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van Gils LAJL, Corsten MFM, Koelman CAC, Bosma RJR, Fijnheer RR, Mulder AHLL, Regelink JCJ. Cold case: COVID-19-triggered type 1 cryoglobulinemia. Ann Hematol 2024:10.1007/s00277-024-05970-y. [PMID: 39214930 DOI: 10.1007/s00277-024-05970-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024]
Abstract
A 42-year-old male was referred to the internal medicine department because of renal failure and persistent malaise after a recent SARS-CoV-2 infection. Blood results showed anemia and severe renal insufficiency (hemoglobin of 10.3 g/dL and a creatinine of 2.19 mg/dL). Additional tests revealed a type I cryoglobulinemia with a cryoprecipitate composed of dual IgM (kappa and lambda). Further investigations on the cryoprecipitate revealed that the immunoglobulins were directed against SARS-CoV-2 antigens. In the meanwhile, our patient noticed improvement of his symptoms accompanied by resolution of laboratory abnormalities. Three months later, the cryoglobulin could no longer be detected.Type 1 cryoglobulinemia is usually associated with lymphoproliferative disorders and is characterized by various symptoms caused by cryoprecipitates occluding small blood vessels. This is, to our knowledge, the first case of type I cryoglobulinemia with proven precipitation of SARS-CoV-19 antibodies. COVID-19 induced cryoglobulinemia appears to have a mild disease course and to be self-limiting upon viral clearance.
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Affiliation(s)
- L A J Luuk van Gils
- Meander Medical Center, department of Internal Medicine, Amersfoort, Netherlands.
| | - M F Maarten Corsten
- Meander Medical Center, department of Internal Medicine, Amersfoort, Netherlands
| | - C A Carin Koelman
- Meander Medical Center, department of Medical Microbiology and Medical Immunology, Amersfoort, Netherlands
| | - R J Renate Bosma
- Meander Medical Center, department of Internal Medicine, Amersfoort, Netherlands
| | - R Rob Fijnheer
- Meander Medical Center, department of Internal Medicine, Amersfoort, Netherlands
| | | | - J C Josien Regelink
- Meander Medical Center, department of Internal Medicine, Amersfoort, Netherlands
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Kopańko M, Zabłudowska M, Zajkowska M, Gudowska-Sawczuk M, Mucha M, Mroczko B. The Impact of COVID-19 on the Guillain-Barré Syndrome Incidence. Biomedicines 2024; 12:1248. [PMID: 38927455 PMCID: PMC11201746 DOI: 10.3390/biomedicines12061248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/28/2024] [Accepted: 06/01/2024] [Indexed: 06/28/2024] Open
Abstract
Despite the fact that the global COVID-19 pandemic has officially ended, we continue to feel its effects and discover new correlations between SARS-CoV-2 infection and changes in the organism that have occurred in patients. It has been shown that the disease can be associated with a variety of complications, including disorders of the nervous system such as a characteristic loss of smell and taste, as well as less commonly reported incidents such as cranial polyneuropathy or neuromuscular disorders. Nervous system diseases that are suspected to be related to COVID-19 include Guillain-Barré syndrome, which is frequently caused by viruses. During the course of the disease, autoimmunity destroys peripheral nerves, which despite its rare occurrence, can lead to serious consequences, such as symmetrical muscle weakness and deep reflexes, or even their complete abolition. Since the beginning of the pandemic, case reports suggesting a relationship between these two disease entities have been published, and in some countries, the increasing number of Guillain-Barré syndrome cases have also been reported. This suggests that previous contact with SARS-CoV-2 may have had an impact on their occurrence. This article is a review and summary of the literature that raises awareness of the neurological symptoms' prevalence, including Guillain-Barré syndrome, which may be impacted by the commonly occurring COVID-19 disease or vaccination against it. The aim of this review was to better understand the mechanisms of the virus's action on the nervous system, allowing for better detection and the prevention of its complications.
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Affiliation(s)
- Magdalena Kopańko
- Department of Biochemical Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland (M.G.-S.); (B.M.)
| | - Magdalena Zabłudowska
- Department of Biochemical Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland (M.G.-S.); (B.M.)
| | - Monika Zajkowska
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland
| | - Monika Gudowska-Sawczuk
- Department of Biochemical Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland (M.G.-S.); (B.M.)
| | - Mateusz Mucha
- Department of Oncological Surgery with Specialized Cancer Treatment Units, Maria Sklodowska-Curie Oncology Center, 15-027 Bialystok, Poland
| | - Barbara Mroczko
- Department of Biochemical Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland (M.G.-S.); (B.M.)
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland
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3
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Tasdemir V, Sirin NG, Cakar A, Culha A, Soysal A, Elmali AD, Gunduz A, Arslan B, Yalcin D, Atakli D, Orhan EK, Sanli E, Tuzun E, Gozke E, Gursoy E, Savrun FK, Uslu FI, Aysal F, Durmus H, Bulbul H, Ertas FI, Uluc K, Tutkavul K, Baysal L, Baslo MB, Kiziltan M, Mercan M, Pazarci N, Uzun N, Akan O, Cokar O, Koytak PK, Sürmeli R, Gunaydin S, Ayas S, Baslo SA, Yayla V, Yilmaz V, Parman Y, Matur Z, Acar ZU, Oge AE. Electrodiagnostic methods to verify Guillain-Barré syndrome subtypes in Istanbul: A prospective multicenter study. J Peripher Nerv Syst 2024; 29:72-81. [PMID: 38291679 DOI: 10.1111/jns.12612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND AND AIMS This study aimed to identify the clinical characteristics and electrodiagnostic subtypes of Guillain-Barré syndrome (GBS) in Istanbul. METHODS Patients with GBS were prospectively recruited between April 2019 and March 2022 and two electrodiagnostic examinations were performed on each patient. The criteria of Ho et al., Hadden et al., Rajabally et al., and Uncini et al. were compared for the differentiation of demyelinating and axonal subtypes, and their relations with anti-ganglioside antibodies were analyzed. RESULTS One hundred seventy-seven patients were included, 69 before the coronavirus disease 2019 pandemic (April 2019-February 2020) and 108 during the pandemic (March 2020-March 2022), without substantial changes in monthly frequencies. As compared with the criteria of Uncini et al., demyelinating GBS subtype diagnosis was more frequent according to the Ho et al. and Hadden et al. criteria (95/162, 58.6% vs. 110/174, 63.2% and 121/174, 69.5%, respectively), and less frequent according to Rajabally et al.'s criteria (76/174, 43.7%). Fourteen patients' diagnoses made using Rajabally et al.'s criteria were shifted to the other subtype with the second electrodiagnostic examination. Of the 106 analyzed patients, 22 had immunoglobulin G anti-ganglioside antibodies (14 with the axonal subtype). They had less frequent sensory symptoms (54.5% vs. 83.1%, p = 0.009), a more frequent history of previous gastroenteritis (54.5% vs. 22.9%, p = 0.007), and a more severe disease as compared with those without antibodies. INTERPRETATION Serial electrodiagnostic examinations are more helpful for accurate subtype diagnosis of GBS because of the dynamic pathophysiology of the disease. We observed no significant increase in GBS frequency during the pandemic in this metropolis.
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Affiliation(s)
- Volkan Tasdemir
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Nermin Gorkem Sirin
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Arman Cakar
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Ayla Culha
- Haseki Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Aysun Soysal
- Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Ayse Deniz Elmali
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Aysegul Gunduz
- Cerrahpasa Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Beyza Arslan
- Department of Neurology and Clinical Neurophysiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Destina Yalcin
- Umraniye Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Dilek Atakli
- Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Elif Kocasoy Orhan
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Elif Sanli
- Aziz Sancar Institute of Experimental Medicine, Department of Neuroscience, Istanbul University, Istanbul, Turkey
| | - Erdem Tuzun
- Aziz Sancar Institute of Experimental Medicine, Department of Neuroscience, Istanbul University, Istanbul, Turkey
| | - Eren Gozke
- Fatih Sultan Mehmet Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Esra Gursoy
- Faculty of Medicine Hospital, Department of Neurology, Bezmialem Vakif University, Istanbul, Turkey
| | - Feray Karaali Savrun
- Cerrahpasa Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ferda Ilgen Uslu
- Faculty of Medicine Hospital, Department of Neurology, Bezmialem Vakif University, Istanbul, Turkey
| | - Fikret Aysal
- Faculty of Medicine, Department of Neurology, Medipol University, Istanbul, Turkey
| | - Hacer Durmus
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Hafsa Bulbul
- Department of Neurology and Clinical Neurophysiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - F Inci Ertas
- Sisli Hamidiye Etfal Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Kayihan Uluc
- Department of Neurology and Clinical Neurophysiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Kemal Tutkavul
- Haydarpaşa Numune Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Leyla Baysal
- Prof. Dr. Cemil Taşçıoğlu City Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Baris Baslo
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Meral Kiziltan
- Cerrahpasa Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Metin Mercan
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Nevin Pazarci
- Umraniye Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Nurten Uzun
- Cerrahpasa Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Onur Akan
- Prof. Dr. Cemil Taşçıoğlu City Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Ozlem Cokar
- Haseki Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Pinar Kahraman Koytak
- Department of Neurology and Clinical Neurophysiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Reyhan Sürmeli
- Umraniye Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Sefer Gunaydin
- Haseki Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Selahattin Ayas
- Cerrahpasa Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sezin Alpaydin Baslo
- Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Vildan Yayla
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Vuslat Yilmaz
- Aziz Sancar Institute of Experimental Medicine, Department of Neuroscience, Istanbul University, Istanbul, Turkey
| | - Yesim Parman
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Zeliha Matur
- Faculty of Medicine Hospital, Department of Neurology, Bezmialem Vakif University, Istanbul, Turkey
| | - Zeynep Unlusoy Acar
- Haseki Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Ali Emre Oge
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
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Censi S, Bisaccia G, Gallina S, Tomassini V, Uncini A. Guillain-Barré syndrome and SARS-CoV-2 infection: a systematic review and meta-analysis on a debated issue and evidence for the 'Italian factor'. Eur J Neurol 2024; 31:e16094. [PMID: 37823707 PMCID: PMC11235836 DOI: 10.1111/ene.16094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/07/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND AND PURPOSE The association between Guillain-Barré syndrome (GBS) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is debated. This study reappraises, after three pandemic years, the epidemiological data and the features of GBS in SARS-CoV-2 patients. METHODS A systematic review and meta-analysis of case reports/series and cohort studies published between 1 January 2020 and 19 April 2023 was performed. RESULTS In all, 209 case reports/series (304 patients) and 26 cohort studies were included. The risk of GBS in northern Italy during the first pandemic wave was 2.85 times increased (95% confidence interval [CI] 1.54; 5.25) whereas in some countries the risk during the first pandemic year was 0.17 times reduced (risk ratio 0.83, 95% CI 0.75; 0.93). The incidence of GBS in SARS-CoV-2 Italian hospitalized cohorts was 8.55 per 1000 (95% CI 5.33; 12.49) with an estimated incidence of 0.13 GBS per 1000 in the SARS-CoV-2 infected population. In European cohorts the pooled rate of GBS with SARS-CoV-2 infection was 61.3% of the total. GBS patients with SARS-CoV-2 infection showed more frequently, but not differently from non-infected patients, the classical clinical presentation and the demyelinating subtype. Cranial nerves were more frequently involved in SARS-CoV-2 infected patients. CONCLUSIONS An increased risk of GBS occurred in northern Italy during early COVID-19 pandemic. The recognition of the 'Italian factor' reconciles contrasting results of the epidemiological studies. The slightly reduced GBS risk in other countries and the relatively high frequency of GBS associated with SARS-CoV-2 infection can be explained by the adopted health measures that decreased the circulation of other GBS infective antecedents.
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Affiliation(s)
- Stefano Censi
- Department of Neuroscience, Imaging and Clinical Sciences; Institute for Advanced Biomedical Technologies (ITAB)‘G. d'Annunzio’ University of Chieti‐PescaraChietiItaly
| | - Giandomenico Bisaccia
- Department of Neuroscience, Imaging and Clinical Sciences; Institute for Advanced Biomedical Technologies (ITAB)‘G. d'Annunzio’ University of Chieti‐PescaraChietiItaly
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences; Institute for Advanced Biomedical Technologies (ITAB)‘G. d'Annunzio’ University of Chieti‐PescaraChietiItaly
| | - Valentina Tomassini
- Department of Neuroscience, Imaging and Clinical Sciences; Institute for Advanced Biomedical Technologies (ITAB)‘G. d'Annunzio’ University of Chieti‐PescaraChietiItaly
- Clinical NeurologySS. Annunziata University HospitalChietiItaly
| | - Antonino Uncini
- Department of Neuroscience, Imaging and Clinical Sciences; Institute for Advanced Biomedical Technologies (ITAB)‘G. d'Annunzio’ University of Chieti‐PescaraChietiItaly
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Olbert E, Alhani N, Struhal W. Retrospective analysis of COVID-19 patients with Guillain-Barre, Miller-Fisher, and opsoclonus-myoclonus-ataxia syndromes-a case series. Wien Med Wochenschr 2024; 174:30-34. [PMID: 37523107 PMCID: PMC10810910 DOI: 10.1007/s10354-023-01018-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/23/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND In accordance with the rising number of SARS-CoV‑2 infections, reports of neurological complications have also increased. They include cerebrovascular diseases but also immunological diseases such as Guillain-Barre syndrome (GBS), Miller-Fisher syndrome (MFS), and opsoclonus-myoclonus-ataxia syndrome (OMAS). While GBS and MFS are typical postinfectious complications, OMAS has only recently been described in the context of COVID-19. GBS, MFS, and OMAS can occur as para- and postinfectious, with different underlying pathomechanisms depending on the time of neurological symptom onset. The study aimed to describe clinical features, time between infection and onset of neurological symptoms, and outcome for these diseases. METHODS All COVID-19 patients treated in the neurological ward between January 2020 and December 2022 were screened for GBS, MFS, and OMAS. The clinical features of all patients, with a particular focus on the time of onset of neurological symptoms, were analyzed. RESULTS This case series included 12 patients (7 GBS, 2 MFS, 3 OMAS). All GBS and one MFS patient received immunomodulatory treatment. Three patients (2 GBS, 1 OMAS) had a severe COVID-19 infection and received mechanical ventilation. In patients with OMAS, only one patient received treatment with intravenous immunoglobulin and cortisone. The remaining two patients, both with disease onset concurrent with SARS-COV‑2 infection, recovered swiftly without treatment. In all subgroups, patients with concurrent onset of neurological symptoms and COVID-19 infection showed a trend toward shorter disease duration. CONCLUSION All patient groups displayed a shorter disease duration if the onset of neurological symptoms occurred shortly after the COVID-19 diagnosis. In particular, both the OMAS patients with symptom onset concurrent with COVID-19 showed only abortive symptoms followed by a swift recovery. This observation would suggest different pathomechanisms for immune-mediated diseases depending on the time of onset after an infection.
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Affiliation(s)
- Elisabeth Olbert
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Austria.
- Department of Neurology, University Hospital Tulln, Alter Ziegelweg 10, 3430, Tulln an der Donau, Austria.
| | - Naela Alhani
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Austria
- Department of Neurology, University Hospital Tulln, Alter Ziegelweg 10, 3430, Tulln an der Donau, Austria
| | - Walter Struhal
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Austria
- Department of Neurology, University Hospital Tulln, Alter Ziegelweg 10, 3430, Tulln an der Donau, Austria
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Hadhiah K, Alhashim A, Al-Dandan HA, Alhassan E, Alqarni AM, Memish AAA, Alabdali M. Guillain-Barré syndrome post-SARS-CoV-2 vaccine: a systematic review and data analysis on its clinical, laboratory, electrophysiological, and radiological features. Front Neurol 2024; 15:1332364. [PMID: 38352138 PMCID: PMC10863047 DOI: 10.3389/fneur.2024.1332364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/08/2024] [Indexed: 02/16/2024] Open
Abstract
Introduction Guillain-Barré syndrome (GBS) is a rare disease that affects almost 0.8-1.9 cases per 100,000 people worldwide every year. This is the most prevalent cause of subacute flaccid paralyzing illness today. It is a subacute inflammatory demyelinating polyradiculoneuropathy; the typical scenario involves ascending symmetrical flaccid paralysis, but in some circumstances, sensory, autonomic, and cranial neuropathy may also be involved. Several vaccines have been found to have complications since the previous century. Numerous case reports of GBS in the literature have been reported following COVID-19 vaccines in recent times. Objective This study aimed to conduct a comprehensive examination of GBS cases that have been reported after COVID-19 vaccines; to analyze the descriptive statistical analysis of data gathered regarding clinical, laboratory, electrophysiological, and radiological characteristics; to discuss, based on the available evidence, whether the disease has a preference for a particular vaccine type; and to speculate on the potential pathogenesis. Methodology This review has been carried out by recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Result Reviewing 60 case reports illustrated that most of them are from the USA (18.1%) and the majority of affected individuals were males (60%). The results favored the association between vector-based SARS-CoV-2 vaccine, particularly AstraZeneca vaccine, and the GBS. The mean of symptoms onset is 11.4 days. The results of diagnostic tests such as LP are consistent mostly with albumin-cytological dissociation (81.81%), where brain and spine MRI was unremarkable in 59.52%. Regarding electrodiagnostic tests, AIDP is the most common variant (61.81%). The management was not consistent among the case reports. However, IVIG is the most frequent way of treating these patients (68.33%). The functional outcome was documented in 47 patients; 65% improved with medical management. Conclusion This study aimed to conduct a systematic review of reported cases of GBS following COVID-19 vaccines and descriptive statistical analysis of collected data on clinical, laboratory, electrophysiological, and radiological features, to discuss, based on available results, whether the disease has a predilection to a specific vaccine type and to speculate the potential pathogenesis.
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Affiliation(s)
| | - Ali Alhashim
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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7
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Chen Y, Li K, Lv W, Xie J, Qian Y, Cui C, Deng B. What Is the Impact of the Novel Coronavirus and the Vaccination on Guillain-Barre Syndrome? Mol Neurobiol 2023:10.1007/s12035-023-03638-8. [PMID: 37728848 DOI: 10.1007/s12035-023-03638-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
The COVID-19 pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has resulted in devastating medical and economic consequences worldwide over the past 3 years. As the pandemic enters a new stage, it is essential to consider the potential impact on rare diseases such as Guillain-Barre syndrome (GBS), which has been intimately associated with COVID-19 since the first COVID-19-related GBS case was reported in January 2020. There are notable differences between COVID-19-related GBS and GBS without COVID-19 in terms of diagnostic types and clinical manifestations. Furthermore, with the widespread administration of COVID-19 vaccines, there have been reports of GBS occurring shortly after vaccination, which requires close attention despite its rarity. This review also explores the vaccines associated with heightened GBS risks, offering insights that may guide vaccination policies and clinical practice. To provide a visual summary of these findings, we have included a graphical abstract. This article will discuss the characteristic manifestations of GBS patients after being positive for the novel coronavirus and the safety of several COVID-19 vaccines. Firstly, this article comprehensively expounds and discusses the epidemiological aspects of novel coronavirus-related GBS. For example, from the perspective of the same population, the expected incidence of GBS in the COVID-19-positive population (persons/100,000 persons/ year) is about 43 times that of the COVID-19-negative population, and the incidence of GBS is significantly increased. Secondly, the clinical characteristics of COVID-19-negative GBS patients and SARS-CoV-2-GBS (SC2-GBS) patients were summarized and compared. Thirdly, this article reviews GBS cases in the current adverse events after COVID-19 vaccination and analyzes and discusses from multiple perspectives, such as the incidence of GBS events, the age proportion of patients, and the interval of onset.
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Affiliation(s)
- Yinuo Chen
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- First Clinical College of Wenzhou Medical University, Wenzhou, China
| | - Kezheng Li
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- First Clinical College of Wenzhou Medical University, Wenzhou, China
| | - Wenjing Lv
- Department of Geriatrics, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jiali Xie
- Department of Neurology, Shanghai East Hospital, Tongji University, Shanghai, People's Republic of China
| | - Yuqin Qian
- Department of Neurology, Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Can Cui
- Department of Clinical Sciences Malmö, Lund University, Skåne, Sweden
| | - Binbin Deng
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
- First Clinical College of Wenzhou Medical University, Wenzhou, China.
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8
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Guan Y, Yu C, Fei Y, Wang Q, Wang P, Zuo W, Wu H, Qi X, Shi Q. Case Report: Four cases of SARS-CoV-2-associated Guillain-Barré Syndrome with SARS-CoV-2-positive cerebrospinal fluid detected by metagenomic next-generation sequencing: a retrospective case series from China. Front Immunol 2023; 14:1258579. [PMID: 37701436 PMCID: PMC10493301 DOI: 10.3389/fimmu.2023.1258579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is often absent or at low levels in the cerebrospinal fluid (CSF) of patients with previous SARS-CoV-2-associated Guillain-Barré syndrome (GBS). This has led to speculation that SARS-CoV-2-associated GBS is more likely mediated by post-infectious immunity or a parainfection. This understanding has influenced the development of treatment regimens for SARS-CoV-2-associated GBS. This paper reports our experience with four Chinese patients with SARS-CoV-2-associated GBS who tested positive for SARS-CoV-2 RNA in the CSF. They developed symptoms of peripheral nerve damage 4-15 days after fever and confirmed SARS-CoV-2 infection, all of whom presented with progressive weakness of both lower limbs; three with autonomic nerve function impairment such as constipation and urination disorder; and one with polycranial neuritis and Miller-Fisher syndrome. Three patients were tested for anti-ganglioside antibodies, and one tested positive for GD1a-IgG. Four patients recovered well after treatment with anti-viral drugs combined with intravenous immunoglobulin. The present results showed that SARS-CoV-2 RNA can be detected via mNGS in the CSF of some patients with SARS-CoV-2-associated GBS, suggesting that SARS-CoV-2-associated GBS may have multiple pathogeneses.
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Affiliation(s)
- Yalin Guan
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Changshen Yu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Yunhan Fei
- Department of Emergency, Tianjin Huanhu Hospital, Tianjin, China
| | - Qiushi Wang
- Infection Business Unit, Tianjin Novogene Med LAB Co., Ltd., Tianjin, China
- Infection Business Unit, Novogene Co., Ltd., Beijing, China
| | - Pan Wang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Wenchao Zuo
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Hao Wu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Xuemei Qi
- Department of Neurology, The second hospital of tianjin medical university, Tianjin, China
| | - Qiyun Shi
- Infection Business Unit, Tianjin Novogene Med LAB Co., Ltd., Tianjin, China
- Infection Business Unit, Novogene Co., Ltd., Beijing, China
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9
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Sanchez-Boluarte SS, Aguirre-Quispe W, Tacunan-Cuellar J, Sanchez-Boluarte AN, Segura-Chavez D. Disability evaluation in patients with Guillain-Barre syndrome and SARS-CoV-2 infection. Front Neurol 2023; 14:1191520. [PMID: 37483451 PMCID: PMC10356584 DOI: 10.3389/fneur.2023.1191520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
Objective Several cases of Guillain-Barre syndrome (GBS) associated with SARS-CoV-2 infection have been described. This study illustrated the demographic, clinical, and neurophysiological characteristics of patients with GBS and COVID-19, as well as associated factors with disability at discharge. Materials and methods A retrospective analytical observational study was conducted. It included patients diagnosed with GBS admitted in a national reference center in Peru between 2019 and 2021. Epidemiological, clinical, neurophysiological, and cerebrospinal fluid data were analyzed. A multivariate analysis, using the generalized linear model, was performed, considering the presence of disability at discharge as the dependent variable. Results Eight-one subjects diagnosed with GBS were included. The mean age was 46.8 years (SD: 15.2), with a predominance of males (61.73%). The most frequent clinical presentation was the classic sensory-motor form in 74 cases (91.36%) with AIDP (82.35%) as the most frequent neurophysiological pattern in the group with COVID-19, while AMAN pattern predominated (59.26%) in those without COVID-19 (p = <0.000). The disability prevalence ratio at discharge between subjects with COVID-19 and those without COVID-19 was 1.89 (CI 1.06-3.34), p = 0.030, adjusted for age, sex, and neurophysiological subtype. Conclusion The neurophysiologic subtype AIDP, and a higher disability were associated with the presence of COVID-19.
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Affiliation(s)
| | - Wilfor Aguirre-Quispe
- Neurosciences, Clinical Effectiveness and Public Health Research Group, Universidad Científica del Sur, Lima, Peru
| | - Jhon Tacunan-Cuellar
- Department of Neurophysiology, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | | | - Darwin Segura-Chavez
- Department of Neurophysiology, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
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10
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Martic V, Fejzic E, Danilovic M, Lazarevic S, Rajic S, Roganovic M, Stojanov A, Jovin Z, Debeljevic M, Raicevic R. Guillain-Barre Syndrome Followed by Covid-19 Infection, Vaccination and Other Precipitating Factors during the Pandemic. Ann Indian Acad Neurol 2023; 26:256-260. [PMID: 37538436 PMCID: PMC10394436 DOI: 10.4103/aian.aian_974_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/08/2023] [Accepted: 02/19/2023] [Indexed: 08/05/2023] Open
Abstract
Background and Aims Guillain-Barré syndrome (GBS) is usually triggered by an infection. Vaccination is mentioned as a possible trigger in a small number of GBS cases. The aim of this study was to notice GBS distinctness provoked by various triggers during the COVID-19 pandemic. Material and Methods A total of 109 GBS patients were divided into three groups, respectively: COVID-19 infection associated (19 patients), COVID-19 vaccination associated (16 patients) and precipitated by some other factors (74 patients). We compared the clinical, neurophysiological and laboratory characteristics of these three groups. Results Neither were differences recorded in the age of the patients of these three groups at the time of illness, nor in the number of days from the precipitating factor to the onset of symptoms. There were no clinical differences between groups related to severity of the disease or patients' recovery. The only clinical difference was observed in relation to facial nerve bilateral affection because it was significantly higher in the post-vaccination group. According to neurophysiological findings, demyelinating form dominated in all three groups. Conclusion Clinical characteristics, electrophysiological findings and laboratory characteristics did not differ significantly in Guillain-Barre syndrome followed by COVID-19 infection, vaccination and other precipitating factors during the pandemic. The bilateral involvement of facial nerves was significantly higher in the post-vaccination group. Most of these cases had a mild form of the disorder-distal paresthesias GBS variant.
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Affiliation(s)
- Vesna Martic
- Military Medical Academy, Clinic of Neurology, Belgrade, Serbia
| | - Esmer Fejzic
- Military Medical Academy, Clinic of Neurology, Belgrade, Serbia
| | - Milos Danilovic
- Military Medical Academy, Clinic of Neurology, Belgrade, Serbia
| | - Snezana Lazarevic
- Department of Neurology, University of Kragujevac, Serbia, Faculty of Medical Sciences, Kragujevac, Serbia
| | - Sonja Rajic
- Clinical Center of Vojvodina, Neurology Clinic, Medical Faculty, University in Novi Sad, Montenegro, Serbia
| | - Milovan Roganovic
- Clinical Centre of Montenegro, Clinic for Neurology, Podgorica, Montenegro, Serbia
| | | | - Zita Jovin
- Clinical Center of Vojvodina, Neurology Clinic, Medical Faculty, University in Novi Sad, Montenegro, Serbia
| | - Mladen Debeljevic
- Clinical Centre of Montenegro, Clinic for Neurology, Podgorica, Montenegro, Serbia
| | - Ranko Raicevic
- Military Medical Academy, Clinic of Neurology, Belgrade, Serbia
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11
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Manganotti P, Garascia G, Furlanis G, Buoite Stella A. Efficacy of intravenous immunoglobulin (IVIg) on COVID-19-related neurological disorders over the last 2 years: an up-to-date narrative review. Front Neurosci 2023; 17:1159929. [PMID: 37179564 PMCID: PMC10166837 DOI: 10.3389/fnins.2023.1159929] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/03/2023] [Indexed: 05/15/2023] Open
Abstract
Introduction Among the clinical manifestations of SARS-CoV-2 infection, neurological features have been commonly reported and the state-of-the-art technique suggests several mechanisms of action providing a pathophysiological rationale for central and peripheral neurological system involvement. However, during the 1st months of the pandemic, clinicians were challenged to find the best therapeutic options to treat COVID-19-related neurological conditions. Methods We explored the indexed medical literature in order to answer the question of whether IVIg could be included as a valid weapon in the therapeutic arsenal against COVID-19-induced neurological disorders. Results Virtually, all reviewed studies were in agreement of detecting an acceptable to great efficacy upon IVIg employment in neurological diseases, with no or mild adverse effects. In the first part of this narrative review, the interaction of SARS-CoV-2 with the nervous system has been discussed and the IVIg mechanisms of action were reviewed. In the second part, we collected scientific literature data over the last 2 years to discuss the use of IVIg therapy in different neuro-COVID conditions, thus providing a summary of the treatment strategies and key findings. Discussion Intravenous immunoglobulin (IVIg) therapy is a versatile tool with multiple molecular targets and mechanisms of action that might respond to some of the suggested effects of infection through inflammatory and autoimmune responses. As such, IVIg therapy has been used in several COVID-19-related neurological diseases, including polyneuropathies, encephalitis, and status epilepticus, and results have often shown improvement of symptoms, thus suggesting IVIg treatment to be safe and effective.
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12
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Zheng X, Fang Y, Song Y, Liu S, Liu K, Zhu J, Wu X. Is there a causal nexus between COVID-19 infection, COVID-19 vaccination, and Guillain-Barré syndrome? Eur J Med Res 2023; 28:98. [PMID: 36841799 PMCID: PMC9958317 DOI: 10.1186/s40001-023-01055-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/08/2023] [Indexed: 02/27/2023] Open
Abstract
Guillain-Barré syndrome (GBS) is an immune-mediated inflammatory polyradiculoneuropathy, which commonly leads to a very high level of neurological disability. Especially, after the global outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the causation between GBS and SARS-CoV-2 infection and the coronavirus disease 2019 (COVID-19) vaccination have aroused widespread concern. In the review, we analyzed the impacts of SARS-CoV-2 infection and COVID-19 vaccination on GBS globally, aiming to further understand the characteristics of GBS associated with COVID-19. Based on the electrophysiological data, patients suffering from GBS related to COVID-19 manifested as an acute inflammatory demyelinating polyneuropathy (AIDP). Moreover, we summarized the current findings, which may evidence GBS linking to SARS-CoV-2 infection and COVID-19 vaccination, and discussed the underlying mechanisms whether and how the SARS-CoV-2 virus and COVID-19 vaccination can induce GBS and its variants.
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Affiliation(s)
- Xiaoxiao Zheng
- grid.64924.3d0000 0004 1760 5735Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Jilin University, Xinmin Street 1#, Changchun, 130021 China
| | - Yong Fang
- grid.64924.3d0000 0004 1760 5735Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Jilin University, Xinmin Street 1#, Changchun, 130021 China
| | - Yanna Song
- grid.412558.f0000 0004 1762 1794Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shan Liu
- grid.64924.3d0000 0004 1760 5735The Second Hospital of Jilin University, Jilin University, Changchun, China
| | - Kangding Liu
- grid.64924.3d0000 0004 1760 5735Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Jilin University, Xinmin Street 1#, Changchun, 130021 China
| | - Jie Zhu
- Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Jilin University, Xinmin Street 1#, Changchun, 130021, China. .,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Karolinska University Hospital, Solna, Stockholm, Sweden.
| | - Xiujuan Wu
- Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Jilin University, Xinmin Street 1#, Changchun, 130021, China.
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13
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Immunological, Clinical, and Epidemiological Features of Guillain-Barré Syndrome Associated with SARS-CoV-2 Infection. Acta Neurol Scand 2023. [DOI: 10.1155/2023/5380946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Objectives. There is a growing interest in understanding the association between Guillain-Barré syndrome (GBS) and SARS-CoV-2 infection. The aim of this study was to analyse various characteristics of GBS before and after the pandemic outbreak and thus identify possible distinctive features of GBS associated with SARS-CoV-2 (GBS-S). Material and Methods. In our centre, we retrospectively reviewed the records of patients diagnosed with GBS between January 2018 and March 2022. Epidemiological, clinical, and immunological data were analysed and compared between patients with GBS according to the time of diagnosis and antecedent events. Results. Thirty-nine patients with GBS were included: nine (23.1%) were diagnosed with GBS-S. GBS-S was most frequent in 2020 (6/13, 46.1%). Most of these patients developed a postinfectious classic demyelinating variant (4/9, 44.4%) with frequent bilateral facial paralysis (4/9, 44.4%). Serum antiganglioside antibodies (AGAs) were found in 1/9 patients with GBS-S. Serum anti-SSA/Ro60 antibodies were highly prevalent in GBS-S (7/9 (77.8%) vs. 3/11 (27.3%),
). Three cases associated with SARS-CoV-2 vaccination (GBS-V) were detected. Of note, two had bilateral facial paralysis and anti-SSA/Ro60 antibodies. Conclusion. Our findings suggest that SARS-CoV-2 has become an important antecedent event associated with GBS in our setting. GBS-S shows a postinfectious demyelinating immune-mediated profile with negative serological testing for AGAs. Serum anti-SSA/Ro60 antibodies were found frequently in these patients. Bilateral facial paralysis stands out as a possible characteristic clinical feature both in GBS-S and GBS-V. Larger, prospective studies are needed for a better understanding of its immunopathogenesis.
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14
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Sourani A, Rezvani M, Foroughi M, Baradaran Mahdavi S. Spontaneous intramedullary hematoma following COVID-19 vaccination: A case report. Clin Case Rep 2022; 10:e6743. [PMID: 36545562 PMCID: PMC9761661 DOI: 10.1002/ccr3.6743] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/21/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
A 67-year-old female was hospitalized due to right-sided hemiparesis and neck pain with rapid deterioration to a deep coma. She had received the Sinopharm vaccine 2 days earlier. MRI showed extensive cervicothoracic hematomyelia. She received intensive medical care for 2 months and was discharged. An 18-month follow-up showed significant neurological recovery.
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Affiliation(s)
- Arman Sourani
- Department of Neurosurgery, School of MedicineIsfahan University of Medical SciencesIsfahanIran
| | - Majid Rezvani
- Department of Neurosurgery, School of MedicineIsfahan University of Medical SciencesIsfahanIran
| | - Mina Foroughi
- Student Research CommitteeIsfahan University of Medical SciencesIsfahanIran
| | - Sadegh Baradaran Mahdavi
- Department of Physical Medicine and Rehabilitation, School of Medicine, Student Research Committee, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non‐Communicable DiseaseIsfahan University of Medical SciencesIsfahanIran
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15
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Khurshid A, Khurshid M, Sohail A, Raza IM, Ahsan MK, Alam Shah MUF, Taseer AR, Nashwan AJ, Ullah I. Facial palsy as a manifestation of COVID-19: A systematic review of cases. Health Sci Rep 2022; 5:e887. [PMID: 36320650 PMCID: PMC9616168 DOI: 10.1002/hsr2.887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022] Open
Abstract
Background and Aims Facial palsy is a rare complication of the COVID-19 infection. Herein, we conducted a systematic review of all published cases of facial palsy post-COVID-19 infection in an attempt to educate the general population and medical practitioners regarding the likely occurrence of facial palsy in COVID-19 patients, its detection, effective treatment plan, and prognosis of the condition. Methods We searched PubMed, Google Scholar, and Directory of Open Access Journals (DOAJ) from December 1, 2019 to September 21, 2021. Results We included 49 studies bearing accounts of 75 cases who had facial palsy. The mean age of patients was 42.9 ± 19.59 years, with a male-to-female ratio of 8:7. The majority of the cases were reported from Brazil (n = 14), USA (n = 9), Turkey (n = 9), and Spain (n = 9). Noticeably, 30.14% of COVID-19 patients were diagnosed with Guillain-Barré syndrome. In total, 22.97% of patients complained of bilateral facial paralysis (n = 17), whereas ipsilateral paralysis was observed in 77.03% (n = 57). These were common complaints of Lagophthalmos, otalgia, facial drooping, dysarthria, and compromised forehead wrinkling. The treatment regimen mainly included the use of corticosteroids (n = 51) (69.86%), antivirals (n = 23) (31.51%), IVIG (n = 18) (24.66%), antibiotics (n = 13) (17.81%), antiretroviral (n = 9) (12.33%), and antimalarial (n = 8) (10.96%) medications. In all, 35.62% of patients (n = 26) adhered to a combination of antiviral and corticosteroid-based therapy. Positive treatment outcomes were observed in 83.58% (n = 56) of cases. In contrast, 10 patients (14.93%) showed nonsignificant recovery, out of which 3 (4.48%) died from the disease. Conclusion The association of facial palsy with COVID-19 is controversial and therefore requires further investigation and published work to confirm a causal relationship. However, physicians should not overlook the likelihood of facial palsy post-COVID-19 infection and treat it accordingly.
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Affiliation(s)
- Aiman Khurshid
- Department of Forensic Medicine Abbasi Shaheed Hospital Karachi Pakistan
| | - Maman Khurshid
- Department of Internal Medicine Dow University of Health Sciences Karachi Pakistan
| | - Aruba Sohail
- Department of Internal Medicine Dow University of Health Sciences Karachi Pakistan
| | - Imran Mansoor Raza
- Department of Internal Medicine Dow University of Health Sciences Karachi Pakistan
| | | | | | - Anab Rehan Taseer
- Department of Pulmonology, Lady Reading Hospital (LRH) Peshawar Pakistan
| | | | - Irfan Ullah
- Kabir Medical College Gandhara University Peshawar Pakistan
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16
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Haykal MA, Menkes DL. The Clinical Neurophysiology of COVID-19- Direct Infection, Long-Term Sequelae and Para-Immunization responses: A literature review. Clin Neurophysiol Pract 2022; 8:3-11. [PMID: 36275861 PMCID: PMC9574576 DOI: 10.1016/j.cnp.2022.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/29/2022] [Accepted: 09/09/2022] [Indexed: 11/06/2022] Open
Abstract
The COVID-19 pandemic resulting from the SARS-CoV-2 virus is in its third year. There is continuously evolving information regarding its pathophysiology and its effects on the nervous system. Clinical neurophysiology techniques are commonly employed to assess for neuroanatomical localization and/or defining the spectrum of neurological illness. There is an evolving body of literature delineating the effects of the SARS-CoV-2 virus on the nervous system as well as para-immunization responses to vaccination against this virus. This review focuses on the use of neurophysiological diagnostic modalities in the evaluation of potential acute and long-term neurological complications in patients that experience direct infection with SARS-CoV-2 and analyzes those reports of para-immunization responses to vaccination against the SARS-CoV-2 virus. The neurophysiological modalities to be discussed include electroencephalography (EEG), evoked potentials (EPs), nerve conduction studies and electromyography (EMG/NCV), autonomic function tests, transcranial magnetic stimulation (TMS) and Transcranial Doppler ultrasound (TCD).
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17
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Fakhari MS, Poorsaadat L, Mahmoodiyeh B. Guillain-Barré syndrome following COVID-19 vaccine: A case report. Clin Case Rep 2022; 10:e6451. [PMID: 36254149 PMCID: PMC9558586 DOI: 10.1002/ccr3.6451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 11/11/2022] Open
Abstract
Coronavirus disease is a viral infection affecting different organs with various morbidities and mortality. Vaccines are used to control the disease. COVID-19 vaccines have brought many benefits but their adverse effects should not be ignored. Here, we report a case of Guillain-Barré Syndrome Following Sinopharm COVID-19 Vaccine.
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Affiliation(s)
| | - Leila Poorsaadat
- Department of Neurology, School of MedicineArak University of Medical SciencesArakIran
| | - Behnam Mahmoodiyeh
- Department of Anesthesiology, School of MedicineArak University of Medical SciencesArakIran
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18
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Zhang Q, Li J, Weng L. A bibliometric analysis of COVID-19 publications in neurology by using the visual mapping method. Front Public Health 2022; 10:937008. [PMID: 35958855 PMCID: PMC9362596 DOI: 10.3389/fpubh.2022.937008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/30/2022] [Indexed: 01/08/2023] Open
Abstract
Background The characteristic symptom of coronavirus disease 2019 (COVID-19) is respiratory distress, but neurological symptoms are the most frequent extra-pulmonary symptoms. This study aims to explore the current status and hot topics of neurology-related research on COVID-19 using bibliometric analysis. Methods Publications regarding neurology and COVID-19 were retrieved from the Web of Science Core Collection (WoSCC) on March 28 2022. The Advanced search was conducted using “TS = (‘COVID 19’ or ‘Novel Coronavirus 2019’ or ‘Coronavirus disease 2019’ or ‘2019-nCOV’ or ‘SARS-CoV-2’ or ‘coronavirus-2’) and TS = (‘neurology’or ‘neurological’ or ‘nervous system’ or ‘neurodegenerative disease’ or ‘brain’ or ‘cerebra’ or ‘nerve’)”. Microsoft Excel 2010 and VOSviewer were used to characterize the largest contributors, including the authors, journals, institutions, and countries. The hot topics and knowledge network were analyzed by CiteSpace and VOSviewer. Results A total of 5,329 publications between 2020 and 2022 were retrieved. The United States, Italy, and the United Kingdom were three key contributors to this field. Harvard Medical School, the Tehran University of Medical Sciences, and the UCL Queen Square Institute of Neurology were the major institutions with the largest publications. Josef Finsterer from the University of São Paulo (Austria) was the most prolific author. Tom Solomon from the University of Liverpool (UK) was the most cited author. Neurological Sciences and Frontiers in Neurology were the first two most productive journals, while Journal of Neurology held the first in terms of total citations and citations per publication. Cerebrovascular diseases, neurodegenerative diseases, encephalitis and encephalopathy, neuroimmune complications, neurological presentation in children, long COVID and mental health, and telemedicine were the central topics regarding the neurology-related research on COVID-19. Conclusion Neurology-related research on COVID-19 has attracted considerable attention worldwide. Research topics shifted from “morality, autopsy, and telemedicine” in 2020 to various COVID-19-related neurological symptoms in 2021, such as “stroke,” “Alzheimer's disease,” “Parkinson's disease,” “Guillain–Barre syndrome,” “multiple sclerosis,” “seizures in children,” and “long COVID.” “Applications of telemedicine in neurology during COVID-19 pandemic,” “COVID-19-related neurological complications and mechanism,” and “long COVID” require further study.
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Affiliation(s)
- Qian Zhang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
- Hypothalamic-Pituitary Research Center, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jian Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
- Hydrocephalus Center, Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Ling Weng
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Ling Weng
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19
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Filosto M, Cotti Piccinelli S, Gazzina S, Foresti C, Frigeni B, Servalli MC, Sessa M, Cosentino G, Marchioni E, Ravaglia S, Briani C, Castellani F, Zara G, Bianchi F, Del Carro U, Fazio R, Filippi M, Magni E, Natalini G, Palmerini F, Perotti AM, Bellomo A, Osio M, Nascimbene C, Carpo M, Rasera A, Squintani G, Doneddu PE, Bertasi V, Cotelli MS, Bertolasi L, Fabrizi GM, Ferrari S, Ranieri F, Caprioli F, Grappa E, Manganotti P, Bellavita G, Furlanis G, De Maria G, Leggio U, Poli L, Rasulo F, Latronico N, Nobile-Orazio E, Beghi E, Padovani A, Uncini A. Guillain-Barré Syndrome and COVID-19: a one-year observational multicenter study. Eur J Neurol 2022; 29:3358-3367. [PMID: 35837806 PMCID: PMC9349567 DOI: 10.1111/ene.15497] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/04/2022] [Accepted: 07/07/2022] [Indexed: 01/08/2023]
Abstract
Background and purpose Many single cases and small series of Guillain–Barré syndrome (GBS) associated with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection were reported during the coronavirus disease 19 (COVID‐19) outbreak worldwide. However, the debate regarding the possible role of infection in causing GBS is still ongoing. This multicenter study aimed to evaluate epidemiological and clinical findings of GBS diagnosed during the COVID‐19 pandemic in northeastern Italy in order to further investigate the possible association between GBS and COVID‐19. Methods Guillain–Barré syndrome cases diagnosed in 14 referral hospitals from northern Italy between March 2020 and March 2021 were collected and divided into COVID‐19‐positive and COVID‐19‐negative. As a control population, GBS patients diagnosed in the same hospitals from January 2019 to February 2020 were considered. Results The estimated incidence of GBS in 2020 was 1.41 cases per 100,000 persons/year (95% confidence interval 1.18–1.68) versus 0.89 cases per 100,000 persons/year (95% confidence interval 0.71–1.11) in 2019. The cumulative incidence of GBS increased by 59% in the period March 2020–March 2021 and, most importantly, COVID‐19‐positive GBS patients represented about 50% of the total GBS cases with most of them occurring during the two first pandemic waves in spring and autumn 2020. COVID‐19‐negative GBS cases from March 2020 to March 2021 declined by 22% compared to February 2019–February 2020. Conclusions Other than showing an increase of GBS in northern Italy in the “COVID‐19 era” compared to the previous year, this study emphasizes how GBS cases related to COVID‐19 represent a significant part of the total, thus suggesting a relation between COVID‐19 and GBS.
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Affiliation(s)
- Massimiliano Filosto
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,NeMO-Brescia Clinical Center for Neuromuscular Diseases, Brescia, Italy
| | - Stefano Cotti Piccinelli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Unit of Neurology, ASST Spedali Civili, Brescia, Italy
| | - Stefano Gazzina
- Unit of Neurophysiopathology, ASST Spedali Civili, Brescia, Italy
| | - Camillo Foresti
- Unit of Neurology and Neurophysiology, ASST PG23, Bergamo, Italy
| | - Barbara Frigeni
- Unit of Neurology and Neurophysiology, ASST PG23, Bergamo, Italy
| | | | - Maria Sessa
- Unit of Neurology and Neurophysiology, ASST PG23, Bergamo, Italy
| | - Giuseppe Cosentino
- IRCCS Mondino Foundation, Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Enrico Marchioni
- IRCCS Mondino Foundation, Neurooncology and Neuroinflammation Unit, Pavia, Italy
| | - Sabrina Ravaglia
- IRCCS Mondino Foundation, Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Chiara Briani
- Neurology Unit, Azienda Ospedale-Università di Padova, Padova, Italy
| | | | - Gabriella Zara
- Neurology Unit, Azienda Ospedale-Università di Padova, Padova, Italy
| | - Francesca Bianchi
- Neurology and Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy.,Vita Salute San Raffaele University, Milano, Italy
| | - Ubaldo Del Carro
- Neurology and Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy.,Vita Salute San Raffaele University, Milano, Italy
| | - Raffaella Fazio
- Neurology and Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy.,Vita Salute San Raffaele University, Milano, Italy
| | - Massimo Filippi
- Neurology and Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy.,Vita Salute San Raffaele University, Milano, Italy
| | - Eugenio Magni
- Unit of Neurology, Fondazione Poliambulanza, Brescia, Italy
| | - Giuseppe Natalini
- Unit of Intensive Care and Anesthesiology, Fondazione Poliambulanza, Brescia, Italy
| | | | | | - Andrea Bellomo
- "Luigi Sacco" Department of Biomedical and Clinical Sciences, University of Milan, Milano, Italy
| | - Maurizio Osio
- Unit of Neurology, ASST Fatebenefratelli Sacco, Milano
| | | | | | | | | | - Pietro Emiliano Doneddu
- Department of Neurology, Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Clinical and Research Institute; Department of Medical Biotechnology and Translational Medicine, Milan University, Milan, Italy
| | | | | | - Laura Bertolasi
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Gian Maria Fabrizi
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Sergio Ferrari
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Ranieri
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Elena Grappa
- Intensive Care Unit, ASST Cremona, Cremona, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy
| | - Giulia Bellavita
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy
| | - Giovanni Furlanis
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy
| | | | - Ugo Leggio
- Unit of Neurophysiopathology, ASST Spedali Civili, Brescia, Italy
| | - Loris Poli
- Unit of Neurology, ASST Spedali Civili, Brescia, Italy
| | - Frank Rasulo
- Department of Anesthesia, Critical Care and Emergency, ASST Spedali Civili, Brescia; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Nicola Latronico
- Department of Anesthesia, Critical Care and Emergency, ASST Spedali Civili, Brescia; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Eduardo Nobile-Orazio
- Department of Neurology, Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Clinical and Research Institute; Department of Medical Biotechnology and Translational Medicine, Milan University, Milan, Italy
| | - Ettore Beghi
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Unit of Neurology, ASST Spedali Civili, Brescia, Italy
| | - Antonino Uncini
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti-Pescara, Italy
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20
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Carmona-Torre F, Mínguez-Olaondo A, López-Bravo A, Tijero B, Grozeva V, Walcker M, Azkune-Galparsoro H, López de Munain A, Alcaide AB, Quiroga J, Del Pozo JL, Gómez-Esteban JC. Dysautonomia in COVID-19 Patients: A Narrative Review on Clinical Course, Diagnostic and Therapeutic Strategies. Front Neurol 2022; 13:886609. [PMID: 35720084 PMCID: PMC9198643 DOI: 10.3389/fneur.2022.886609] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/28/2022] [Indexed: 12/27/2022] Open
Abstract
Introduction On March 11, 2020, the World Health Organization sounded the COVID-19 pandemic alarm. While efforts in the first few months focused on reducing the mortality of infected patients, there is increasing data on the effects of long-term infection (Post-COVID-19 condition). Among the different symptoms described after acute infection, those derived from autonomic dysfunction are especially frequent and limiting. Objective To conduct a narrative review synthesizing current evidence of the signs and symptoms of dysautonomia in patients diagnosed with COVID-19, together with a compilation of available treatment guidelines. Results Autonomic dysfunction associated with SARS-CoV-2 infection occurs at different temporal stages. Some of the proposed pathophysiological mechanisms include direct tissue damage, immune dysregulation, hormonal disturbances, elevated cytokine levels, and persistent low-grade infection. Acute autonomic dysfunction has a direct impact on the mortality risk, given its repercussions on the respiratory, cardiovascular, and neurological systems. Iatrogenic autonomic dysfunction is a side effect caused by the drugs used and/or admission to the intensive care unit. Finally, late dysautonomia occurs in 2.5% of patients with Post-COVID-19 condition. While orthostatic hypotension and neurally-mediated syncope should be considered, postural orthostatic tachycardia syndrome (POTS) appears to be the most common autonomic phenotype among these patients. A review of diagnostic and treatment guidelines focused on each type of dysautonomic condition was done. Conclusion Symptoms deriving from autonomic dysfunction involvement are common in those affected by COVID-19. These symptoms have a great impact on the quality of life both in the short and medium to long term. A better understanding of the pathophysiological mechanisms of Post-COVID manifestations that affect the autonomic nervous system, and targeted therapeutic management could help reduce the sequelae of COVID-19, especially if we act in the earliest phases of the disease.
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Affiliation(s)
- Francisco Carmona-Torre
- Infectious Disease Service, University Clinic of Navarra, Pamplona, Spain.,COVID-19 Department, University Clinic of Navarra, Pamplona, Spain.,Immune and Infectious Inflammatory Diseases Research, IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Ane Mínguez-Olaondo
- Neurology Department, Donostia University Hospital-OSAKIDETZA, San Sebastián, Spain.,ATHENEA Neuroclinics, Policlínica Gipuzkoa Grupo Quironsalud, Donostia, Spain.,Neuroscience Area, Biodonostia Research Institute, San Sebastián, Spain.,Neurology Department, Faculty of Medicine, University of Deusto, Bilbao, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Madrid, Spain
| | - Alba López-Bravo
- Neurology Department, Hospital Reina Sofía de Tudela-OSASUNBIDEA, Tudela, Spain.,Aragon Institute for Health Research (IIS-A), Zaragoza, Spain
| | - Beatriz Tijero
- Neurology Department, Faculty of Medicine, University of Deusto, Bilbao, Spain.,Neurodegenerative Diseases Group Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.,Neurology Department, Cruces University Hospital-OSAKIDETZA, Barakaldo, Spain
| | | | - Michaela Walcker
- ATHENEA Neuroclinics, Policlínica Gipuzkoa Grupo Quironsalud, Donostia, Spain
| | - Harkaitz Azkune-Galparsoro
- Neuroscience Area, Biodonostia Research Institute, San Sebastián, Spain.,Infectious Disease Department, Donostia University Hospital-OSAKIDETZA, San Sebastián, Spain.,Department of Neurosciences, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Adolfo López de Munain
- Neurology Department, Donostia University Hospital-OSAKIDETZA, San Sebastián, Spain.,ATHENEA Neuroclinics, Policlínica Gipuzkoa Grupo Quironsalud, Donostia, Spain.,Neuroscience Area, Biodonostia Research Institute, San Sebastián, Spain.,Neurology Department, Faculty of Medicine, University of Deusto, Bilbao, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Madrid, Spain.,Department of Neurosciences, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Ana Belen Alcaide
- COVID-19 Department, University Clinic of Navarra, Pamplona, Spain.,Pulmonary Department, University Clinic of Navarra, Pamplona, Spain
| | - Jorge Quiroga
- COVID-19 Department, University Clinic of Navarra, Pamplona, Spain.,Immune and Infectious Inflammatory Diseases Research, IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.,Internal Medicine Department, University Clinic of Navarra, Pamplona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Institute Carlos III, Madrid, Spain
| | - Jose Luis Del Pozo
- Infectious Disease Service, University Clinic of Navarra, Pamplona, Spain.,COVID-19 Department, University Clinic of Navarra, Pamplona, Spain.,Immune and Infectious Inflammatory Diseases Research, IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Juan Carlos Gómez-Esteban
- ATHENEA Neuroclinics, Policlínica Gipuzkoa Grupo Quironsalud, Donostia, Spain.,Neurology Department, Faculty of Medicine, University of Deusto, Bilbao, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Madrid, Spain.,Neurodegenerative Diseases Group Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.,Neurology Department, Cruces University Hospital-OSAKIDETZA, Barakaldo, Spain.,Department of Neurosciences, University of the Basque Country (UPV/EHU), Leioa, Spain
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21
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SİPAHİOĞLU H, ELMAAĞAÇ M, CELİK KANTAR Y, GÜNAL Aİ. Acute motor and sensory axonal neuropathy (AMSAN) associated with COVİD-19 infection ; a case report. JOURNAL OF EMERGENCY MEDICINE CASE REPORTS 2022. [DOI: 10.33706/jemcr.1099690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Myalgia and headache are relatively common in COVID-19 disease, but the serious neurological disease is rare. In this case, we describe the symptoms and clinic of AMSAN, a rare variant of Guillain-Barre syndrome (GBS) due to COVID 19. We presented a case of AMSAN, a rare variant of GBS, in a 46-year-old male patient with a poor overall condition that did not recover after COVID-19 disease, loss of strength in all four extremities, and CSF and EMG findings. We added another GBS case due to Covid-19 infection to the literature. It should always be kept in mind that GBS may develop after the COVID-19 disease.
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22
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Mussinatto I, Benevenuta C, Caci A, Calvo M, Impastato M, Barra M, Genovese E, Timeus F. Possible association between Guillain‑Barré syndrome and SARS‑CoV‑2 infection in children: A case report and literature review. Exp Ther Med 2022; 24:462. [PMID: 35747147 PMCID: PMC9204538 DOI: 10.3892/etm.2022.11389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/13/2022] [Indexed: 11/05/2022] Open
Abstract
Neurological manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported in adults and in children, varying from mild to more debilitant symptoms, including fatigue, headache and dizziness. A series of studies have revealed a possible association between Guillain-Barré syndrome (GBS), the most common cause of acute flaccid paralysis at all ages, and SARS-CoV-2 infection. Case reports of novel coronavirus disease 2019 (COVID-19)-associated GBS mainly include adult patients, while only a few pediatric cases have been reported. The present study describes a case of GBS in an Italian 9-year-old girl with previous SARS-CoV-2 infection as a possible trigger, and also conducts a literature review on pediatric COVID-19-associated GBS cases.
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Affiliation(s)
| | | | - Anna Caci
- Department of Pediatrics, Chivasso Hospital, I‑10034 Turin, Italy
| | - Mario Calvo
- Department of Pediatrics, Chivasso Hospital, I‑10034 Turin, Italy
| | - Maria Impastato
- Department of Child Neuropsychiatry, ASL TO 4, Chivasso Hospital, I‑10034 Turin, Italy
| | - Massimo Barra
- Department of Neurology, Chivasso Hospital, I‑10034 Turin, Italy
| | - Egidio Genovese
- Department of Neuroradiology, Chivasso Hospital, I‑10034 Turin, Italy
| | - Fabio Timeus
- Department of Pediatrics, Chivasso Hospital, I‑10034 Turin, Italy
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23
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Radišić V, Ždraljević M, Perić S, Mladenović B, Ralić B, Jovanović DR, Berisavac I. Is there a difference between GBS triggered by COVID-19 and those of other origins? THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022; 58:54. [PMID: 35601875 PMCID: PMC9107584 DOI: 10.1186/s41983-022-00486-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/22/2022] [Indexed: 01/08/2023] Open
Abstract
Background Since the outbreak of the coronavirus disease 2019 (COVID-19), an increasing number of Guillain–Barré syndrome (GBS) cases following the infection has been reported. The aim of our study was to detect patients with GBS treated in our hospital over a 1-year period and to compare the characteristics and outcomes of those triggered by COVID-19 with the rest of GBS patients. Our prospective study included 29 patients who were diagnosed with GBS from March 2020 to March 2021. Based on the preceding event, patients were stratified as post-COVID-19 and non-COVID-19. The GBS disability scale (GDS) was used to assess functional disability. Results We identified 10 (34.5%) patients with post-COVID-19 GBS and 19 (65.5%) patients with non-COVID-19 GBS. The median time from the preceding event to the symptoms onset was longer in post-COVID-19 than in non-COVID-19 GBS patients (p = 0.04). However, the time from the symptom onset to the nadir did not differ (p = 0.12). GDS at admission, as well as at nadir, did not differ between these two groups. The level of proteinorrachia was higher in post-COVID-19 GBS patients (p = 0.035). The most frequent subtype of GBS in both groups was acute inflammatory demyelinating polyneuropathy (AIDP). GDS score at discharge (p = 0.56) did not differ between two study groups. Conclusions There was no difference in clinical and electrophysiological features, disease course, and outcome in post-COVID-19 compared with non-COVID-19 GBS patients.
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24
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Khazaal S, Harb J, Rima M, Annweiler C, Wu Y, Cao Z, Abi Khattar Z, Legros C, Kovacic H, Fajloun Z, Sabatier JM. The Pathophysiology of Long COVID throughout the Renin-Angiotensin System. Molecules 2022; 27:2903. [PMID: 35566253 PMCID: PMC9101946 DOI: 10.3390/molecules27092903] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 01/08/2023] Open
Abstract
COVID-19 has expanded across the world since its discovery in Wuhan (China) and has had a significant impact on people's lives and health. Long COVID is a term coined by the World Health Organization (WHO) to describe a variety of persistent symptoms after acute SARS-CoV-2 infection. Long COVID has been demonstrated to affect various SARS-CoV-2-infected persons, independently of the acute disease severity. The symptoms of long COVID, like acute COVID-19, consist in the set of damage to various organs and systems such as the respiratory, cardiovascular, neurological, endocrine, urinary, and immune systems. Fatigue, dyspnea, cardiac abnormalities, cognitive and attention impairments, sleep disturbances, post-traumatic stress disorder, muscle pain, concentration problems, and headache were all reported as symptoms of long COVID. At the molecular level, the renin-angiotensin system (RAS) is heavily involved in the pathogenesis of this illness, much as it is in the acute phase of the viral infection. In this review, we summarize the impact of long COVID on several organs and tissues, with a special focus on the significance of the RAS in the disease pathogenesis. Long COVID risk factors and potential therapy approaches are also explored.
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Affiliation(s)
- Shaymaa Khazaal
- Faculty of Sciences 3, Department of Biology, Lebanese University, Campus Michel Slayman Ras Maska, Tripoli P.O. Box 45061, Lebanon;
| | - Julien Harb
- Faculty of Medicine and Medical Sciences, University of Balamand, Dekouene Campus, Sin El Fil P.O. Box 55251, Lebanon;
| | - Mohamad Rima
- Laboratory of Applied Biotechnology (LBA3B), Azm Center for Research in Biotechnology and Its Applications, EDST, Lebanese University, Tripoli P.O. Box 45061, Lebanon;
| | - Cédric Annweiler
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital & Laboratoire de Psychologie des Pays de la Loire, LPPL EA 4638, SFR Confluences, University of Angers, 44312 Angers, France;
| | - Yingliang Wu
- State Key Laboratory of Virology, Modern Virology Research Center, College of Life Sciences, Wuhan University, Wuhan 430072, China; (Y.W.); (Z.C.)
| | - Zhijian Cao
- State Key Laboratory of Virology, Modern Virology Research Center, College of Life Sciences, Wuhan University, Wuhan 430072, China; (Y.W.); (Z.C.)
| | - Ziad Abi Khattar
- Laboratory of Georesources, Geosciences and Environment (L2GE), Microbiology/Tox-Ecotoxicology Team, Faculty of Sciences 2, Lebanese University, Campus Fanar, Jdeidet El-Matn, Beirut P.O. Box 90656, Lebanon;
| | - Christian Legros
- INSERM, CNRS, MITOVASC, Team 2 CarMe, SFR ICAT, University of Angers, 49000, France;
| | - Hervé Kovacic
- Institut de Neurophysiopathologie (INP), Aix-Marseille Université CNRS, 13385 Marseille, France;
| | - Ziad Fajloun
- Faculty of Sciences 3, Department of Biology, Lebanese University, Campus Michel Slayman Ras Maska, Tripoli P.O. Box 45061, Lebanon;
- Laboratory of Applied Biotechnology (LBA3B), Azm Center for Research in Biotechnology and Its Applications, EDST, Lebanese University, Tripoli P.O. Box 45061, Lebanon;
| | - Jean-Marc Sabatier
- Institut de Neurophysiopathologie (INP), Aix-Marseille Université CNRS, 13385 Marseille, France;
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25
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Singh J, Kumar N, Dinkar A. Demographic, clinical, investigational characteristics of COVID-19 related Guillain-Barré syndrome with differences from typical and another virus-related Guillain-Barré syndrome. Infect Disord Drug Targets 2022; 22:IDDT-EPUB-123097. [PMID: 35507796 DOI: 10.2174/1871526522666220429134113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/02/2022] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUNDS SARS-CoV-2 infection typically presents with fever and respiratory symptoms. Besides this, COVID-19 related central and peripheral nervous system manifestations are emerging. OBJECTIVES This study summarises the demographics, clinical profile, laboratory findings, management strategies, and outcomes in a large number of patients with COVID-19 related GBS and its variants. We also compared its clinical profile with Zika and dengue virus-related GBS. METHODS Authors carried out a literature search up to Dec 31, 2020, in MEDLINE, PubMed, SCOPUS, Cochrane database, and Google Scholar for all published articles. RESULTS The study identified 54 different types of articles consisting of 70 cases from 17 countries worldwide. Maximum cases 15 (21.4%) were identified from Italy, followed by USA 12 (17.1%), Spain 11 (15.7%), and Iran 10 (14.3%). The age group more than 60 years had most cases with 32 (45.7%) cases followed by age group 40-60 with cases 25 (35.7%) with male and female ratio 2. Maximum cases were treated with IVIG infusion 58 (82.9%), followed by Plasma exchange 13 (18.6%) cases. Out of 70 cases, 7 (10%) cases were manifested as Miller-Fisher syndrome. The most predominant electrodiagnostic variant was demyelinating neuropathy in 41 (73.21%) cases. The outcome reported in 67 cases was survival in 63 (90%) cases and the death of 4 (5.7%) cases. CONCLUSION Covid 19 related GBS were reported worldwide with a better outcome. Both postinfectious or parainfectious patterns were reported. Early recognition with prompt management of GBS can prevent further severe morbidity and mortality.
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Affiliation(s)
- Jitendra Singh
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P, India
| | - Nilesh Kumar
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P, India
| | - Anju Dinkar
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P, India
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26
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Galassi G, Marchioni A. Acute neuromuscular syndromes with respiratory failure during COVID-19 pandemic: where we stand and challenges ahead. J Clin Neurosci 2022; 101:264-275. [PMID: 35660960 PMCID: PMC9050587 DOI: 10.1016/j.jocn.2022.03.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 03/15/2022] [Accepted: 03/29/2022] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 2019 (COVID-19), a disease caused by the novel betacoronavirus SARS-COV-2, has become a global pandemic threat. SARS- COV-2 is structurally similar to SARS-COV, and both bind to the angiotensin-converting enzyme 2 (ACE2) receptor to enter human cells. While patients typically present with fever, shortness of breath, sore throat, and cough, in some cases neurologic manifestations occur due to both direct and indirect involvement of the nervous system. Case reports include anosmia, ageusia, central respiratory failure, stroke, acute necrotizing hemorrhagic encephalopathy, toxic-metabolic encephalopathy, headache, myalgia, myelitis, ataxia, and various neuropsychiatric manifestations. Some patients with COVID-19 may present with concurrent acute neuromuscular syndromes such as myasthenic crisis (MC), Guillain–Barré syndrome (GBS) and idiopathic inflammatory myopathies (IIM); these conditions coupled with respiratory failure could trigger a life-threatening condition. Here, we review the current state of knowledge on acute neuromuscular syndromes with respiratory failure related to COVID-19 infection in an attempt to clarify and to manage the muscle dysfunction overlapping SARS-COV-2 infection.
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27
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Ergin Beton O, Ozturk Tan O, Bilen S. The potential association between COVID-19 disease and Guillain-Barré syndrome. Neurol Res 2022; 44:855-860. [PMID: 35348038 DOI: 10.1080/01616412.2022.2056342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim is to investigate the rate of GBS in the pre- and postpandemic period and potential differences in probable COVID-19-associated Guillain-Barré syndrome (GBS) cases and nonassociated cases. The medical records of individuals older than 18 years who were hospitalized with acute and rapidly developing progressive extremity weakness between March 2019 and March 2021 were analyzed retrospectively, and the rate of GBS 1 year before the first reported COVID-19 case (March 2020) in Turkey and 1 year later was compared. Neurological symptoms, medical histories, and GBS disability scores, as well as the findings of electrophysiological, blood, and cerebrospinal fluid (CSF) investigations at the time of presentation, were reviewed. The GBS cases were divided into those with confirmed COVID-19 within 6 weeks before the clinical presentation of GBS and those without COVID-19. The rate of COVID-19 was significantly higher in the patients with GBS as an etiological factor. When the probable COVID-19-associated GBS cases and nonassociated cases were compared, there was a significant between-group difference with respect to sedimentation, C-reactive protein, D-dimer, ferritin, albumin, lymphocyte number, mean platelet volume, neutrophil-lymphocyte ratio, fibrinogen, and lactate dehydrogenase values. In addition, there was a significant between-group difference in admission and discharge disability scores. The GBS rate did not increase after the COVID-19 pandemic, but probable COVID-19-associated GBS significantly affected inflammatory markers and admission-discharge GBS disability scores.
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Affiliation(s)
| | | | - Sule Bilen
- Department of Neurology, City Hospital, Ankara, Turkey
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28
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Nishida K, Sakashita K, Uchibori A, Chiba A, Futamura N. [COVID-19-associated Guillain-Barré syndrome in infectious period: a case report]. Rinsho Shinkeigaku 2022; 62:293-297. [PMID: 35354729 DOI: 10.5692/clinicalneurol.cn-001710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 75-year-old man with a history of hypertension developed weakness and sensory disturbance in the extremities 1 week after upper respiratory tract infection and faced difficulty walking. Screening at the time of hospital admission revealed an incidental positive SARS-CoV-2 PCR test, and COVID-19 was diagnosed. Neurological findings showed dysarthria, dysphagia, absence of deep tendon reflexes in the extremities, distal-dominant muscle weakness, sensory disturbance, urinary retention and constipation. Nerve conduction studies showed prolonged distal latency, decreased conduction velocity, and poor F-wave response, leading to a diagnosis of COVID-19-associated Guillain-Barré syndrome (GBS). The patient was treated with intravenous immunoglobulin, and his neurological symptoms improved without the need of a ventilator. Anti-ganglioside autoantibodies were negative. The patient developed GBS during the infectious period of SARS-CoV-2 and was treated in the isolation ward by clinical staff with personal protective equipment. Because COVID-19-associated GBS can develop during the infectious period of SARS-CoV-2, it is important for neurologists to consider GBS and other neurological disorders as being potentially COVID-19-related, and to treat patients with COVID-19 accordingly.
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Affiliation(s)
- Katsuya Nishida
- Division of Neurology, National Hospital Organization Hyogo-Chuo National Hospital
| | - Kento Sakashita
- Division of Neurology, National Hospital Organization Hyogo-Chuo National Hospital
| | - Ayumi Uchibori
- Department of Neurology, Faculty of Medicine, Kyorin University
| | - Atsuro Chiba
- Department of Neurology, Faculty of Medicine, Kyorin University
| | - Naonobu Futamura
- Division of Neurology, National Hospital Organization Hyogo-Chuo National Hospital
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29
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Hasrat NH, Kadhum HJ, Hashim AR, Yakob ZA, Kadhim LA, Farid HA. Neurographic Evidence of Inflammatory Polyneuropathies in Peri-COVID-19 Circumstances and Their Relationship With Acute Disease Severity and Inflammatory Storm. Cureus 2022; 14:e23517. [PMID: 35495005 PMCID: PMC9038593 DOI: 10.7759/cureus.23517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2022] [Indexed: 11/12/2022] Open
Abstract
Recently, there has been increasing evidence among people infected with coronavirus disease 2019 (COVID-19) of being diagnosed with the typical acute post-infectious inflammatory polyneuroradiculopathy that was formerly known as Guillain-Barré syndrome (GBS), and it is not uncommon that some of them develop chronic inflammatory demyelinating polyneuroradiculopathy (CIDP). However, there is still a large debate and controversy about the link between COVID-19 and polyneuropathy. As a result, a multicentric retrospective cohort study was conducted in Basrah Governorate in the south of Iraq that included 2240 patients over a period of six months. Of those, 1344 patients had a history of COVID-19 in the previous year, and 1.14% of them developed inflammatory polyneuropathy, while only 0.29% (896 patients) of those with no history of COVID-19 had developed inflammatory polyneuropathy. This difference is highly significant, with a relative risk equal to six. The majority of the inflammatory polyneuropathy (44.4%) was diagnosed four to 12 weeks after the COVID-19 infection, with GBS being the most common type (72.2% of cases). Moreover, the nerve conduction velocity, the distal latency, and the amplitude of the most studied nerves were slower, more prolonged, and lower, respectively, among the COVID-19 groups compared with the non-COVID-19 group. Furthermore, there is an inverse correlation between the nerve conduction velocity in the majority of studied nerves and certain inflammatory biomarkers, such as serum ferritin, interleukin-6, and c-reactive protein. Although the occurrence of inflammatory polyneuropathy is more common among the less severe groups of COVID-19, if it occurs in the severe groups, it shows a more aggressive presentation.
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30
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Hot Topics on COVID-19 and Its Possible Association with Guillain-Barré Syndrome. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2022. [DOI: 10.3390/ctn6010007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
As the COVID-19 pandemic progresses, reports of neurological manifestations are increasing. However, despite a high number of case reports and case series on COVID-19 and Guillain-Barré-Syndrome (GBS), a causal association is still highly debated, due to the lack of case-control studies. In this opinion paper, we focus on a few clinically relevant questions regarding the possible link between GBS and SARS-CoV-2 infection or vaccination based on our personal clinical experience and literature review.
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Trentinaglia M, Lippi G, Salvagno GL, Rispoli MG, De Angelis MV, Castellani F, Alberti D, Maniscalco GT, Rossi F, Turri M, Rossi P, Del Zotto E, Fusina S, Cardellini D, Zivelonghi C, Volonghi I, Monaco S, Briani C, Ferrari S, Mariotto S. Peripheral neuropathies during the COVID-19 pandemic: is there a relation? Immunol Res 2022; 70:408-413. [PMID: 35237933 PMCID: PMC8890815 DOI: 10.1007/s12026-022-09272-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/24/2022] [Indexed: 12/26/2022]
Affiliation(s)
- Milena Trentinaglia
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, P.le LA Scuro 10, 37134, Verona, Italy
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Gian Luca Salvagno
- Section of Clinical Biochemistry, University of Verona, Verona, Italy.,Service of Laboratory Medicine, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | | | | | | | - Daniela Alberti
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, P.le LA Scuro 10, 37134, Verona, Italy
| | - Giorgia T Maniscalco
- Department of Neurology and Stroke Unit, "A. Cardarelli Hospital", Naples, Italy
| | - Francesca Rossi
- Neurology Unit, Mater Salutis Hospital, Legnago, Verona, Italy
| | - Mara Turri
- Department of Neurology/Stroke Unit, San Maurizio Hospital, Bolzano, Italy
| | - Patrizia Rossi
- Neurology Unit, St Bassano Hospital, Bassano del Grappa, Vicenza, Italy
| | | | - Simone Fusina
- Neurology Unit, S. Bonifacio Hospital, Verona, Italy
| | | | - Cecilia Zivelonghi
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, P.le LA Scuro 10, 37134, Verona, Italy
| | - Irene Volonghi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Salvatore Monaco
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, P.le LA Scuro 10, 37134, Verona, Italy
| | - Chiara Briani
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Sergio Ferrari
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, P.le LA Scuro 10, 37134, Verona, Italy
| | - Sara Mariotto
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, P.le LA Scuro 10, 37134, Verona, Italy.
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32
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Aryal R, Karki S, Rajbhandari S, Gajurel BP, Karn R, Rajbhandari R, Paudel S, Gautam N, Shrestha A, Ojha R. Guillain-Barré syndrome associated with Coronavirus disease 2019: A case from Nepal. Clin Case Rep 2022; 10:e05638. [PMID: 35356179 PMCID: PMC8941331 DOI: 10.1002/ccr3.5638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 02/11/2022] [Accepted: 03/07/2022] [Indexed: 12/21/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) has now spread widely after the outbreak since December 31, 2019. Guillain-Barré syndrome is an immunological postinfectious neuropathy, which has been reported to be a rare but possible complication COVID-19. We report a case of Guillain-Barré syndrome associated with COVID-19 in Nepal.
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Affiliation(s)
- Roshan Aryal
- Maharajgunj Medical CampusInstitute of MedicineTribhuvan UniversityKathmanduNepal
| | - Shivaji Karki
- Maharajgunj Medical CampusInstitute of MedicineTribhuvan UniversityKathmanduNepal
| | - Shreesti Rajbhandari
- Maharajgunj Medical CampusInstitute of MedicineTribhuvan UniversityKathmanduNepal
| | | | - Ragesh Karn
- Department of NeurologyInstitute of MedicineTribhuvan UniversityKathmanduNepal
| | - Reema Rajbhandari
- Department of NeurologyInstitute of MedicineTribhuvan UniversityKathmanduNepal
| | - Sunanda Paudel
- Department of NeurologyInstitute of MedicineTribhuvan UniversityKathmanduNepal
| | - Niraj Gautam
- Department of NeurologyInstitute of MedicineTribhuvan UniversityKathmanduNepal
| | - Ashish Shrestha
- Department of NeurologyInstitute of MedicineTribhuvan UniversityKathmanduNepal
| | - Rajeev Ojha
- Department of NeurologyInstitute of MedicineTribhuvan UniversityKathmanduNepal
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33
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Sneag DB, Geannette C, Queler S, Shin S, Winfree C, Hausman M, Bryce C, Simpson D. Long-Segment Nonfocal Peripheral Neuropathies After COVID-19 Infection: A Case Report of Magnetic Resonance Neurography Findings. HSS J 2022; 18:156-160. [PMID: 35087345 PMCID: PMC8753541 DOI: 10.1177/15563316211009207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/19/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Darryl B. Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
- Darryl B. Sneag, MD, Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY 10021-4898, USA.
| | - Christian Geannette
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Sophie Queler
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Susan Shin
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher Winfree
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Michael Hausman
- Upper Extremity Surgery, Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Clare Bryce
- Department of Pathology, Mount Sinai Hospital, New York, NY, USA
| | - David Simpson
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Finsterer J, Scorza FA, Scorza CA, Fiorini AC. Consider differentials before diagnosing COVID-19 associated polyradiculitis. Eur J Transl Myol 2022; 32. [PMID: 35000350 DOI: 10.4081/ejtm.2022.10111] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/23/2021] [Indexed: 11/22/2022] Open
Abstract
Evidence is accumulating that SARS-CoV-2 infections and SARS-CoV-2 vaccinations can induce Guillain-Barre syndrome (GBS). More than 400 GBS cases after SARS-CoV-2 infection respectively vaccination have been reported as per the end of 2021. GBS is usually diagnosed according to the Brighton criteria, but also the Besta criteria or Hadden criteria are applied. The diagnosis can be supported by MRI with contrast medium of the cranial or spinal nerves showing enhancing nerve roots. As GBS can be complicated by autonomic dysfunction such as pupillary abnormalities, salivatory dysfunction, reduced heart rate variability, bowel disturbance (constipation, diarrhea), urinary hesitancy, urinary retention, or impotence, it is crucial to investigate GBS patients for autonomic involvement. Before diagnosing GBS various differentials need to be excluded, including neuropathy as a side effect of the anti-SARS-CoV-2 medication, critical ill neuropathy in COVID-19 patients treated on the ICU, and compression neuropathy in COVID-19 patients requiring long-term ventilation.
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Affiliation(s)
| | | | | | - Ana Claudia Fiorini
- Phonoaudiology Department, Federal University of São Paulo (UNIFESP), Sao Paulo.
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35
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Barišić N, Turudić D, Marić LS, Tešović G. Vaccination in pediatric acquired inflammatory immune-mediated neuromuscular disorders. Eur J Paediatr Neurol 2022; 36:159-176. [PMID: 34998097 DOI: 10.1016/j.ejpn.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/15/2021] [Accepted: 12/18/2021] [Indexed: 11/26/2022]
Abstract
AIM To analyse literature data on vaccine related induction, worsening of the disease and disease reccurrences as well as vaccine safety and efficacy among pediatric patients with acquired inflammatory immune-mediated neuromuscular disorders (NMD). METHODS Medline, Pub Med and Scopus database search from 1975 to 2020 focused on pediatric age was conducted including peer reviews, meta analyses and epidemiological studies on vaccination and Guillain-Barré syndrome (GBS), Bell's palsy, optic neuritis (ON), myasthenia gravis (MG), chronic inflammatory demyelinating polyneuropathy (CIDP) and immune-mediated inflammatory myopathy (IM). RESULTS AND CONCLUSION s: There are no strong evidence supporting relationship between vaccination with different pediatric vaccines and development of first episodes or reccurrences of GBS, Bell's palsy, optic neuritis (ON), juvenile MG, CIDP, and IM. The vaccination and revaccination with inactivated vaccines is considered safe in children with medical history of GBS, Bell's palsy, ON, MG and IM. Caution when immunization against influenza, quadrivalent conjugated meningococcal vaccine (MCV4) and pneumococcal disease and avoiding tetanus toxoid immunization in CIDP patients is suggested. Patients with immune mediated acquired NMD should be vaccinated with live vaccines before the initiation of immunosupressive treatment. Immunosuppressed patients with low protective antibody titers should be considered for revaccination.
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Affiliation(s)
- Nina Barišić
- Department of Pediatrics, Clinical Medical Centre, Zagreb, Croatia; University of Zagreb, School of Medicine, Zagreb, Croatia.
| | - Daniel Turudić
- Department of Pediatrics, Clinical Medical Centre, Zagreb, Croatia
| | - Lorna Stemberger Marić
- University of Zagreb, School of Medicine, Zagreb, Croatia; University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Zagreb, Croatia
| | - Goran Tešović
- University of Zagreb, School of Medicine, Zagreb, Croatia; University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Zagreb, Croatia
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36
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Guillain-Barré Syndrome in the COVID-19 Pandemic. Neurol Int 2021; 14:34-48. [PMID: 35076589 PMCID: PMC8788454 DOI: 10.3390/neurolint14010003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 12/18/2022] Open
Abstract
There have been several reported cases of severe acute respiratory syndrome (SARS-CoV-2) infection that were associated with an increased incidence of neurological manifestations, including Guillain–Barré syndrome (GBS). This review aims to present information on the reports of GBS associated with coronavirus disease 2019 (COVID-19) infection. Our review is retrospective work examining articles published from the 1 April 2020 to the 8 May 2021 in the English language. We used the diagnostic criteria and classification published by the National Institute of Neurological Disorders and Stroke and Brighton Collaboration. GBS is usually a postinfectious syndrome, but GBS in the COVID-19 pandemic also takes on a para-infectious profile. In the reports, the genetic factor has a role in developing GBS in some patients. In conclusion, the association between COVID-19 and GBS is not very clear. Still, one mechanism is strongly associated with COVID-19 and immune-mediated neurological complications, which is molecular mimicry between SARS-CoV-2 and human autoantigens.
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37
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Neurologic Complications in Adult and Pediatric Patients with SARS-CoV-2 Infection. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2021. [DOI: 10.3390/ctn6010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
SARS-CoV-2 has an impact on the nervous system as a result of pathological cellular and molecular events at the level of vascular and neural tissue. Severe neurologic manifestations including stroke, ataxia, seizure, and depressed level of consciousness are prevalent in patients with SARS-CoV-2 infection. Although the mechanism is still unclear, SARS-CoV-2 has been associated with the pathogenesis of intravascular coagulation and angiotensin-converting enzyme-I, both exacerbating systemic inflammation and contributing to hypercoagulation or blood–brain barrier leakage, resulting in ischemic or hemorrhagic stroke. On the other hand, the SARS-CoV-2 spike protein in neural tissue and within the cerebrospinal fluid may induce neural dysfunction, resulting in neuroinflammation, which is exacerbated by peripheral and neural hypercytokinemia that can lead to neuronal damage and subsequent neuroinflammation. A deeper understanding of the fundamental biological mechanisms of neurologic manifestations in SARS-CoV-2 infection can pave the way to identifying a single biomarker or network of biomarkers to help target neuroprotective therapy in patients at risk for developing neurological complications.
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Du YY, Zhao W, Zhou XL, Zeng M, Yang DH, Xie XZ, Huang SH, Jiang YJ, Yang WH, Guo H, Sun H, Liu JY, Liu P, Zhou ZG, Luo H, Liu J. Survivors of COVID-19 exhibit altered amplitudes of low frequency fluctuation in the brain: a resting-state functional magnetic resonance imaging study at 1-year follow-up. Neural Regen Res 2021; 17:1576-1581. [PMID: 34916443 PMCID: PMC8771089 DOI: 10.4103/1673-5374.327361] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Although some short-term follow-up studies have found that individuals recovering from coronavirus disease 2019 (COVID-19) exhibit anxiety, depression, and altered brain microstructure, their long-term physical problems, neuropsychiatric sequelae, and changes in brain function remain unknown. This observational cohort study collected 1-year follow-up data from 22 patients who had been hospitalized with COVID-19 (8 males and 11 females, aged 54.2 ± 8.7 years). Fatigue and myalgia were persistent symptoms at the 1-year follow-up. The resting state functional magnetic resonance imaging revealed that compared with 29 healthy controls (7 males and 18 females, aged 50.5 ± 11.6 years), COVID-19 survivors had greatly increased amplitude of low-frequency fluctuation (ALFF) values in the left precentral gyrus, middle frontal gyrus, inferior frontal gyrus of operculum, inferior frontal gyrus of triangle, insula, hippocampus, parahippocampal gyrus, fusiform gyrus, postcentral gyrus, inferior parietal angular gyrus, supramarginal gyrus, angular gyrus, thalamus, middle temporal gyrus, inferior temporal gyrus, caudate, and putamen. ALFF values in the left caudate of the COVID-19 survivors were positively correlated with their Athens Insomnia Scale scores, and those in the left precentral gyrus were positively correlated with neutrophil count during hospitalization. The long-term follow-up results suggest that the ALFF in brain regions related to mood and sleep regulation were altered in COVID-19 survivors. This can help us understand the neurobiological mechanisms of COVID-19-related neuropsychiatric sequelae. This study was approved by the Ethics Committee of the Second Xiangya Hospital of Central South University (approval No. 2020S004) on March 19, 2020.
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Affiliation(s)
- Yan-Yao Du
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Wei Zhao
- Department of Radiology, The Second Xiangya Hospital of Central South University; Clinical Research Center for Medical Imaging in Hunan Province, Changsha, Hunan Province, China
| | - Xiang-Lin Zhou
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Mu Zeng
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Dan-Hui Yang
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Xing-Zhi Xie
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Si-Hong Huang
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Ying-Jia Jiang
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Wen-Han Yang
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Hu Guo
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Hui Sun
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Ji-Yang Liu
- Department of Respiratory Medicine, The First Hospital of Changsha, Changsha, Hunan Province, China
| | - Ping Liu
- Department of Respiratory Medicine, The First Hospital of Changsha, Changsha, Hunan Province, China
| | - Zhi-Guo Zhou
- Department of Respiratory Medicine, The First Hospital of Changsha, Changsha, Hunan Province, China
| | - Hong Luo
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Jun Liu
- Department of Radiology, The Second Xiangya Hospital of Central South University; Clinical Research Center for Medical Imaging in Hunan Province; Department of Radiology Quality Control Center, Hunan Province, Changsha, Hunan Province, China
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39
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Bagnato S, Ferraro M, Boccagni C, Battaglia G, D’Agostino T, Prestandrea C, Bellavia MA, Rubino F. COVID-19 Neuromuscular Involvement in Post-Acute Rehabilitation. Brain Sci 2021; 11:brainsci11121611. [PMID: 34942912 PMCID: PMC8699176 DOI: 10.3390/brainsci11121611] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 11/29/2021] [Accepted: 12/02/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Coronavirus disease 2019 (COVID-19) is associated with muscle and nerve injuries as a consequence of prolonged critical illness or the infection itself. In this study, we evaluated neuromuscular involvement in patients who underwent post-acute intensive rehabilitation after COVID-19. Methods: Clinical and neurophysiological evaluations, including nerve conduction studies and electromyography, were performed on 21 consecutive patients admitted for rehabilitation after COVID-19. Results: Clinical signs suggesting muscle or nerve involvement (weakness, reduced deep tendon reflexes, impaired sensitivity, abnormal gait) were found in 19 patients. Neurophysiological examinations confirmed neuromuscular involvement in 17 patients: a likely association of critical illness myopathy (CIM) and critical illness polyneuropathy (CIP) was found in 5 patients; CIM alone was found in 4 patients; axonal sensory-motor polyneuropathy was found in 4 patients (CIP in 2 patients, metabolic polyneuropathy in 2 patients); Guillain-Barré syndrome was found in 2 patients (classical demyelinating sensory-motor polyneuropathy and acute motor axonal neuropathy, respectively); peroneal nerve injury was found in 1 patient; and pre-existing L4 radiculopathy was found in 1 patient. Conclusions: Neuromuscular involvement is a very common finding among patients admitted for rehabilitation after COVID-19, and proper investigation should be conducted when muscle or nerve injury is suspected for adequate rehabilitative strategy planning.
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Affiliation(s)
- Sergio Bagnato
- Unit of Neurophysiology, Rehabilitation Department, Giuseppe Giglio Foundation, 90015 Cefalù, Italy; (M.F.); (C.B.); (T.D.); (C.P.); (M.A.B.); (F.R.)
- Correspondence:
| | - Manfredi Ferraro
- Unit of Neurophysiology, Rehabilitation Department, Giuseppe Giglio Foundation, 90015 Cefalù, Italy; (M.F.); (C.B.); (T.D.); (C.P.); (M.A.B.); (F.R.)
| | - Cristina Boccagni
- Unit of Neurophysiology, Rehabilitation Department, Giuseppe Giglio Foundation, 90015 Cefalù, Italy; (M.F.); (C.B.); (T.D.); (C.P.); (M.A.B.); (F.R.)
| | - Gianluca Battaglia
- Unit of Cardiac and Pulmonary Rehabilitation, Rehabilitation Department, Giuseppe Giglio Foundation, 90015 Cefalù, Italy;
| | - Tiziana D’Agostino
- Unit of Neurophysiology, Rehabilitation Department, Giuseppe Giglio Foundation, 90015 Cefalù, Italy; (M.F.); (C.B.); (T.D.); (C.P.); (M.A.B.); (F.R.)
| | - Caterina Prestandrea
- Unit of Neurophysiology, Rehabilitation Department, Giuseppe Giglio Foundation, 90015 Cefalù, Italy; (M.F.); (C.B.); (T.D.); (C.P.); (M.A.B.); (F.R.)
| | - Marina Angela Bellavia
- Unit of Neurophysiology, Rehabilitation Department, Giuseppe Giglio Foundation, 90015 Cefalù, Italy; (M.F.); (C.B.); (T.D.); (C.P.); (M.A.B.); (F.R.)
| | - Francesca Rubino
- Unit of Neurophysiology, Rehabilitation Department, Giuseppe Giglio Foundation, 90015 Cefalù, Italy; (M.F.); (C.B.); (T.D.); (C.P.); (M.A.B.); (F.R.)
- Unit of Cardiac and Pulmonary Rehabilitation, Rehabilitation Department, Giuseppe Giglio Foundation, 90015 Cefalù, Italy;
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40
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Koike H, Chiba A, Katsuno M. Emerging Infection, Vaccination, and Guillain-Barré Syndrome: A Review. Neurol Ther 2021; 10:523-537. [PMID: 34117994 PMCID: PMC8196284 DOI: 10.1007/s40120-021-00261-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/28/2021] [Indexed: 02/07/2023] Open
Abstract
Guillain-Barré syndrome (GBS) is an autoimmune disorder of the peripheral nervous system that typically develops within 4 weeks after infection. In addition to conventional infectious diseases with which we are familiar, emerging infectious diseases, such as Zika virus infection and coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have also been suggested to be associated with GBS. GBS is mainly categorized into a demyelinating subtype known as acute inflammatory demyelinating polyneuropathy (AIDP) and an axonal subtype known as acute motor axonal neuropathy (AMAN). Most patients who develop GBS after Zika virus infection or COVID-19 have AIDP. The concept of molecular mimicry between pathogens and human peripheral nerve components was established through studies of AMAN with anti-ganglioside GM1 antibodies occurring after Campylobacter jejuni infection. Although such mimicry between specific pathogens and myelin or Schwann cell components has not been clearly demonstrated in AIDP, a similarity of Zika virus and SARS-CoV-2 proteins to human proteins has been suggested. With the development of global commerce and travel, emerging infectious diseases will continue to threaten public health. From this viewpoint, the development of vaccines and antiviral drugs is important to prepare for and control emerging infectious diseases. Although a decrease in the number of patients after the 2015-2016 Zika epidemic increased the difficulty in conducting phase 3 trials for Zika virus vaccines, the efficacy and safety of new vaccines have recently been demonstrated for COVID-19. In general, vaccines can decrease the risk of infectious disease by stimulating the immune system, and discussions regarding an increased risk of autoimmune disorders, such as GBS, have been ongoing for many years. However, the risk of GBS is not considered a legitimate reason to limit the administration of currently available vaccines, as only a trivial association or no association with GBS has been demonstrated.
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Affiliation(s)
- Haruki Koike
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan.
| | - Atsuro Chiba
- Department of Neurology, Faculty of Medicine, Kyorin University, Tokyo, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
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41
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Simon DW, Schober ME. Acute central and peripheral nervous system injury associated with coronavirus disease 2019: recognition and treatment strategies. Curr Opin Pediatr 2021; 33:591-596. [PMID: 34670263 PMCID: PMC8577290 DOI: 10.1097/mop.0000000000001070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Acute central and peripheral nervous system injury may occur in association with coronavirus disease 2019 (COVID-19) caused by infection with the severe acute respiratory syndrome coronavirus 2 virus. This review will assist readers to recognize neurologic manifestations associated with COVID-19 including common and life-threatening symptoms and diagnostic testing. We will also review current recommendations for treatment of neurologic injury associated with COVID-19 infection in children. RECENT FINDINGS Data from systematic reviews and prospectively collected cohorts of children with COVID-19 are beginning to characterize the breadth of neurologic manifestations associated with COVID-19 in the acute infectious and postinfectious periods. Among hospitalized children in particular, neurologic symptoms are common. Life threatening conditions including encephalitis, myelitis, stroke, and demyelinating syndromes have been reported. Within the pediatric population, age, and preexisting neurologic conditions appear to be important factors in determining likely phenotypes. Treatment at this time is based on careful neuromonitoring, supportive care, and neuromodulatory therapies as indicated. SUMMARY Neurologic symptoms are common in children with COVID-19 and may be life threatening. The pathophysiology, therapeutic options, and long-term outcomes from COVID-19 associated neurologic injury are currently being investigated.
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Affiliation(s)
- Dennis W. Simon
- Department of Critical Care Medicine
- Safar Center for Resuscitation Research
- UPMC Children's Hospital of Pittsburgh Neuroscience Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Michelle E. Schober
- Department of Pediatrics, Division of Critical Care, University of Utah, Salt Lake City, Utah, USA
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42
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Ishiyama H, Ishii J, Yoshimura H, Tsunogae M, Fujiwara S, Hiya S, Inui R, Shiomi Y, Nakazawa S, Kimura M, Kuroda T, Murakami Y, Maekawa K, Ohara N, Kohara N, Kawamoto M. Neurological Manifestations and Long-term Sequelae in Hospitalized Patients with COVID-19. Intern Med 2021; 60:3559-3567. [PMID: 34511566 PMCID: PMC8666216 DOI: 10.2169/internalmedicine.7802-21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022] Open
Abstract
Objective Various neurological manifestations have been increasingly reported in coronavirus disease 2019 (COVID-19). We determined the neurological features and long-term sequelae in hospitalized COVID-19 patients. Methods We retrospectively studied 95 consecutive hospitalized patients with COVID-19 between March 1 and May 13, 2020. Acute neurological presentations (within two weeks of the symptom onset of COVID-19) were compared between 60 non-severe and 35 severely infected patients who required high-flow oxygen. In the 12 ventilated patients (the most severe group), we evaluated neurological complications during admission, subacute neurological presentations, and neurological sequelae (51 and 137 days from the onset [median], respectively). Results Of the 95 patients (mean age 53 years old; 40% women), 63% had acute neurological presentations, with an increased prevalence in cases of severe infections (83% vs. 52%, p<0.001). Impaired consciousness and limb weakness were more frequent in severe patients than in non-severe ones (0% vs. 49%; p<0.001, and 0% vs. 54%; p<0.001, respectively). In the most severe group (mean age 72 years old; 42% women), 83% of patients had neurological complications [cerebrovascular disease (17%), encephalopathy (82%), and neuropathy (55%)], and 92% had subacute neurological presentations [impaired consciousness (17%), higher brain dysfunction (82%), limb weakness (75%), and tremor (58%)]. Neurological sequelae were found in 83% of cases, including higher brain dysfunction (73%), limb weakness (50%), and tremor (58%). Conclusions Neurological manifestations are common in COVID-19, with the possibility of long-lasting sequelae.
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Affiliation(s)
- Hiroyuki Ishiyama
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Junko Ishii
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Hajime Yoshimura
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Marie Tsunogae
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Satoru Fujiwara
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Satomi Hiya
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Ryoma Inui
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Yuma Shiomi
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Shinsaku Nakazawa
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Masamune Kimura
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Takehito Kuroda
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Yasutaka Murakami
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Kota Maekawa
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Nobuyuki Ohara
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Nobuo Kohara
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Michi Kawamoto
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
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43
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Li X, Wang Y, Wang H, Wang Y. SARS-CoV-2-associated Guillain-Barré syndrome is a para-infectious disease. QJM 2021; 114:625-635. [PMID: 34043803 PMCID: PMC8195029 DOI: 10.1093/qjmed/hcab157] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 12/20/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been linked to the Guillain-Barré syndrome (GBS). The objective of the present study is to identify specific clinical features of cases of GBS reported in the literature associated with SARS-CoV-2 infection. We searched Pubmed, and included single case reports and case series with full text in English, reporting original data of patients with GBS and a confirmed recent SARS-CoV-2 infection. Clinical data were extracted. We identified 28 articles (22 single case reports and 6 case series), reporting on a total of 44 GBS patients with confirmed SARS-CoV-2 infection. SARS-CoV-2 infection was confirmed through serum reverse transcriptase-polymerase chain reaction in 72.7% of cases. A total of 40 patients (91%) had symptoms compatible with SARS-CoV-2 infection before the onset of the GBS. The median period between the onset of symptoms of SARS-CoV-2 infection and symptoms of the GBS was 11.2 days (range, 2-23). The most common clinical features were: leg weakness (61.4%), leg paresthesia (50%), arm weakness (50.4%), arm paresthesia (50.4%), hyporeflexia/areflexia (48%) and ataxia (22.7%). In total, 38.6% (n = 17) were found to have facial paralysis. Among 37 patients in whom nerve-conduction studies and electromyography were performed, of which 26 patients (59.1%) were consistent with the acute inflammatory demyelinating polyneuropathy subtype of the GBS. The present retrospective analysis support the role of the SARS-CoV-2 infection in the development of the GBS, may trigger GBS as para-infectious disease, and lead to SARS-CoV-2-associated GBS.
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Affiliation(s)
- Xiujun Li
- School of Clinical Medicine, Chifeng University, Chifeng 024005, PR China
- Corresponding author: Yumin Wang, Department of Respiratory and Critical Care Medicine, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing 100049, People's Republic of China. E-mail:
| | - Yanchao Wang
- Department of Neurology, The Affiliated Hospital of Chifeng University, Chifeng 024005, PR China
| | - Hongquan Wang
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing 100049, People's Republic of China
| | - Yumin Wang
- Department of Respiratory and Critical Care Medicine, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing 100049, People's Republic of China
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44
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Manolis TA, Apostolopoulos EJ, Manolis AA, Melita H, Manolis AS. COVID-19 Infection: A Neuropsychiatric Perspective. J Neuropsychiatry Clin Neurosci 2021; 33:266-279. [PMID: 34280318 DOI: 10.1176/appi.neuropsych.20110277] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
As a potentially life-threatening disease with no definitive treatment and without fully implemented population-wide vaccination, COVID-19 has created unprecedented turmoil in socioeconomic life worldwide. In addition to physical signs from the respiratory and many other systems, the SARS-CoV-2 virus produces a broad range of neurological and neuropsychiatric problems, including olfactory and gustatory impairments, encephalopathy and delirium, stroke and neuromuscular complications, stress reactions, and psychoses. Moreover, the psychosocial impact of the pandemic and its indirect effects on neuropsychiatric health in noninfected individuals in the general public and among health care workers are similarly far-ranging. In addition to acute neuropsychiatric manifestations, COVID-19 may also produce late neuropsychiatric sequelae as a function of the psychoneuroimmunological cascade that it provokes. The present article presents a state-of-the-science review of these issues through an integrative review and synthesis of case series, large-cohort studies, and relevant meta-analyses. Heuristics for evaluation and further study of the neuropsychiatric manifestations of SARS-CoV-2 infection are offered.
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Affiliation(s)
- Theodora A Manolis
- Red Cross Hospital, Athens, Greece (T. A. Manolis); Canterbury Christ Church University, Canterbury, United Kingdom (Apostolopoulos); Patras University School of Medicine, Patras, Greece (A. A. Manolis); Onassis Cardiac Surgery Center, Athens, Greece (Melita); and Athens University School of Medicine, Greece (A. S. Manolis)
| | - Evdoxia J Apostolopoulos
- Red Cross Hospital, Athens, Greece (T. A. Manolis); Canterbury Christ Church University, Canterbury, United Kingdom (Apostolopoulos); Patras University School of Medicine, Patras, Greece (A. A. Manolis); Onassis Cardiac Surgery Center, Athens, Greece (Melita); and Athens University School of Medicine, Greece (A. S. Manolis)
| | - Antonis A Manolis
- Red Cross Hospital, Athens, Greece (T. A. Manolis); Canterbury Christ Church University, Canterbury, United Kingdom (Apostolopoulos); Patras University School of Medicine, Patras, Greece (A. A. Manolis); Onassis Cardiac Surgery Center, Athens, Greece (Melita); and Athens University School of Medicine, Greece (A. S. Manolis)
| | - Helen Melita
- Red Cross Hospital, Athens, Greece (T. A. Manolis); Canterbury Christ Church University, Canterbury, United Kingdom (Apostolopoulos); Patras University School of Medicine, Patras, Greece (A. A. Manolis); Onassis Cardiac Surgery Center, Athens, Greece (Melita); and Athens University School of Medicine, Greece (A. S. Manolis)
| | - Antonis S Manolis
- Red Cross Hospital, Athens, Greece (T. A. Manolis); Canterbury Christ Church University, Canterbury, United Kingdom (Apostolopoulos); Patras University School of Medicine, Patras, Greece (A. A. Manolis); Onassis Cardiac Surgery Center, Athens, Greece (Melita); and Athens University School of Medicine, Greece (A. S. Manolis)
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45
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Elavarasi A, Srivastava VP, Garg A. COVID-19-Related Multifocal Demyelinating Neuropathy: Causation or Association. Cureus 2021; 13:e17770. [PMID: 34659981 PMCID: PMC8494154 DOI: 10.7759/cureus.17770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 01/07/2023] Open
Abstract
COVID-19 produces pulmonary symptoms in the majority of symptomatic patients. However, demyelinating illnesses of the central and peripheral nervous system are reported in few patients. We report a case of multifocal demyelination involving the peripheral nerves as well as the optic nerve who developed these symptoms while on corticosteroid therapy, which was being given for treating the COVID-19-related inflammatory state. He improved with a short course of steroids. This is the first reported case of multifocal demyelinating neuropathy in relation to COVID-19 to the best of our knowledge. Though there have been reports of COVID-19-associated central nervous system and peripheral nervous system demyelinating illness, whether COVID-19 is causative or just an association is yet to be discerned.
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Affiliation(s)
| | - Vasantha Padma Srivastava
- Neurology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND.,Neurology, All India Institute, New Delhi, IND
| | - Ajay Garg
- Neuro-radiology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
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46
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Shao SC, Wang CH, Chang KC, Hung MJ, Chen HY, Liao SC. Guillain-Barré Syndrome Associated with COVID-19 Vaccination. Emerg Infect Dis 2021; 27:3175-3178. [PMID: 34648420 PMCID: PMC8632191 DOI: 10.3201/eid2712.211634] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We conducted a multi-institutional study in Taiwan and a systematic review of the literature for reports of Guillain-Barré syndrome after coronavirus disease vaccination. This condition, mostly the classic form and the acute inflammatory demyelinating polyneuropathy subtype, has been reported in 39 cases and has occurred within 2 weeks of vaccine administration.
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47
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Grisold W, Moro E, Teresa Ferretti M, Hege Aamodt A, Arabia G, Lebedeva ER, Carvalho V, Rakusa M, Vonck K, Aybeck S, Hassan Mansour A, Goudier R, Giovannoni G, Jaarsma J, Judit Molnar M, Matczack M, Bassetti C, de Visser M. Gender issues during the times of COVID-19 pandemic. Eur J Neurol 2021; 28:e73-e77. [PMID: 33751757 PMCID: PMC8239897 DOI: 10.1111/ene.14815] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Wolfgang Grisold
- Ludwig Boltzmann Institute for Experimental and Clinical TraumatologyViennaAustria
| | - Elena Moro
- Division of NeurologyCHU of GrenobleGrenoble Alpes UniversityGrenoble Institute of NeuroscienceGrenobleFrance
| | | | | | - Gennarina Arabia
- Institute of NeurologyUniversity ‘Magna Graecia’ of CatanzaroCatanzaroItaly
| | - Elena R. Lebedeva
- International Headache Centre ‘Europe‐Asia’Ural State Medical UniversityYekaterinburgRussia
| | - Vanessa Carvalho
- Department of NeurologyHospital Pedro HispanoMatosinhos Local Health UnitMatosinhosPortugal
| | - Martin Rakusa
- Department of NeurologyMedical Research DepartmentUniversity Medical Centre MariborMariborSlovenia
| | - Kristl Vonck
- Department of NeurologyInstitute for NeuroscienceGhent University HospitalGhentBelgium
| | - Selma Aybeck
- Department of NeurologyInselspitalBern University HospitalUniversity of BernBernSwitzerland
| | | | - Riadh Goudier
- Department of NeurologyRazi HospitalTunisTunisia
- Faculty of MedicineUniversity Tunis El ManarTunisTunisia
| | - Gavin Giovannoni
- Blizard InstituteBarts and the London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - Joke Jaarsma
- European Federation of Neurological AssociationsBrusselsBelgium
| | - Maria Judit Molnar
- Institute of Genomic Medicine and Rare DisordersSemmelweis UniversityBudapestHungary
| | | | - Claudio Bassetti
- Department of NeurologyUniversity of BernInselspital, BernSwitzerland
| | - Marianne de Visser
- Department of NeurologyAmsterdam UMCUniversity of AmsterdamAmsterdam NeuroscienceAmsterdamThe Netherlands
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48
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Mehta SK, Sunder A. Getting paralysed after COVID: Guillain-Barre syndrome. J Family Med Prim Care 2021; 10:2706-2708. [PMID: 34568159 PMCID: PMC8415676 DOI: 10.4103/jfmpc.jfmpc_2454_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/21/2021] [Accepted: 04/09/2021] [Indexed: 11/04/2022] Open
Abstract
Neurological involvement after coronavirus disease (COVID-19) pneumonias is common and occurs in almost one-third of the patients. The commonest neurological symptoms are ageusia, anosmia, headache, nausea, vomiting, dizziness, and myalgia. Guillain-Barre syndrome (GBS) is a rare manifestation of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection; whereas the common neurological manifestations of the SARS-CoV-2 infection occur with the onset of the respiratory symptoms and may be due to the direct invasion of the nervous system by the virus, GBS in COVID-19 follows a time lag of 1-4 weeks and may be attributable to the immune mechanism of molecular mimicry. Here we report a case of GBS in a patient of COVID-19 which occurred on the 22nd day after the onset of the disease. The patient recovered completely and went home walking.
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Affiliation(s)
- Sameer K Mehta
- Department of Medicine, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Ashok Sunder
- Department of Medicine, Tata Main Hospital, Jamshedpur, Jharkhand, India
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49
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Luijten LWG, Leonhard SE, van der Eijk AA, Doets AY, Appeltshauser L, Arends S, Attarian S, Benedetti L, Briani C, Casasnovas C, Castellani F, Dardiotis E, Echaniz-Laguna A, Garssen MPJ, Harbo T, Huizinga R, Humm AM, Jellema K, van der Kooi AJ, Kuitwaard K, Kuntzer T, Kusunoki S, Lascano AM, Martinez-Hernandez E, Rinaldi S, Samijn JPA, Scheidegger O, Tsouni P, Vicino A, Visser LH, Walgaard C, Wang Y, Wirtz PW, Ripellino P, Jacobs BC. Guillain-Barré syndrome after SARS-CoV-2 infection in an international prospective cohort study. Brain 2021; 144:3392-3404. [PMID: 34553216 PMCID: PMC8677532 DOI: 10.1093/brain/awab279] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/29/2021] [Accepted: 07/04/2021] [Indexed: 12/22/2022] Open
Abstract
In the wake of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, an increasing number of patients with neurological disorders, including Guillain-Barré syndrome (GBS), have been reported following this infection. It remains unclear, however, if these cases are coincidental or not, as most publications were case reports or small regional retrospective cohort studies. The International GBS Outcome Study is an ongoing prospective observational cohort study enrolling patients with GBS within 2 weeks from onset of weakness. Data from patients included in this study, between 30 January 2020 and 30 May 2020, were used to investigate clinical and laboratory signs of a preceding or concurrent SARS-CoV-2 infection and to describe the associated clinical phenotype and disease course. Patients were classified according to the SARS-CoV-2 case definitions of the European Centre for Disease Prevention and Control and laboratory recommendations of the World Health Organization. Forty-nine patients with GBS were included, of whom eight (16%) had a confirmed and three (6%) a probable SARS-CoV-2 infection. Nine of these 11 patients had no serological evidence of other recent preceding infections associated with GBS, whereas two had serological evidence of a recent Campylobacter jejuni infection. Patients with a confirmed or probable SARS-CoV-2 infection frequently had a sensorimotor variant 8/11 (73%) and facial palsy 7/11 (64%). The eight patients who underwent electrophysiological examination all had a demyelinating subtype, which was more prevalent than the other patients included in the same time window [14/30 (47%), P = 0.012] as well as historical region and age-matched control subjects included in the International GBS Outcome Study before the pandemic [23/44 (52%), P = 0.016]. The median time from the onset of infection to neurological symptoms was 16 days (interquartile range 12-22). Patients with SARS-CoV-2 infection shared uniform neurological features, similar to those previously described in other post-viral GBS patients. The frequency (22%) of a preceding SARS-CoV-2 infection in our study population was higher than estimates of the contemporaneous background prevalence of SARS-CoV-2, which may be a result of recruitment bias during the pandemic, but could also indicate that GBS may rarely follow a recent SARS-CoV-2 infection. Consistent with previous studies, we found no increase in patient recruitment during the pandemic for our ongoing International GBS Outcome Study compared to previous years, making a strong relationship of GBS with SARS-CoV-2 unlikely. A case-control study is required to determine if there is a causative link or not.
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Affiliation(s)
- Linda W G Luijten
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands,Department of Neurology, St. Elisabeth-TweeSteden Hospital, 5022 GC, Tilburg, The Netherlands
| | - Sonja E Leonhard
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands
| | - Annemiek A van der Eijk
- Department of Viroscience, Unit Clinical Virology, Erasmus MC, University Medical Center Rotterdam, 3015 CN, Rotterdam, The Netherlands
| | - Alex Y Doets
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands
| | | | - Samuel Arends
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands,Department of Neurology, Haga Hospital, 2545 AA Den Haag, The Netherlands
| | - Shahram Attarian
- Reference Center for Neuromuscular Disorders and ALS, Hôpital de La Timone, 13005 Marseille, France
| | - Luana Benedetti
- Department of Neurology, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
| | - Chiara Briani
- Neurology Unit, Department of Neuroscience, University of Padova, 35128 Padova, Italy
| | - Carlos Casasnovas
- Neuromuscular Unit, Department of Neurology, Bellvitge University Hospital, Neurometabolic Diseases Group, IDIBELL and CIBERER, Barcelona, Spain
| | - Francesca Castellani
- Neurology Unit, Department of Neuroscience, University of Padova, 35128 Padova, Italy
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, 41110 Larissa, Greece
| | | | - Marcel P J Garssen
- Department of Neurology, Jeroen Bosch Hospital, 5223 GZ ‘s-Hertogenbosch, The Netherlands
| | - Thomas Harbo
- Department of Neurology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Ruth Huizinga
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Andrea M Humm
- Unit of Neurology, Department of Internal Medicine, HFR Fribourg—Hôpital Cantonal, CH-1708 Fribourg, Switzerland
| | - Korné Jellema
- Department of Neurology, Haaglanden Medical Center, 2512 VA, Den Haag, The Netherlands
| | - Anneke J van der Kooi
- Department of Neurology, Amsterdam University Medical Center, Location AMC, University of Amsterdam, Neuroscience institute, 1105 AZ Amsterdam, The Netherlands
| | - Krista Kuitwaard
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands,Department of Neurology, Albert Schweitzer Hospital, 3318 AT Dordrecht, The Netherlands
| | - Thierry Kuntzer
- Nerve-muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital CHUV and University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Susumu Kusunoki
- Department of Neurology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama City, Osaka 589-8511, Japan
| | - Agustina M Lascano
- Department of Neurology, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | | | - Simon Rinaldi
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, OX3 9DU Oxford, UK
| | - Johnny P A Samijn
- Department of Neurology, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands
| | - Olivier Scheidegger
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Pinelopi Tsouni
- Nerve-muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital CHUV and University of Lausanne, CH-1011 Lausanne, Switzerland,Department of Neurology, Hôpital du Valais, 1950 Sion, Switzerland
| | - Alex Vicino
- Nerve-muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital CHUV and University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Leo H Visser
- Department of Neurology, St. Elisabeth-TweeSteden Hospital, 5022 GC, Tilburg, The Netherlands
| | - Christa Walgaard
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands,Department of Neurology, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands
| | - Yuzhong Wang
- Department of Neurology, Affiliated Hospital of Jining Medical University, 272029 Jining, China
| | - Paul W Wirtz
- Department of Neurology, Haga Hospital, 2545 AA Den Haag, The Netherlands
| | - Paolo Ripellino
- Department of Neurology, Neurocenter of Southern Switzerland, 6903 Lugano, Switzerland
| | - Bart C Jacobs
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands,Department of Immunology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands,Correspondence to: Bart C. Jacobs, MD, PhD Departments of Neurology and Immunology, Erasmus MC University Medical Center Rotterdam, Room number: EE-2289 Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands E-mail:
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50
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Somkuwar AS, Shende D, Arbat S, Bakamwar S. Guillian-Barre Syndrome in COVID-19 Pregnancy-First Case Report. Ann Indian Acad Neurol 2021; 24:804-805. [PMID: 35002160 PMCID: PMC8680897 DOI: 10.4103/aian.aian_1272_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/07/2021] [Indexed: 11/05/2022] Open
Affiliation(s)
- Anand S Somkuwar
- Department of Neurology, KRIMS Hospital, Ramdaspeth, Nagpur, Maharashtra, India
| | - Dipti Shende
- Department of Obstetrics, KRIMS Hospital, Ramdaspeth, Nagpur, Maharashtra, India
| | - Sameer Arbat
- Department of Gynaecology, KRIMS Hospital, Ramdaspeth, Nagpur, Maharashtra, India
| | - Swapnil Bakamwar
- Department of Pulmonology, KRIMS Hospital, Ramdaspeth, Nagpur, Maharashtra, India
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