Guillain-Barr é syndrome in COVID-19: A scoping review

  1. Imran Ahmad
  2. Farooq Azam Rathore

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Abstract

Introduction

The novel corona virus (COVID19) can result in several neurological complications. Guillain-Barré Syndrome (GBS) is one of them and has been reported from different parts of the world in this pandemic. It is an acute post infectious polyneuropathy. The review aims to summarize the demographic features, clinical presentation, diagnostics workup, and management strategies of COVID-19 associated GBS reported in literature.

Material and method

We searched Medline, PubMed Central, SCOPUS and Google Scholar using pre-defined keywords, with no time limits and in English language only. We aimed to include all kind of manuscripts. Last search was done on 18 th May 2020.

Demographics, clinical features, diagnostic workup, management, and outcomes were documented in the data sheet.

Results

We identified 24 cases of COVID-19 associated GBS. Most of the cases were reported from Italy followed by USA. Majority were males (18 /24) The age ranged from 23 -84 years. The clinical presentation was typical sensory-motor GBS in most. Nine patients had facial palsy of which five had bilateral involvement. Two patients had bilateral abducent nerve palsy while two presented as paraparetic GBS variant with autonomic dysfunction. Electrodiagnostics was performed in 17 patients only and 12 had typical features of acute inflammatory demyelinating polyneuropathy.. Intravenous immunoglobulins were the preferred mode of treatment in most of the patient. There was one death, and most were discharged to rehabilitation or home.

Conclusion

GBS is a frequent neurological complication associated with COVID-19. There is no clear causative relationship between GBS, and COVID-19 at present and more data are needed to establish the casualty. However, most cases have a post-infectious onset with male preponderance. Most of the cases have a typical presentation but some may present in an atypical way. Prognosis is generally good.

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  1. ScreenIT

    SciScore for 10.1101/2020.06.13.20130062: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations: Despite a rigorous search methodology for this review, we were not able to perform literature search all the major English bio-medical literature search databases due to lack of resources and access. There is a possibility that we might have missed some cases which we hope will be identified in the systematic reviews registered in the International prospective register of systematic reviews. The total number of confirmed cases of COVID-19 globally is now more than 7 million but we were able to document only 24 cases of GBS reported in the English biomedical literature so far. This is a very small number of cases to make a causal relationship or a definitive conclusion regarding COVID-19 associated GBS. Due to the wide spread of the disease and wide variations in the documentation and reporting of data from different parts of the world, there are chances that mild cases of GBS or cases with limited involvement might be missed or do not report to hospitals. Moreover, neurological services are not widely available in many developing countries and there is a possibility that some COVID-19 associated GBS cases remain undiagnosed due to lack of expertise in neurology. In addition, mortality in COVID-19 cases due to rapidly progressive respiratory failure is usually attributed to the COVID-19 itself. There is a possibility of co-existing GBS which may contribute to the worsening of the condition. We hope that as more data from different parts of the world is shared, thi...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1101/2020.06.13.20130062v1 on medRxiv