rutgers.edu/news/rutgers-reports-first-instance-covid-19-triggering-recurrent-guillain-barre-syndrome. Accessed Dec. 15, 2020.