1
|
Li CMF, Chang YC, Yang L, Budhram A. Evaluating yield and utilization of ganglioside antibody testing in clinical practice. J Neurol Sci 2024; 457:122903. [PMID: 38295535 DOI: 10.1016/j.jns.2024.122903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND AND OBJECTIVES Ganglioside antibodies can help diagnose distinct acute and chronic inflammatory neuropathies including axonal variants of Guillain-Barre syndrome, Miller-Fisher syndrome (MFS), multifocal motor neuropathy, and chronic sensory ataxic neuropathies. Because ganglioside antibody testing may be routinely ordered in patients with suspected inflammatory neuropathy, we sought to evaluate its yield and utilization in clinical practice. METHODS We performed a retrospective chart review of all patients at London Health Sciences Centre who underwent ganglioside antibody testing between April 2019 and August 2023. The disease phenotype was determined for each patient, and the proportion of all tests that yielded a true-positive result was calculated. Ganglioside antibody positivity was classified as a true-positive result if the disease phenotype was robustly associated with the detected ganglioside antibody and there was no other more likely diagnosis. RESULTS We identified 92 patients who underwent ganglioside antibody testing. One patient (1%) was classified as having a true-positive result; this patient had GQ1b-IgG positivity with MFS. Among 92 patients tested, 20 patients (22%) had a disease phenotype that was considered to be robustly associated with ganglioside antibody positivity. CONCLUSIONS The yield of ganglioside antibody testing in clinical practice is low. We found that this testing is frequently ordered in patients with disease phenotypes that are not robustly associated with ganglioside antibody positivity, indicating that suboptimal test utilization is a primary contributor to its low yield. Restricting ganglioside antibody testing to patients with characteristic disease phenotypes would be valuable to improving yield and utilization of this testing.
Collapse
Affiliation(s)
- Cathy Meng Fei Li
- Department of Clinical Neurological Sciences, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Yiu-Chia Chang
- Department of Clinical Neurological Sciences, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Liju Yang
- Department of Pathology and Laboratory Medicine, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Adrian Budhram
- Department of Clinical Neurological Sciences, Western University, London Health Sciences Centre, London, Ontario, Canada; Department of Pathology and Laboratory Medicine, Western University, London Health Sciences Centre, London, Ontario, Canada.
| |
Collapse
|
2
|
Yella VT, Pareek S, Meena B, Sasanka KSBSK, Thangaraju P, T Y SS. A Systematic Review of the COVID Vaccine's Impact on the Nervous System. Curr Drug Saf 2024; 19:CDS-EPUB-137813. [PMID: 38275049 DOI: 10.2174/0115748863273931231121072231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/05/2023] [Indexed: 01/27/2024]
Abstract
AIMS & OBJECTIVES The objective of this study was to conduct a systematic review of research pertaining to the COVID-19 vaccine and its association with neurological complications. METHOD We performed a comprehensive search of the literature using Google Scholar, PubMed, and NCBI databases from December 2021 to December 2022. For Google Scholar, PubMed, and NCBI databases we used the following key search terms: "neurological adverse effects", "COVID-19 vaccination", "SARS-CoV-2", CNS complications, and CNS adverse effects. Two reviewer authors individually searched and assessed the titles and abstracts of all articles. The third reviewer resolved the disagreement between them. Data were documented regarding title, study location, type of study, type of COVID-19 vaccine, type of neurological complications/adverse effects, and sample size. RESULTS From our findings, it is confirmed that these neurological complications like GuillainBarre syndrome (23.6%), Neuromyelitis Optica spectrum disorder (5.5%), Neuropathy (6.9%), Transverse Myelitis (8.3%) and Acute disseminated Encephalomyelitis (4.1%) are majorly affected in most of the people. The increase in risks associated with SARS-CoV-2 infection far outweighs any previously reported associations with vaccination. CONCLUSION We found no safety signal was observed between COVID-19 vaccines and the immune-mediated neurological events. Before assuming a causal relationship, the side effects of the COVID-19 vaccine should first be carefully examined to rule out known associated factors. Symptom onset was within two weeks of vaccination in the majority of cases; as such, this seems to be a high-risk period warranting vigilance.
Collapse
Affiliation(s)
| | - Sumit Pareek
- Medical Student, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| | - Bhumika Meena
- Medical Student, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| | | | | | - Sree Sudha T Y
- Department of Pharmacology, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| |
Collapse
|
3
|
Wang J, Dong S, Fang M, Fan Z, Xu Y. Omadacycline for the Treatment of Severe Chlamydia psittaci Pneumonia Complicated with Guillain-Barre Syndrome. Infect Drug Resist 2024; 17:81-87. [PMID: 38223561 PMCID: PMC10787558 DOI: 10.2147/idr.s437100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/29/2023] [Indexed: 01/16/2024] Open
Abstract
Background Chlamydia psittaci (C. psittaci) is a pathogen that is seldom implicated in community-acquired pneumonia and is rarely linked to severe pneumonia. Reports of severe C. psittaci pneumonia accompanied by Guillain-Barre syndrome (GBS) are scarce. Tetracyclines are the preferred therapeutic approach for psittacosis. Omadacycline, a novel tetracycline, demonstrates strong antibacterial efficacy against typical bacteria and atypical pathogens, including C. psittaci. However, its application in the treatment of psittacosis pneumonia remains constrained. Case Presentation A 77-year-old female patient was admitted to the hospital presenting with symptoms of fever, low back pain, and headache. The diagnosis of C. psittaci was established through the utilization of metagenomic next-generation sequencing (mNGS). Initial administration of moxifloxacin, meropenem, piperacillin-tazobactam, and doxycycline proved to be ineffective. Subsequent omadacycline leaded to the successful resolution of fever and dyspnea. However, after the endotracheal tube was removed, the patient experienced a rapid decline in symmetrical limb strength, leading to a diagnosis of GBS based on clinical manifestations, cerebrospinal fluid analysis, and electromyography. Following a 5-day course of immunoglobulin therapy and nutritional nerve treatment, the patient's condition ameliorated, culminating in an uncomplicated discharge. Conclusion This case provides evidence supporting the potential use of omadacycline as a therapeutic option for the treatment of severe C. psittaci pneumonia. The utilization of mNGS technology is of paramount importance in the prompt identification of uncommon pathogens, including C. psittaci. Nevertheless, the occurrence of GBS should be taken into consideration when C. psittaci pneumonia is accompanied by symmetrical limb weakness. These findings have important implications for the diagnosis, treatment, and management of patients with C. psittaci pneumonia.
Collapse
Affiliation(s)
- Juan Wang
- Department of Emergency, Affiliated Hangzhou First People`s Hospital, School of Medicine, Westlake University, Hangzhou, People’s Republic of China
| | - Shuangyong Dong
- Department of Emergency, Affiliated Hangzhou First People`s Hospital, School of Medicine, Westlake University, Hangzhou, People’s Republic of China
| | - Mengjuan Fang
- Department of Emergency, Affiliated Hangzhou First People`s Hospital, School of Medicine, Westlake University, Hangzhou, People’s Republic of China
| | - Zhiyan Fan
- Department of Emergency, Affiliated Hangzhou First People`s Hospital, School of Medicine, Westlake University, Hangzhou, People’s Republic of China
| | - Yuansheng Xu
- Department of Emergency, Affiliated Hangzhou First People`s Hospital, School of Medicine, Westlake University, Hangzhou, People’s Republic of China
| |
Collapse
|
4
|
Seok HY, Eun MY, Kim S, Lee JJ, Oh GR, Kim GY, Sohn SI. Reversible cerebral vasoconstriction syndrome in Guillain-Barre syndrome: a case report and literature review. Neurol Sci 2024; 45:101-107. [PMID: 37676373 DOI: 10.1007/s10072-023-07061-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/02/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by transient constriction of cerebral arteries, leading to severe headache and potential complications. The association between RCVS and Guillain-Barre syndrome (GBS) is rare and poorly understood and warrants further investigation. METHODS A detailed case of RCVS in a patient with GBS was presented, followed by a comprehensive literature review. PubMed, Embase, and Google Scholar were searched for relevant cases and studies. RESULTS The case involved a 62-year-old woman with GBS who developed RCVS. The literature review identified three additional reported cases. RCVS in GBS primarily affected middle-aged women and presented with a variety of neurological symptoms. Neuroimaging showed reversible vasoconstriction in the cerebral arteries, along with other complications such as posterior reversible encephalopathy syndrome, subarachnoid hemorrhage, and infarcts. While the treatment for GBS consisted mainly of intravenous immunoglobulin, specific treatments for RCVS remain unclear. CONCLUSIONS The coexistence of RCVS and GBS is a rare occurrence. RCVS in GBS may result from the disruption of cerebral vascular tone regulation, possibly influenced by GBS-related dysautonomia and consequent high blood pressure. Recognizing RCVS in GBS patients is critical for appropriate management.
Collapse
Affiliation(s)
- Hung Youl Seok
- Department of Neurology, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Mi-Yeon Eun
- Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea.
| | - Sohyeon Kim
- Department of Neurology, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Jae-Joon Lee
- Department of Neurology, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Gi Ryeong Oh
- Department of Neurology, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Geun Yeong Kim
- Department of Neurology, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Sung-Il Sohn
- Department of Neurology, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| |
Collapse
|
5
|
Wang L, Ding Y, Liu J, Zheng G, Li S, Jiang W, Chen K, Luan X, Chen Y, Wang S, Zhang G. The analysis of serum lipids profile in Guillain-Barre syndrome. Front Immunol 2023; 14:1301577. [PMID: 38143756 PMCID: PMC10739405 DOI: 10.3389/fimmu.2023.1301577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/24/2023] [Indexed: 12/26/2023] Open
Abstract
Background Guillain-Barre syndrome (GBS) is an immune-mediated inflammatory peripheral neuropathy. This study aimed to conduct a systematic analysis of the serum lipids profile in GBS. Methods We measured the serum lipids profile in 85 GBS patients and compared it with that of 85 healthy controls matched for age and sex. Additionally, we analyzed the correlation between lipids and the severity, subtypes, precursor infections, clinical outcomes, clinical symptoms, immunotherapy, and other laboratory markers of GBS. Results Compared to the healthy controls, GBS exhibited significantly elevated levels of Apolipoprotein B (APOB), Apolipoprotein C2 (APOC2), Apolipoprotein C3 (APOC3), Apolipoprotein E (APOE), triglycerides (TG), and residual cholesterol (RC). Conversely, Apolipoprotein A1 (APOA1), Apolipoprotein A2 (APOA2), and high-density lipoprotein (HDL) were substantially lower in GBS. Severe GBS displayed noticeably higher levels of APOC3 and total cholesterol (TC) compared to those with mild disease. Regarding different clinical outcomes, readmitted GBS demonstrated higher RC expression than those who were not readmitted. Moreover, GBS who tested positive for neuro-virus antibody IGG in cerebrospinal fluid (CSF) exhibited heightened expression of APOC3 in comparison to those who tested negative. GBS with cranial nerve damage showed significantly reduced expression of HDL and APOA1 than those without such damage. Additionally, GBS experiencing limb pain demonstrated markedly decreased HDL expression. Patients showed a significant reduction in TC after intravenous immunoglobulin therapy. We observed a significant positive correlation between lipids and inflammatory markers, including TNF-α, IL-1β, erythrocyte sedimentation rate (ESR), white blood cells, monocytes, and neutrophils in GBS. Notably, APOA1 exhibited a negative correlation with ESR. Furthermore, our findings suggest a potential association between lipids and the immune status of GBS. Conclusion The research demonstrated a strong connection between lipids and the severity, subtypes, clinical outcomes, precursor infections, clinical symptoms, immunotherapy, inflammation, and immune status of GBS. This implies that a low-fat diet or the use of lipid-lowering medications may potentially serve as an approach for managing GBS, offering a fresh viewpoint for clinical treatment of this condition.
Collapse
Affiliation(s)
- Lijuan Wang
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Medical Products Administration (NMPA) Key Laboratory for Quality Control of In Vitro Diagnostics, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yaowei Ding
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Medical Products Administration (NMPA) Key Laboratory for Quality Control of In Vitro Diagnostics, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jie Liu
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Medical Products Administration (NMPA) Key Laboratory for Quality Control of In Vitro Diagnostics, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guanghui Zheng
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Medical Products Administration (NMPA) Key Laboratory for Quality Control of In Vitro Diagnostics, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Siwen Li
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Medical Products Administration (NMPA) Key Laboratory for Quality Control of In Vitro Diagnostics, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wencan Jiang
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Medical Products Administration (NMPA) Key Laboratory for Quality Control of In Vitro Diagnostics, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kelin Chen
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Medical Products Administration (NMPA) Key Laboratory for Quality Control of In Vitro Diagnostics, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Luan
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Medical Products Administration (NMPA) Key Laboratory for Quality Control of In Vitro Diagnostics, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuxin Chen
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Medical Products Administration (NMPA) Key Laboratory for Quality Control of In Vitro Diagnostics, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Siqi Wang
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Medical Products Administration (NMPA) Key Laboratory for Quality Control of In Vitro Diagnostics, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guojun Zhang
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Medical Products Administration (NMPA) Key Laboratory for Quality Control of In Vitro Diagnostics, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
6
|
Wachira VK, Farinasso CM, Silva RB, Peixoto HM, de Oliveira MRF. Incidence of Guillain-Barré syndrome in the world between 1985 and 2020: A systematic review. Glob Epidemiol 2023; 5:100098. [PMID: 37638372 PMCID: PMC10445966 DOI: 10.1016/j.gloepi.2023.100098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 01/13/2023] Open
Abstract
Introduction Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyradiculoneuropathy that affects the peripheral nervous system. The study aimed to describe the incidence of GBS in the world up to the year 2020. Methods A systematic review was conducted. Searches were done in four databases, PUBMED, EMBASE, EBSCO and Biblioteca virtual em Saude (BVS), and in grey literature and manual search in the reference lists of eligible studies. Results A total of 72 studies were included. The incidence of GBS among the cohort studies varied from 0.30 to 6.08 cases per 100.000 habitants and 0.42 to 6.58 cases per 100.000 person-years. Among the self-controlled studies, the risk incidence ranged from 0.072 to 1 case per 100.000 habitants and 1.73 to 4.30 cases per 100.000 person-years. Conclusions The reported incidence of GBS in the world among the studies included in the review is slightly higher than that reported in previous studies. The highest incidence rates were associated with public health events of international concern.
Collapse
Affiliation(s)
- Virginia Kagure Wachira
- Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
| | | | | | - Henry Maia Peixoto
- Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
- Instituto de Avaliação de Tecnologia em Saúde, Porto Alegre, Brazil
| | - Maria Regina Fernandes de Oliveira
- Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
- Instituto de Avaliação de Tecnologia em Saúde, Porto Alegre, Brazil
| |
Collapse
|
7
|
Silva Campos JJ, Abels E, Rinder HM, Tormey CA, Jacobs JW. Botulism mimicking Guillain-Barre syndrome: The question of plasma exchange in an unusual case of acute paralysis. J Clin Apher 2023; 38:760-763. [PMID: 37519071 DOI: 10.1002/jca.22081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/17/2023] [Accepted: 07/22/2023] [Indexed: 08/01/2023]
Abstract
Guillain-Barré syndrome (GBS) is an immune-mediated polyradiculoneuropathy and the most common cause of acute flaccid paralysis worldwide. GBS classically presents with acute, progressive, ascending weakness, reduced to absent reflexes, and albuminocytological dissociation on cerebrospinal fluid (CSF) analysis. Botulism is a neurotoxin-mediated acute descending flaccid paralysis with cranial nerve palsies and dysautonomia. Botulism in adults is caused by ingestion/inhalation of botulinum toxin or wound infection with Clostridium botulinum. Both GBS and botulism can rapidly precipitate respiratory failure; thus, prompt diagnosis and treatment are crucial to mitigate poor outcomes. Herein, we describe a case of botulism initially diagnosed as GBS given classic laboratory features, and describe the importance of careful consideration of the most appropriate therapeutic modalities in cases of acute flaccid paralysis, particularly regarding empiric administration of botulinum antitoxin and use of intravenous immune globulin in lieu of plasma exchange for potential GBS to prevent removal of antitoxin.
Collapse
Affiliation(s)
- Juan J Silva Campos
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Elizabeth Abels
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Henry M Rinder
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Internal Medicine (Hematology), Yale School of Medicine, New Haven, Connecticut, USA
| | - Christopher A Tormey
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jeremy W Jacobs
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
8
|
Tsubata T. The ligand interactions of B cell Siglecs are involved in the prevention of autoimmunity to sialylated self-antigens and in the quality control of signaling-competent B cells. Int Immunol 2023; 35:461-473. [PMID: 37504378 DOI: 10.1093/intimm/dxad030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/26/2023] [Indexed: 07/29/2023] Open
Abstract
Sialic acid-binding immunoglobulin-like lectins (Siglecs) are a family of membrane molecules that recognize sialic acid. Most of them are inhibitory receptors that inhibit immune-cell activation by recognizing sialic acid as a self-motif. Human B cells express CD22 (also known as Siglec-2), Siglec-5, Siglec-6 and Siglec-10 whereas mouse B cells express CD22 and Siglec-G (ortholog of human Siglec-10). Siglecs recognize both sialylated molecules expressed on the same cell (cis-ligands) and those expressed by other cells (trans-ligands). In Guillain-Barré syndrome (GBS), antibody production to gangliosides (which are sialic acid-containing glycolipids) expressed by neurons plays a pathogenic role. A Siglec-10 variant deficient in recognition of gangliosides is genetically associated with GBS, suggesting that Siglec-10 induces self-tolerance to gangliosides by recognizing gangliosides as trans-ligands. Recognition of the BCR as a cis-ligand by Siglec-G and CD22 suppresses BCR signaling in B-1 cells and conventional B cells, respectively. This signal suppression prevents excess expansion of B-1 cells and is involved in the quality control of signaling-competent B cells by setting a threshold for tonic signaling during B cell development. CD22 recognizes other cis-ligands including CD22 and β7 integrin. Interaction of CD22 with other CD22 molecules induces CD22 clustering that suppresses CD22-mediated signal inhibition upon BCR ligation, and interaction with β7 integrin maintains its function in the gut-homing of B cells. Taken together, interactions of B cell Siglecs with multiple trans- and cis-ligands play important roles in B cell homeostasis and immune responses.
Collapse
Affiliation(s)
- Takeshi Tsubata
- Department of Pathology, Nihon University School of Dentistry, 1-8-13 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8310, Japan
| |
Collapse
|
9
|
Finsterer J, Scorza FA. Only blame SARS-CoV-2 vaccination for facial palsy after alternative etiologies have been ruled out. Therapie 2023; 78:463-464. [PMID: 37268504 PMCID: PMC10186848 DOI: 10.1016/j.therap.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/15/2023] [Indexed: 06/04/2023]
Affiliation(s)
- Josef Finsterer
- Neurology and Neurophysiology Center, Postfach 20, 1180 Vienna, Austria.
| | - Fulvio A Scorza
- Disciplina de Neurociência, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, SP 05508-220, Brazil
| |
Collapse
|
10
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
11
|
Cabanillas-Lazo M, Quispe-Vicuña C, Cruzalegui-Bazán C, Pascual-Guevara M, Mori-Quispe N, Alva-Diaz C. The neutrophil-to-lymphocyte ratio as a prognostic biomarker in Guillain-Barre syndrome: a systematic review with meta-analysis. Front Neurol 2023; 14:1153690. [PMID: 37333004 PMCID: PMC10272825 DOI: 10.3389/fneur.2023.1153690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/03/2023] [Indexed: 06/20/2023] Open
Abstract
Background and objectives Guillain-Barre syndrome (GBS) is an immune-mediated neuropathy. This has raised the possibility that the neutrophil-lymphocyte ratio (NLR) may be a biomarker of its activity. We conducted a systematic review and meta-analysis to summarize the evidence of NLR as a potential biomarker for GBS. Methods We systematically searched databases (PubMed, Ovid-Medline, Embase, Scopus, Web of Science, SciELO Citation Index, LILACS, and Google Scholar) until October 2021 for studies evaluating pre-treatment NLR values in GBS patients. A meta-analysis using a random-effects model to estimate pooled effects was realized for each outcome and a narrative synthesis when this was not possible. Subgroup and sensitivity analysis were realized. GRADE criteria were used to identify the certainty of evidence for each result. Results Ten studies from 745 originally included were selected. Regarding GBS patients versus healthy controls, a meta-analysis of six studies (968 patients) demonstrated a significant increase in NLR values in GBS patients (MD: 1.76; 95% CI: 1.29, 2.24; I2 = 86%) with moderate certainty due to heterogeneity of GBS diagnosis criteria used. Regarding GBS prognosis, assessed by Hughes Score ≥ 3, NLR had a sensitivity between 67.3 and 81.5 and a specificity between 67.3 and 87.5 with low certainty due to imprecision, and heterogeneity. In relation to respiratory failure, NLR had a sensitivity of 86.5 and specificity of 68.2 with high and moderate certainty, respectively. Discussion With moderate certainty, mean NLR is higher in GBS patients compared to healthy controls. Furthermore, we found that NLR could be a prognostic factor for disability and respiratory failure with low and moderate certainty, respectively. These results may prove useful for NLR in GBS patients; however, further research is needed. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021285212.
Collapse
Affiliation(s)
- Miguel Cabanillas-Lazo
- Red de Eficacia Clínica y Sanitaria (REDECS), Lima, Peru
- Sociedad Científica de San Fernando, Lima, Peru
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Carlos Quispe-Vicuña
- Red de Eficacia Clínica y Sanitaria (REDECS), Lima, Peru
- Sociedad Científica de San Fernando, Lima, Peru
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Claudia Cruzalegui-Bazán
- Red de Eficacia Clínica y Sanitaria (REDECS), Lima, Peru
- Sociedad Científica de San Fernando, Lima, Peru
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Milagros Pascual-Guevara
- Red de Eficacia Clínica y Sanitaria (REDECS), Lima, Peru
- Sociedad Científica de San Fernando, Lima, Peru
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Nicanor Mori-Quispe
- Servicio de Neurología, Departament de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Peru
| | - Carlos Alva-Diaz
- Red de Eficacia Clínica y Sanitaria (REDECS), Lima, Peru
- Servicio de Neurología, Departament de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Peru
- Universidad Señor de Sipán, Chiclayo, Peru
| |
Collapse
|
12
|
Zaki HA, Iftikhar H, Najam M, Masood M, Al-Marri NDR, Elgassim MAM, Fayed M, Shaban EE. Plasma exchange (PE) versus intravenous immunoglobulin (IVIG) for the treatment of Guillain-Barré syndrome (GBS) in patients with severe symptoms: A systematic review and meta-analysis. eNeurologicalSci 2023; 31:100468. [PMID: 37288440 PMCID: PMC10242495 DOI: 10.1016/j.ensci.2023.100468] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/29/2023] [Accepted: 05/18/2023] [Indexed: 06/09/2023] Open
Abstract
Background and purpose Guillain- Barré syndrome (GBS) is a neuropathic condition that leads to the rapid development of impairments and is characterized by weakness and numbness or tingling sensation in the legs and arms and sometimes loss of movement and feeling in the legs, arms, upper body, and face. Currently, the cure for the disease is yet to be developed. However, treatment options such as intravenous immunoglobulin (IVIG) and plasma exchange (PE) have been used to minimize the symptoms and duration of the disease. Therefore, this systematic review and meta-analysis compared the efficacy of IVIG and PE in treating GBS patients with severe symptoms. Methodology Six electronic databases, including PubMed, Embase, Scopus, ScienceDirect, Medline, and Google scholar, were scoured for articles related and relevant to our research. Additionally, more studies were obtained through the reference lists of the studies retrieved from these electronic databases. Quality assessment and statistical data analysis were conducted using Review Manager software (RevMan 5.4.1). Results The search for relevant articles resulted in 3253 articles, of which only 20 were included for review in the current study. A sub-group analysis indicated no significant difference in the curative effect (Hughes score reduces by at least one score 4 weeks after GBS treatment; OR: 1.00; 95% CI: 0.66-1.52; p = 1.00 and Achieving grade 0 or 1 on Hughes scale; OR: 1.03; 95% CI: 0.27-3.94; p = 0.97). Similarly, the statistical showed that the difference in length of hospitalization and duration of mechanical ventilation was insignificant between the IVIG and PE group (Standard Mean Difference (SMD): -0.45; 95% CI: -0.92, 0.02; I2 = 91%; p = 0.06 and SMD: -0.54; 95% CI: -1.67, 0.59; I2 = 93%; p = 0.35, respectively). Moreover, the meta-analysis did not find any significant difference in the risk of GBS relapse (RR: 0.47; 95% CI: 0.20-1.14; p = 0.10) and risk of complications related to the treatment regimens (RR: 1.03; 95% CI: 0.71-1.48; p = 0.89). However, the statistical analysis of outcomes from 3 studies showed that the risk of discontinuation was significantly lower in the IVIG group than in the PE group (RR: 0.22; 95% CI: 0.06-0.88; p = 0.03). Conclusion Our study suggests that IVIG and PE have similar curative effects. Similarly, IVIG seems easier to use and thus can be preferred for treating GBS.
Collapse
Affiliation(s)
- Hany A. Zaki
- Emergency Medicine, Hamad General Hospital, P.O. Box 3050, Doha, Qatar
| | - Haris Iftikhar
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
| | - Mavia Najam
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
| | - Maarij Masood
- Emergency Medicine, Hamad General Hospital, P.O. Box 3050, Doha, Qatar
| | | | | | - Mohamed Fayed
- Emergency Medicine, Hamad General Hospital, P.O. Box 3050, Doha, Qatar
| | - Eman E. Shaban
- Cardiology, Al Jufairi Diagnosis and Treatment, Doha, Qatar
| |
Collapse
|
13
|
Bereda G. How is Guillain-Barre syndrome associated with COVID-19 infection differentiated from hypokalemic periodic paralysis? a case report. Ann Med Surg (Lond) 2023; 85:2203-2207. [PMID: 37228914 PMCID: PMC10205262 DOI: 10.1097/ms9.0000000000000654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/02/2023] [Indexed: 05/27/2023] Open
Abstract
Patients with coronavirus disease 2019 (COVID-19)-associated Guillain-Barre syndrome (GBS) exhibit a range of clinical symptoms, such as cranial nerve paralysis and axonal or motor-sensory electrophysiological signals. Case presentation A 61-year-old retired black African female was brought into the emergency room on 13 May 2022, with a 4-day history of shortness of breath and high-grade fever and a 1-day history of global body weakness (bilateral paralysis of the upper and lower extremities). Motor examination indicated reduced muscular strength in all limbs, with a Medical Research Council score of 2/5 in the right arm of the upper extremities, 1/5 in the right leg of the lower extremities, 1/5 in the left leg of the lower extremities, and 2/5 in the left arm of the upper extremities. Her electrocardiogram revealed ST depression in the anterior-lateral leads and sinus tachycardia. For the COVID-related infection, azithromycin 500 mg per day for 5 days was begun. After cerebrospinal fluid findings supported the diagnosis of GBS, she underwent intravenous immunoglobulin 400 mg/kg every day for 5 days. Clinical discussion In the majority of COVID-19-related GBS cases, areflexic quadriparesis developed suddenly. A COVID-19 infection related to a GBS case was the only one that had preceding signs, including ageusia and hyposmia. By testing serum potassium levels, this study determined that there is no connection between GBS and hypokalemia, which can lead to diagnostic and therapeutic conundrums by evaluating serum potassium levels, which showed a normal value. Conclusion One of the neurological symptoms of the COVID-19 infection is GBS. Several weeks after a COVID-19 acute infection, GBS is frequently observed.
Collapse
Affiliation(s)
- Gudisa Bereda
- Corresponding author. Address: Pharmacy Department, All Africa Leprosy, Tuberculosis and Rehabilitation Training Center, Zenebework, Kolfe Keranio, Addis Ababa182609, Ethiopia. Tel: +251 913 118 492/+251 910 790 650. E-mail: (G. Bereda)
| |
Collapse
|
14
|
Changadiya K, Anadure R, Sreen A, Gupta S, Singh S, Mhatre R. Two unusual cases of Guillain-Barre syndrome after snake bite: the rare immune mediated complication of Elapid venom. Med J Armed Forces India 2023; 79:321-327. [PMID: 37193514 PMCID: PMC10182293 DOI: 10.1016/j.mjafi.2020.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/28/2020] [Indexed: 01/01/2023] Open
Abstract
In this report, we present a series of two unusual cases of elapid snakebite with acute neuroparalysis, that after initial response to standard anti-snake venom therapy, developed recurrence of disabling quadriparesis with dysautonomia, that on detailed evaluation turned out to be immune-mediated polyradiculoneuropathy (GB syndrome). Both the cases then responded to therapy with intravenous immunoglobulins. These cases bring out the rare immune-mediated late complication of snake venom, which if recognized and treated in time, can significantly reduce the morbidity and mortality.
Collapse
Affiliation(s)
- Keval Changadiya
- Senior Resident (Neurology), Army Hospital (R&R), New Delhi, India
| | - R.K. Anadure
- Professor & Head (Neurology), Army Hospital (R&R), New Delhi, India
| | - Amit Sreen
- Senior Advisor (Neurology), Army Hospital (R&R), New Delhi, India
| | - Salil Gupta
- Professor & Head (Medicine), Command Hospital (Air Forces), Bengaluru, India
| | - Sindhu Singh
- Senior Resident (Neurology), Army Hospital (R&R), New Delhi, India
| | - Radhika Mhatre
- Senior Resident (Neuropathology), NIMHANS, Bengaluru, India
| |
Collapse
|
15
|
Reddy YM, Murthy JMK, Osman S, Jaiswal SK, Gattu AK, Pidaparthi L, Boorgu SK, Chavan R, Ramakrishnan B, Yeduguri SR. Guillain-Barré syndrome associated with SARS-CoV-2 vaccination: how is it different? a systematic review and individual participant data meta-analysis. Clin Exp Vaccine Res 2023; 12:143-155. [PMID: 37214140 PMCID: PMC10193105 DOI: 10.7774/cevr.2023.12.2.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/20/2023] [Accepted: 03/31/2023] [Indexed: 05/24/2023] Open
Abstract
Purpose An association between Guillain-Barré syndrome (GBS) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccination has been reported. We aimed to summarize the clinical features of GBS associated with SARS-CoV-2 vaccination and determine the contrasting features from coronavirus disease-19 (COVID-19) associated GBS and GBS following other causes. Materials and Methods We performed PubMed search for articles published between 1 December 2020 and 27 January 2022 using search terms related to "SARS-CoV-2 vaccination" and "GBS". Reference searching of the eligible studies was performed. Sociodemographic and vaccination data, clinical and laboratory features, and outcomes were extracted. We compared these findings with post-COVID-19 GBS and International GBS Outcome Study (IGOS) (GBS from other causes) cohorts. Results We included 100 patients in the analysis. Mean age was 56.88 years, and 53% were males. Six-eight received non-replicating virus vector and 30 took messenger RNA (mRNA) vaccines. The median interval between the vaccination and the GBS onset was 11 days. Limb weakness, facial palsy, sensory symptoms, dysautonomia, and respiratory insufficiency were seen in 78.65%, 53.3%, 77.4%, 23.5%, and 25%, respectively. The commonest clinical and electrodiagnostic subtype were sensory-motor variant (68%) and acute inflammatory demyelinating polyneuropathy (61.4%), respectively. And 43.9% had poor outcome (GBS outcome score ≥3). Pain was common with virus vector than mRNA vaccine, and the latter had severe disease at presentation (Hughes grade ≥3). Sensory phenomenon and facial weakness were common in vaccination cohort than post-COVID-19 and IGOS. Conclusion There are distinct differences between GBS associated with SARS-CoV-2 vaccination and GBS due to other causes. Facial weakness and sensory symptoms were commonly seen in the former and outcomes poor.
Collapse
Affiliation(s)
| | | | - Syed Osman
- Department of Neurology, CARE Hospital, Hyderabad, India
| | | | | | | | | | - Roshan Chavan
- Department of Neurology, CARE Hospital, Hyderabad, India
| | | | | |
Collapse
|
16
|
Garg RK, Paliwal V, Malhotra HS, Singh BP, Rizvi I, Kumar N. Spectrum of Serious Neurological and Psychiatric Adverse Events in Indian COVID-19 Vaccine Recipients: A Systematic Review of Case Reports and Case Series. Neurol India 2023; 71:209-227. [PMID: 37148041 DOI: 10.4103/0028-3886.375420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Indian data regarding serious neurological and psychiatric adverse events, following coronavirus disease 2019 (COVID-19) vaccination, are lacking. We, therefore, systematically evaluated cases of post-vaccinal serious neurological and psychiatric adverse reactions published from India. A systematic review of cases published from India, which were archived in PubMed, Scopus, and Google Scholar databases, was performed; pre-print databases along with ahead-of-print contents were searched in addition. Retrieved articles, as on June 27, 2022, were evaluated following PRISMA guidelines. EndNote 20 web tool was used to make a PRISMA flow chart. Individual patients' data were compiled in a tabular form. The protocol of the systematic review was registered with PROSPERO (CRD42022324183). A total of 64 records describing 136 instances of serious neurological and psychiatric adverse events were identified. More than 50% (36/64) reports were from the following four states, namely, Kerala, Uttar Pradesh, New Delhi, and West Bengal. The mean age of persons developing these complications was 44.89 ± 15.77 years. In the majority, adverse events occurred within 2 weeks of administration of the first dose of COVISHIELD vaccine. Immune-mediated central nervous system (CNS) disorders were identified in 54 instances. Guillain-Barre syndrome and other immune-mediated peripheral neuropathies were reported in 21 cases. Post-vaccinal herpes zoster was recorded in 31 vaccine recipients. Psychiatric adverse events were recorded in six patients. In Indian recipients of COVID-19 vaccine, a variety of serious neurological complications were reported. The overall risk appears minuscule. Immune-mediated central and peripheral neuronal demyelinations were the most frequently reported post-vaccinal adverse events. A large number of cases of herpes zoster have also been reported. Immune-mediated disorders responded well to immunotherapy.
Collapse
Affiliation(s)
- Ravindra Kumar Garg
- Department of Neurology, King George's Medical University, Lucknow, UP, India
| | - Vimal Paliwal
- Department of Neurology, Sanjay Gandhi Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | | | | | - Imran Rizvi
- Department of Neurology, King George's Medical University, Lucknow, UP, India
| | - Neeraj Kumar
- Department of Neurology, King George's Medical University, Lucknow, UP, India
| |
Collapse
|
17
|
McGonigal R, Cunningham ME, Smyth D, Chou M, Barrie JA, Wilkie A, Campbell C, Saatman KE, Lunn M, Willison HJ. The endogenous calpain inhibitor calpastatin attenuates axon degeneration in murine Guillain-Barré syndrome. J Peripher Nerv Syst 2023; 28:4-16. [PMID: 36335586 PMCID: PMC10947122 DOI: 10.1111/jns.12520] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/24/2022] [Accepted: 10/30/2022] [Indexed: 11/08/2022]
Abstract
Axon degeneration accounts for the poor clinical outcome in Guillain-Barré syndrome (GBS), yet no treatments target this key pathogenic stage. Animal models demonstrate anti-ganglioside antibodies (AGAb) induce axolemmal complement pore formation through which calcium flux activates the intra-axonal calcium-dependent proteases, calpains. We previously showed protection of axonal components using soluble calpain inhibitors in ex vivo GBS mouse models, and herein, we assess the potential of axonally-restricted calpain inhibition as a neuroprotective therapy operating in vivo. Using transgenic mice that over-express the endogenous human calpain inhibitor calpastatin (hCAST) neuronally, we assessed distal motor nerve integrity in our established GBS models. We induced immune-mediated injury with monoclonal AGAb plus a source of human complement. The calpain substrates neurofilament and AnkyrinG, nerve structural proteins, were assessed by immunolabelling and in the case of neurofilament, by single-molecule arrays (Simoa). As the distal intramuscular portion of the phrenic nerve is prominently targeted in our in vivo model, respiratory function was assessed by whole-body plethysmography as the functional output in the acute and extended models. hCAST expression protects distal nerve structural integrity both ex and in vivo, as shown by attenuation of neurofilament breakdown by immunolabelling and Simoa. In an extended in vivo model, while mice still initially undergo respiratory distress owing to acute conduction failure, the recovery phase was accelerated by hCAST expression. Axonal calpain inhibition can protect the axonal integrity of the nerve in an in vivo GBS paradigm and hasten recovery. These studies reinforce the strong justification for developing further animal and human clinical studies using exogenous calpain inhibitors.
Collapse
Affiliation(s)
- Rhona McGonigal
- School of Infection & ImmunityUniversity of GlasgowGlasgowUnited Kingdom
| | | | - Duncan Smyth
- National Hospital for Neurology and Neurosurgery, Centre for Neuromuscular DiseasesUniversity College LondonLondonUnited Kingdom
| | - Michael Chou
- National Hospital for Neurology and Neurosurgery, Centre for Neuromuscular DiseasesUniversity College LondonLondonUnited Kingdom
| | - Jennifer A. Barrie
- School of Infection & ImmunityUniversity of GlasgowGlasgowUnited Kingdom
| | - Andrew Wilkie
- School of Infection & ImmunityUniversity of GlasgowGlasgowUnited Kingdom
| | - Clare Campbell
- School of Infection & ImmunityUniversity of GlasgowGlasgowUnited Kingdom
| | - Kathryn E. Saatman
- Department of Physiology, Spinal Cord and Brain Injury Research CenterUniversity of KentuckyLexingtonKYUSA
| | - Michael Lunn
- National Hospital for Neurology and Neurosurgery, Centre for Neuromuscular DiseasesUniversity College LondonLondonUnited Kingdom
| | - Hugh J. Willison
- School of Infection & ImmunityUniversity of GlasgowGlasgowUnited Kingdom
| |
Collapse
|
18
|
Guémy C, Durand MC, Brisset M, Nicolas G. Changes in electrophysiological findings suggestive of demyelination following Guillain-Barré syndrome: A retrospective study. Muscle Nerve 2023; 67:394-400. [PMID: 36814082 DOI: 10.1002/mus.27803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION/AIMS Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) is the most common form of Guillain-Barré syndrome (GBS) in Western countries. However, electrophysiological descriptions of changes in abnormalities suggestive of demyelination after an AIDP episode are rare. We aimed to describe the clinical and electrophysiological features of AIDP patients after the acute episode, to investigate changes in abnormalities suggestive of demyelination and to compare with electrophysiological features of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). METHODS We reviewed the clinical and electrophysiological characteristics of 61 patients followed at regular intervals after the AIDP episode. RESULTS We detected early electrophysiological abnormalities from the first nerve conduction studies (NCS) performed before 3 wk. Abnormalities suggestive of demyelination worsened on subsequent examinations. This worsening continued after more than 3 mo of follow-up for some parameters. We also found the persistence of abnormalities suggestive of demyelination for long periods after the acute episode, beyond 18 mo of follow-up, despite clinical improvement in most patients. DISCUSSION In AIDP, NCS findings continue to worsen several weeks or even months after the onset of symptoms, and "CIDP-like" abnormalities suggestive of demyelination may persist for a long period of time, in contrast to the existing literature and the usually favorable clinical course. Thus, the discovery of conduction abnormalities on NCS performed long after an AIDP should always be interpreted according to the clinical context and not systematically lead to a diagnosis of CIDP.
Collapse
Affiliation(s)
- Clément Guémy
- Neurology Department, Raymond-Poincaré Hospital, Garches, France
| | | | - Marion Brisset
- Neurology Department, Raymond-Poincaré Hospital, Garches, France.,Physiology Department, Raymond-Poincaré Hospital, Garches, France
| | | |
Collapse
|
19
|
Berrim K, Lakhoua G, Zaiem A, Charfi O, Aouinti I, Kastalli S, Daghfous R, El Aidli S. Guillain-Barré syndrome after COVID-19 vaccines: A Tunisian case series. Br J Clin Pharmacol 2023; 89:574-578. [PMID: 36398559 DOI: 10.1111/bcp.15601] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/25/2022] [Accepted: 11/07/2022] [Indexed: 11/19/2022] Open
Abstract
As the COVID-19 vaccination campaign progresses worldwide, Guillain-Barré syndrome (GBS) vaccine-related cases have been reported. We carried out a retrospective, descriptive study of GBS patients following COVID-19 vaccine, submitted to the National Pharmacovigilance Center of Tunis during the period between March 2021 and May 2022. Our study aimed to identify epidemiological and clinical features of COVID-19 vaccine-associated GBS. We found 9 cases of GBS post COVID-19 vaccination; 5 of them were excluded due to the lack of information, whereas 4 cases were included in this study. Men represented 75% (3/4) of the cases. The most frequently reported vaccine type was ChAdOx1 nCoV-19 vaccine (n = 2 reports [50%]), Ad26.COV2.S vaccine and BNT162b2 vaccine in 1. The mean time interval from vaccination to symptom onset was 15.3 days. Clinical manifestations were different: classical GBS in two cases and GBS with unilateral facial palsy in the other 2 cases. All patients were treated with a course of intravenous immunoglobulin for 5 days. Three patients reported clinical improvement while one case (25%) showed treatment-related fluctuations. Our observations suggest that COVID-19 vaccines may be associated with GBS. Continuous surveillance and further studies are warranted to assess the significance of the association.
Collapse
Affiliation(s)
- Khouloud Berrim
- National Pharmacovigilance Center, Tunis, 1006, Tunisia.,Research Unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis-El-Manar, Tunis, 1007, Tunisia
| | - Ghozlane Lakhoua
- National Pharmacovigilance Center, Tunis, 1006, Tunisia.,Research Unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis-El-Manar, Tunis, 1007, Tunisia
| | - Ahmed Zaiem
- National Pharmacovigilance Center, Tunis, 1006, Tunisia.,Research Unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis-El-Manar, Tunis, 1007, Tunisia
| | - Ons Charfi
- National Pharmacovigilance Center, Tunis, 1006, Tunisia.,Research Unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis-El-Manar, Tunis, 1007, Tunisia
| | - Imen Aouinti
- National Pharmacovigilance Center, Tunis, 1006, Tunisia.,Research Unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis-El-Manar, Tunis, 1007, Tunisia
| | - Sarrah Kastalli
- National Pharmacovigilance Center, Tunis, 1006, Tunisia.,Research Unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis-El-Manar, Tunis, 1007, Tunisia
| | - Riadh Daghfous
- National Pharmacovigilance Center, Tunis, 1006, Tunisia.,Research Unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis-El-Manar, Tunis, 1007, Tunisia
| | - Sihem El Aidli
- National Pharmacovigilance Center, Tunis, 1006, Tunisia.,Research Unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis-El-Manar, Tunis, 1007, Tunisia
| |
Collapse
|
20
|
Fang C, Xu L, Tan J, Tan H, Lin J, Zhao Z. Case Report: Chlamydia psittaci pneumonia complicated by Guillain-Barré syndrome detected using metagenomic next-generation sequencing. Front Cell Infect Microbiol 2023; 12:1070760. [PMID: 36755852 PMCID: PMC9901563 DOI: 10.3389/fcimb.2022.1070760] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/30/2022] [Indexed: 01/24/2023] Open
Abstract
Psittacosis and Guillain-Barré syndrome are both rare clinical diseases with low incidence, and their combination has rarely been reported. Here, we report a case of Chlamydia psittaci pneumonia combined with Guillain-Barré syndrome. The patient initially presented with high fever, difficulty breathing, and fatigue. Chest computerised tomography indicated large consolidation opacities in both lungs. Metagenomic next-generation sequencing clearly identified the pathogen as C. psittaci. The patient's fever subsided after targeted antibiotic treatment, but difficulty breathing and fatigue worsened, and the patient developed symmetric limb numbness and weakness. Lumbar puncture, electrophysiological examination, and clinical characteristics were suggestive of Guillain-Barré syndrome, and the symptoms improved after treatment with human immunoglobulin. The results of this study suggest that metagenomic next-generation sequencing is useful for the rapid diagnosis of pulmonary infectious agents. Psittacosis is closely associated with the development of Guillain-Barré syndrome; however, more cases are needed to support this conclusion, and early targeted antibiotic treatment, immunotherapy, and basic supportive treatment are essential for improving outcomes.
Collapse
Affiliation(s)
- Changquan Fang
- Department of Pulmonary and Critical Care Medicine, Huizhou Central People’s Hospital, Huizhou, Guangdong, China
| | - Limin Xu
- Department of Geriatrics, Huizhou First People’s Hospital, Huizhou, Guangdong, China
| | - Jiarong Tan
- Department of Pulmonary and Critical Care Medicine, Huizhou Central People’s Hospital, Huizhou, Guangdong, China
| | - Hongyi Tan
- Department of Pulmonary and Critical Care Medicine, Huizhou Central People’s Hospital, Huizhou, Guangdong, China
| | - Junhong Lin
- Department of Pulmonary and Critical Care Medicine, Huizhou Central People’s Hospital, Huizhou, Guangdong, China,*Correspondence: Junhong Lin, ; Ziwen Zhao,
| | - Ziwen Zhao
- Department of Pulmonary and Critical Care Medicine, Guangzhou First People’s Hospital Affiliated to South China University of Technology, Guangzhou, Guangdong, China,*Correspondence: Junhong Lin, ; Ziwen Zhao,
| |
Collapse
|
21
|
Finsterer J. Anatomy and physiology argue against SARS-CoV-2-associated Parsonage-Turner syndrome if the accessory nerve is affected. Hand Surg Rehabil 2023; 42:172-173. [PMID: 36608847 PMCID: PMC9809145 DOI: 10.1016/j.hansur.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/21/2022] [Accepted: 12/30/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Josef Finsterer
- Neurology & Neurophysiology Centre, Postfach 20, 1180 Vienna, Austria.
| |
Collapse
|
22
|
Yu M, Nie S, Qiao Y, Ma Y. Guillain-Barre syndrome following COVID-19 vaccines: A review of literature. Front Immunol 2023; 14:1078197. [PMID: 36875094 PMCID: PMC9975597 DOI: 10.3389/fimmu.2023.1078197] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/03/2023] [Indexed: 02/17/2023] Open
Abstract
Objective This study aimed to retrospectively analyze reported Guillain-Barré syndrome (GBS) cases that occurred after COVID-19 vaccination. Methods Case reports of GBS following COVID-19 vaccination that were published before May 14, 2022, were retrieved from PubMed. The cases were retrospectively analyzed for their basic characteristics, vaccine types, the number of vaccination doses before onset, clinical manifestations, laboratory test results, neurophysiological examination results, treatment, and prognosis. Results Retrospective analysis of 60 case reports revealed that post-COVID-19 vaccination GBS occurred mostly after the first dose of the vaccination (54 cases, 90%) and was common for DNA vaccination (38 cases, 63%), common in middle-aged and elderly people (mean age: 54.5 years), and also common in men (36 cases, 60%). The mean time from vaccination to onset was 12.3 days. The classical GBS (31 cases, 52%) was the major clinical classification and the AIDP subtype (37 cases, 71%) was the major neurophysiological subtype, but the positive rate of anti-ganglioside antibodies was low (7 cases, 20%). Bilateral facial nerve palsy (76% vs 18%) and facial palsy with distal paresthesia (38% vs 5%) were more common for DNA vaccination than for RNA vaccination. Conclusion After reviewing the literature, we proposed a possible association between the risk of GBS and the first dose of the COVID-19 vaccines, especially DNA vaccines. The higher rate of facial involvement and a lower positive rate of anti-ganglioside antibodies may be a characteristic feature of GBS following COVID-19 vaccination. The causal relationship between GBS and COVID-19 vaccination remains speculative, more research is needed to establish an association between GBS and COVID-19 vaccination. We recommend surveillance for GBS following vaccination, because it is important in determining the true incidence of GBS following COVID-19 vaccination, as well as in the development of a more safer vaccine.
Collapse
Affiliation(s)
- Miao Yu
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China.,Department of Neurology, Shenyang First People's Hospital, Shenyang, China
| | - Shuang Nie
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yue Qiao
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ying Ma
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
| |
Collapse
|
23
|
Untari NKSD, Kusumastuti K, Suryokusumo G, Sudiana IK. Hyperbaric oxygen therapy improves recovery at acute motor axonal neuropathy case. J Neurosci Rural Pract 2023; 14:145-148. [PMID: 36891088 PMCID: PMC9944315 DOI: 10.25259/jnrp_9_2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 09/22/2022] [Indexed: 12/24/2022] Open
Abstract
Acute motor axonal neuropathy (AMAN) is a rare immune-mediated disorder characterized by acute flaccid paralysis with elevated levels of GM1 antibodies. It is also known as a subtype of the Guillain-Barre syndrome (GBS) and develops since antigen s serve as antibodies in the spinal cord. We report a case diagnosed as AMAN with symptoms of ascending limb symmetrical weakness. A neurological examination revealed a flaccid paralysis with multiple cranial nerve palsies. Electromyography showed an axonal type of GBS. The patient refused bone marrow fluid aspiration. Intravenous immunoglobulin was administered at the high care unit. Unfortunately, despite the standard therapy, an optimal recovery was not obtained. Hyperbaric oxygen (HBO) therapy has been known to be common in illnesses and some clinical diseases. Although it has not been indicated for peripheral neuropathy, a remarkable recovery was soon visible in the HBO-treated AMAN case. The HBO mechanisms involved here are anti-inflammation and immunomodulation.
Collapse
Affiliation(s)
| | - Kurnia Kusumastuti
- Department of Neurology, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Guritno Suryokusumo
- Department of Hyperbaric, Pembangunan Nasional University, Jakarta, Indonesia
| | - I Ketut Sudiana
- Department of Pathology Anatomy, Dr. Soetomo General Hospital, Surabaya, Indonesia
| |
Collapse
|
24
|
Joseph N, Shrigiri S. Predictors of Treatment Outcome and Clinical Profile among Guillain- Barre Syndrome Patients in South India. Rev Recent Clin Trials 2023; 18:258-268. [PMID: 37907491 DOI: 10.2174/0115748871254419231019053136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/15/2023] [Accepted: 09/06/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Guillain-Barre syndrome (GBS) is one of the principal causes of acute neuromuscular weakness and paralysis worldwide. Its clinic-epidemiological profile and factors influencing its treatment outcomes in developing countries are very minimally studied. OBJECTIVE The study aimed to find out the risk factors, clinical presentation, management, and predictors of treatment outcomes among GBS patients admitted in two tertiary care hospitals. MATERIALS AND METHODS Medical records of 121 inpatients with GBS confirmed based on the Brighton criteria over the recent five-year period from June 2017 to May 2022 were examined. Assessment of the severity of GBS was done using the Hughes functional grading scale. RESULTS The mean age at onset was 36.8 ± 18.9 years. The majority of the patients [82 (67.8%)] were males. Antecedent illnesses within 1 month of onset of GBS were present among 34 (28.1%) patients. The majority of them developed respiratory tract illnesses [13 (38.2%)]. Recurrent history of GBS was observed among 4 (3.3%) patients. The median time gap between the onset of antecedent illnesses and the onset of GBS was 5 days (IQR 3, 10). The most common symptom among GBS patients was the weakness of the muscles of the extremities [117 (96.7%)]. The pattern of progression of weakness among 53 (45.3%) of these patients was from the lower to upper limbs. The most common sign noted was hypotonia [64(52.9%)]. Complications due to GBS were observed among 12 (9.9%) patients. The most common complication among them was respiratory distress in 11 (91.7%) patients, followed by autonomic dysfunctions in 8 (66.7%). Albuminocytological dissociation in cerebrospinal fluid was noted among 48 (39.7%) patients. The majority of patients in nerve conduction studies had acute inflammatory demyelinating polyneuropathy [61(50.4%)]. The majority of the GBS patients [68 (56.2%)] were treated using intravenous immunoglobulin (IVIG). 95 (78.5%) patients improved with treatment at the time of discharge. In multivariable analysis, the absence of antecedent illnesses (p =0.029), Brighton's diagnostic certainty levels 1 and 2 of GBS (p =0.024), and being on IVIG treatment (p =0.05) were associated with improvement in disease condition among the patients. CONCLUSION Appropriate diagnosis of GBS using both clinical and laboratory evidence and providing appropriate treatment along with more supervision among GBS patients with a history of antecedent illnesses will help improve their prognosis at the time of discharge.
Collapse
Affiliation(s)
- Nitin Joseph
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Soumya Shrigiri
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| |
Collapse
|
25
|
Güzin Y, Yılmaz U, Pekuz S, Karaoğlu P, Parlak İbiş İB, Kırkgöz HH, Yavuz M, Ünalp A. Retrospective evaluation of Guillain-Barre syndrome in children: A single-center experience. Pediatr Int 2023; 65:e15650. [PMID: 37817404 DOI: 10.1111/ped.15650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/27/2023] [Accepted: 07/12/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Although Guillain-Barré syndrome (GBS) is now the most common cause of acute flaccid paralysis in children, information on the long-term follow-up of GBS is still limited. Identification of prognostic factors can play an important role in treatment strategies and the follow-up of patients. This study aimed to evaluate the effectiveness of monitoring the GBS disability score (DS) in predicting morbidity and mortality. METHODS The patients were separated into two groups those with DS≥ or <3 on admission. These groups were compared in respect of demographic data, clinical and laboratory findings, and the DS recorded on admission and at first, third, sixth, 12th, and 24th months. RESULTS The study included 44 patients (54.5% male, 45.5% female) with a median age of 5 years. The most common involvements during the disease were weakness, ataxia, neuropathic pain, cranial neuropathy, respiratory distress, autonomic dysfunction, and psychiatric symptoms, respectively. In patients with a DS of ≥3, the time from onset of symptoms to hospital admission was shorter, and the length of hospital stay was longer. Children with back pain and autonomic dysfunction had a DS of ≥3. A high 3-month DS was found to be a significant predictor for the development of sequelae. CONCLUSIONS Although progressive muscle weakness and inability to walk are the most common symptoms of GBS, it should be kept in mind that atypical manifestations such as hemiplegia and ophthalmoplegia may also occur. For an objective assessment of clinical improvement during follow-up, the DS for motor functions can be used.
Collapse
Affiliation(s)
- Yiğithan Güzin
- Department of Pediatric Neurology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Unsal Yılmaz
- Department of Pediatric Neurology, Dr Behcet Uz Child Disease and Surgery Training and Research HospitalI, Izmir, Turkey
| | - Serdar Pekuz
- Department of Pediatric Neurology, Dr Behcet Uz Child Disease and Surgery Training and Research HospitalI, Izmir, Turkey
| | - Pakize Karaoğlu
- Department of Pediatric Neurology, Dr Behcet Uz Child Disease and Surgery Training and Research HospitalI, Izmir, Turkey
| | - İpek Burcu Parlak İbiş
- Department of Pediatric Neurology, Dr Behcet Uz Child Disease and Surgery Training and Research HospitalI, Izmir, Turkey
| | - Hatice Hilal Kırkgöz
- Department of Pediatric Neurology, Dr Behcet Uz Child Disease and Surgery Training and Research HospitalI, Izmir, Turkey
| | - Merve Yavuz
- Department of Pediatric Neurology, Dr Behcet Uz Child Disease and Surgery Training and Research HospitalI, Izmir, Turkey
| | - Aycan Ünalp
- Department of Pediatric Neurology, Dr Behcet Uz Child Disease and Surgery Training and Research HospitalI, Izmir, Turkey
| |
Collapse
|
26
|
López-Hernández JC, Vargas-Cañas ES, Estrada SA, Galnares-Olalde J. Guillain-Barre syndrome before and during the COVID-19 pandemic in a referral center of Mexico. GAC MED MEX 2023; 159:315-321. [PMID: 37699231 DOI: 10.24875/gmm.m23000787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/06/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, an increase in the number of Guillain-Barre syndrome (GBS) cases has been reported. OBJECTIVE To describe the clinical characteristics and prognosis of patients with GBS before and during the COVID-19 pandemic. MATERIAL AND METHODS Prospective cohort of GBS patients divided in two subgroups: before (2018-2019) and during (2020-2021) the COVID-19 pandemic. Clinical and paraclinical characteristics, as well as deaths, were recorded. A good prognosis was defined as independent ambulation recovery at three months. RESULTS Two-hundred and one patients were included (123 during and 78 before the pandemic), out of whom 69% were males; age was 45 ± 16 years, and there was 2.5% of in-hospital deaths. During the pandemic, a higher frequency of the demyelinating variant (50%), bulbar cranial nerves involvement (44% vs. 28%), prior history of vaccination (16% vs. 0%), and a lower MRC score (30 ± 16.7 vs. 34.3 ± 17.7) were documented. An increase in the number of cases was observed from July to September (38 vs. 13). There were no significant differences in independent ambulation recovery or in the number of deaths. CONCLUSIONS During the COVID-19 pandemic, a higher number of GBS cases were treated, out of which 16% were associated with the SARS-CoV-2 vaccine; patients treated during the pandemic did not have a worse prognosis.
Collapse
Affiliation(s)
| | | | - S Alexander Estrada
- Neurology Department. Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Javier Galnares-Olalde
- Neurology Department. Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| |
Collapse
|
27
|
Lee H, Heo N, Kwon D, Ha J. Deciphering changes in the incidence of the Guillain-Barré syndrome during the COVID-19 pandemic: a nationwide time-series correlation study. BMJ Neurol Open 2022; 4:e000378. [PMID: 36618976 PMCID: PMC9808757 DOI: 10.1136/bmjno-2022-000378] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022] Open
Abstract
Background Postinfectious autoimmunity is a hallmark of Guillain-Barré syndrome (GBS), and GBS incidence closely parallels that of its immune triggers. Sociobehavioural interventions implemented during the COVID-19 pandemic have altered the infectious disease landscape. Methods This nationwide time-series correlation study analysed GBS incidence, sentinel surveillance and SARS-CoV-2 vaccination data from January 2017 to December 2021 in the National Health Insurance Service and Korean Disease Control and Prevention Agency databases. The incidence of GBS and sentinel gastrointestinal and respiratory infectious diseases during the pandemic (2020-2021) was estimated and compared with both prepandemic (2017-2019) and incidence predicted in a time-series forecasting model. Time-series correlation analysis was used to examine the temporal association between GBS, infectious triggers and SARS-CoV-2 vaccination. Results During the pandemic, the total crude cumulative incidence rate was 2.1 per 100 000 population, which is lower than the prepandemic incidence, especially in age groups of less than 60 years. Seasonality was briefly interrupted during the winter of 2021. The majority of respiratory and some gastrointestinal conditions had a lower-than-expected incidence during the pandemic. Compared with the prepandemic state, during the pandemic period a higher number of gastrointestinal pathogens (Escherichia coli, Campylobacter spp., Clostridium perfringens, Yersinia enterocolitica and enteric adenovirus) had significant, moderate-to-strong positive temporal associations with GBS. The temporal association between SARS-CoV-2 infection and GBS was not significant, but SARS-CoV-2 vaccination exhibited a strong positive temporal association with GBS in 2021. Conclusion The incidence of GBS and sentinel infectious diseases decreased to below-expected levels during the pandemic, with the former attributable to the decreased incidence of non-COVID-19 respiratory and gastrointestinal infections. The evolving incidence of autoimmune postinfectious phenomena following the pandemic needs attention.
Collapse
Affiliation(s)
- Hyunju Lee
- Division of Public Health Emergency Response Research, Korea Disease Control and Prevention Agency, Cheongju, Chungcheongbuk-do, Korea
| | - Namwoo Heo
- Division of Infectious Diseases, Department of Internal Medicine, Yongin Severance Hospital, Yongin, Gyeonggi-do, Korea
| | - Donghyok Kwon
- Division of Public Health Emergency Response Research, Korea Disease Control and Prevention Agency, Cheongju, Chungcheongbuk-do, Korea
| | - Jongmok Ha
- Infectious Disease Control Center, Gyeonggi Provincial Government, Suwon, Gyeonggi-do, Korea,Department of Neurology, Yeoncheon-gun Health Medical center, Yeoncheon-gun, Gyeonggi-do, Korea
| |
Collapse
|
28
|
Khan Z, Ahmad U, Ualiyeva D, Amissah OB, Khan A, Noor Z, Zaman N. Guillain-Barre syndrome: An autoimmune disorder post-COVID-19 vaccination? Clin Immunol Commun 2022; 2:1-5. [PMID: 38620684 PMCID: PMC8697478 DOI: 10.1016/j.clicom.2021.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 05/09/2023]
Abstract
SARS-CoV-2 causes Coronavirus Disease 2019 (COVID-19), an infectious condition that can present none or one or more of these symptoms: fever, cough, headache, sore throat, loss of taste and smell, aches, fatigue and musculoskeletal pain. For the prevention of COVID-19, there are vaccines available including those developed by Pfizer, Moderna, Sinovac, Janssen, and AstraZeneca. Recent evidence has shown that some COVID-19-vaccinated individuals can occasionally develop as a potential side effect Guillain-Barre syndrome (GBS), a severe neurological autoimmune condition in which the immune response against the peripheral nerve system (PNS) can result in significant morbidity. GBS had been linked previously to several viral or bacterial infections, and the finding of GBS after vaccination with certain COVID-19, while rare, should alert medical practitioners for an early diagnosis and targeted treatment. Here we review five cases of GBS that developed in different countries after COVID-19 vaccination.
Collapse
Affiliation(s)
- Zafran Khan
- State Key Laboratory of Respiratory Disease, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, 510530 China
- University of Chinese Academy of Sciences, Beijing 100049, China
- Center for Biotechnology and Microbiology, University of Swat, Pakistan
| | - Ubaid Ahmad
- Center for Biotechnology and Microbiology, University of Swat, Pakistan
| | - Daniya Ualiyeva
- University of Chinese Academy of Sciences, Beijing 100049, China
- Department of Herpetology, Chengdu Institute of Biology, Chinese Academy of Sciences, Chengdu 610041, China
- Faculty of Biology and Biotechnology, Al-Farabi Kazakh National University, Almaty 050040, Kazakhstan
| | | | - Asaf Khan
- Ministry of Education, Key Laboratory of Cell Activities and Stress Adaptations, School of life sciences, Lanzhou University, 730000 Gansu, China
| | - Zohaib Noor
- CAS Key Laboratory of Tropical Marine Bio-Resources and Ecology, Guangdong, China
- Key Laboratory of Applied Marine Biology, South China Sea Institute of Oceanology, Chinese Academy of Sciences, Guangzhou, China
| | - Nasib Zaman
- Center for Biotechnology and Microbiology, University of Swat, Pakistan
| |
Collapse
|
29
|
Shah SMI, Yasmin F, Memon RS, Jatoi NN, Savul IS, Kazmi S, Monawwer SA, Zafar MDB, Asghar MS, Tahir MJ, Lee KY. COVID-19 and myasthenia gravis: A review of neurological implications of the SARS-COV-2. Brain Behav 2022; 12:e2789. [PMID: 36306401 PMCID: PMC9759145 DOI: 10.1002/brb3.2789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/10/2022] [Accepted: 09/24/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION This review highlights the potential mechanisms of neuromuscular manifestation of COVID-19, especially myasthenia gravis (MG). METHODS An extensive literature search was conducted by two independent investigators using PubMed/MEDLINE and Google Scholar from its inception to December 2020. RESULTS Exacerbations of clinical symptoms in patients of MG who were treated with some commonly used COVID-19 drugs has been reported, with updated recommendations of management of symptoms of neuromuscular disorders. Severe acute respiratory syndrome coronavirus 2 can induce the immune response to trigger autoimmune neurological disorders. CONCLUSIONS Further clinical studies are warranted to indicate and rather confirm if MG in the setting of COVID-19 can pre-existent subclinically or develop as a new-onset disease.
Collapse
Affiliation(s)
| | - Farah Yasmin
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Roha Saeed Memon
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Nadia Nazir Jatoi
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Ilma Saleh Savul
- Department of Internal Medicine, St. Joseph Medical Center, Houston, Texas, USA
| | - Sana Kazmi
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Muhammad Daim Bin Zafar
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | | | - Ka Yiu Lee
- Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| |
Collapse
|
30
|
Tabatabaee S, Rezania F, Alwedaie SMJ, Malekdar E, Badi Z, Tabatabaei SM, Mirzaasgari Z. Post COVID-19 vaccination Guillain-Barre syndrome: three cases. Hum Vaccin Immunother 2022; 18:2045153. [PMID: 35240922 PMCID: PMC9196795 DOI: 10.1080/21645515.2022.2045153] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Guillain-Barré syndrome (GBS) is an acute inflammatory polyradiculoneuropathy. In two-thirds of patients, it is preceded by an upper respiratory or gastrointestinal tract infection. Temporally associated cases of GBS following COVID-19 vaccination have been described with different COVID-19 vaccines. In this study, we report three cases of GBS patients following COVID-19 vaccine. Two of the studied patients received the Sinopharm vaccine and one patient received the AstraZeneca vaccine. All patients were diagnosed with acute motor axonal neuropathy (AMAN) type of GBS, on nerve conduction studies. All three patients responded well to treatment with intravenous immunoglobulin (IVIg). The association between COVID-19 vaccination and GBS is not well understood and more studies are needed to establish whether it is merely an association or a causal relationship.
Collapse
Affiliation(s)
- Seyedehnarges Tabatabaee
- Department of Neurology, Firoozgar Hospital, School of Medicine, Iran university of medical sciences, Tehran, Iran
| | - Fatemeh Rezania
- Neurosciences Department, St Vincents Hospital, Melbourne, Australia
| | | | | | - Zahra Badi
- Department of Neurology, Erfan Hospital, Tehran, Iran
| | | | - Zahra Mirzaasgari
- Department of Neurology, Firoozgar Hospital, School of Medicine, Iran university of medical sciences, Tehran, Iran.,Shafa Neuroscience Research Center, Khatam Alanbia Hospital, Tehran, Iran
| |
Collapse
|
31
|
Gunawan PY, Tiffani P, Lalisang L. Guillain-Barre Syndrome Following SARS-CoV-2 Vaccination: A Case Report. Clin Psychopharmacol Neurosci 2022; 20:777-780. [PMID: 36263653 PMCID: PMC9606431 DOI: 10.9758/cpn.2022.20.4.777] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/02/2022] [Indexed: 12/23/2022]
Abstract
After more than a year of Coronavirus disease 2019 pandemic, in 2021 Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) vaccination have been made possible and vaccine was distributed globally. Since then, there have been reports of symptoms following SARS-CoV-2 vaccination, including neurological symptoms of ascending paralysis known as Guillain-Barre syndrome. In this report, we describe the first case of Guillain-Barre syndrome following vaccination in Indonesia. Symptoms of ascending paralysis were of late onset after the first dose, however, were full blown after receiving the second dose followed by left-sided facial paralysis.
Collapse
Affiliation(s)
- Pricilla Yani Gunawan
- Department of Neurology, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia,Department of Neurology, Siloam Hospital Lippo Village, Tangerang, Indonesia,Address for correspondence: Pricilla Yani Gunawan Department of Neurology, Faculty of Medicine, Universitas Pelita Harapan, Jl. Jend. Sudirman No.20, Tangerang 15810, Indonesia, E-mail: , ORCID: https://orcid.org/0000-0002-5620-3267
| | - Pamela Tiffani
- Department of Neurology, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Lilie Lalisang
- Department of Neurology, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia,Department of Neurology, Siloam Hospital Lippo Village, Tangerang, Indonesia
| |
Collapse
|
32
|
Gupta A, Ranga A, Prakash NB, Khanna M. Rehabilitation outcomes in patients with post-COVID-19 vaccine-associated Guillain-Barre syndrome. J Neurosci Rural Pract 2022; 13:684-690. [PMID: 36743741 PMCID: PMC9893936 DOI: 10.25259/jnrp-2022-6-26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/20/2022] [Indexed: 12/05/2022] Open
Abstract
Objective With COVID-19 vaccination campaign worldwide, associated Guillain-Barre syndrome (GBS) is being increasingly reported from different countries. The objectives of the study were to observe the clinical profile and rehabilitation outcomes in patients with post-COVID-19 vaccine-associated GBS. Material and Method This prospective study was conducted in neurological rehabilitation unit with in-patients. A detailed customized rehabilitation program was formulated based on the clinical status and associated complications. Outcome measures were documented on the day of admission and at discharge and compared. Results The study included 16 patients (eight males) of which 15 (93.75%) received the CoviShield (AstraZeneca) and 1 Covaxin (Bharat Biotech) vaccine. The median (IQR) duration of first symptom was 9 (18.25) days and for motor symptoms 18 (12.75) days. Functional improvement was observed in patients using Barthel index scores and Hughes disability scores and overall neuropathy limitation scale. All rehabilitation outcomes showed a statistically significant improvement (P < 0.05) from the time of admission to discharge. At discharge, complete independence in activities of daily living was achieved in 4 (25%) patients and 5 (31.25%) were minimally dependent. Three (18.75%) patients were walking independently, seven (43.75%) with minimal support, and four with walker (25%). Nine (56.25%) patients needed bilateral ankle-foot orthosis and two bilateral knee gaiters for locomotion. Conclusion Comprehensive inpatient rehabilitation interventions in patients with post-COVID-19 vaccine-associated GBS result in significant functional recovery.
Collapse
Affiliation(s)
- Anupam Gupta
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Anurag Ranga
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Naveen B Prakash
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Meeka Khanna
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| |
Collapse
|
33
|
Finsterer J. Comment on: Neurological Manifestations Associated With SARS-CoV-2 in Children: A Case Series. J Cent Nerv Syst Dis 2022; 14:11795735221123915. [PMID: 36118140 PMCID: PMC9478691 DOI: 10.1177/11795735221123915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/17/2022] [Indexed: 11/23/2022] Open
|
34
|
Khan E, Jindal H, Mishra P, Suvvari TK, Jonna S. The 2021 Zika outbreak in Uttar Pradesh state of India: Tackling the emerging public health threat. Trop Doct 2022; 52:474-478. [PMID: 35818774 DOI: 10.1177/00494755221113285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Zika virus is an RNA virus belonging to the Flavivirus family that is chiefly transmitted by the female Aedes mosquito. The Zika virus first infected humans in Uganda and Tanzania in 1952. Since, it has spread to several parts of the world causing outbreaks of variable extent. In India, these outbreaks have been reported from Gujarat, Tamil Nadu, Madhya Pradesh, Rajasthan, Kerala, and Maharashtra. The most recent outbreak is from the most populous state of India, Uttar Pradesh, where the climate is conducive to the breeding and transmission of other arboviral infections such as Dengue, Chikungunya, and Malaria. These infections also happen to share similar incubation periods and overlapping clinical manifestations with Zika virus (ZIKV) infection, leading to misdiagnoses or delayed diagnosis. We aim to provide an account of the outbreak, its repercussions, errors made in attempting to contain the spread of the disease, and, measures to be taken in the future.
Collapse
Affiliation(s)
- Efa Khan
- Faculty of Medicine, 30076Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, India
| | - Himanshu Jindal
- Faculty of Medicine, 30076Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, India
| | - Priya Mishra
- Faculty of Medicine, 30076Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, India
| | | | - Sadhana Jonna
- Intern Physician, King George Hospital, Vizag, India
| |
Collapse
|
35
|
Komarasamy TV, Adnan NAA, James W, Balasubramaniam VRMT. Zika Virus Neuropathogenesis: The Different Brain Cells, Host Factors and Mechanisms Involved. Front Immunol 2022; 13:773191. [PMID: 35371036 PMCID: PMC8966389 DOI: 10.3389/fimmu.2022.773191] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/21/2022] [Indexed: 12/16/2022] Open
Abstract
Zika virus (ZIKV), despite being discovered six decades earlier, became a major health concern only after an epidemic in French Polynesia and an increase in the number of microcephaly cases in Brazil. Substantial evidence has been found to support the link between ZIKV and neurological complications in infants. The virus targets various cells in the brain, including radial glial cells, neural progenitor cells (NPCs), astrocytes, microglial and glioblastoma stem cells. It affects the brain cells by exploiting different mechanisms, mainly through apoptosis and cell cycle dysregulation. The modulation of host immune response and the inflammatory process has also been demonstrated to play a critical role in ZIKV induced neurological complications. In addition to that, different ZIKV strains have exhibited specific neurotropism and unique molecular mechanisms. This review provides a comprehensive and up-to-date overview of ZIKV-induced neuroimmunopathogenesis by dissecting its main target cells in the brain, and the underlying cellular and molecular mechanisms. We highlighted the roles of the different ZIKV host factors and how they exploit specific host factors through various mechanisms. Overall, it covers key components for understanding the crosstalk between ZIKV and the brain.
Collapse
Affiliation(s)
- Thamil Vaani Komarasamy
- Infection and Immunity Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Nur Amelia Azreen Adnan
- Infection and Immunity Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - William James
- Sir William Dunn School of Pathology, University of Oxford, Oxford, United Kingdom
| | - Vinod R M T Balasubramaniam
- Infection and Immunity Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| |
Collapse
|
36
|
Lahoz Fernandez PE, Miranda Pereira J, Fonseca Risso I, Baleeiro Rodrigues Silva P, Freitas Barboza IC, Vieira Silveira CG, Diogo Silva G, Marzorati Kuntz Puglia P, Genaro Mutarelli E. Guillain-Barre syndrome following COVID-19 vaccines: A scoping review. Acta Neurol Scand 2022; 145:393-398. [PMID: 34967005 DOI: 10.1111/ane.13575] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/30/2021] [Accepted: 12/07/2021] [Indexed: 11/28/2022]
Abstract
Guillain-Barre syndrome following COVID-19 vaccines (GBSfCV19v) is a reported adverse effect that remains unclear. We present a structured review based on two case reports of GBSfCV19v, a systematic review, and Vaccine Adverse Event Reporting System (VAERS) analysis to estimate the risk and describe the clinical characteristics (CC) of these events. We've searched on MEDLINE and Embase, from the inception to May 20, 2021, using the keywords: "Guillain barre syndrome" and cross-referenced with "covid-19 vaccines." We estimated the risk of GBSfCV19v, comparing it with the risk of GBS following the influenza vaccine (GBSfIv), considering the VAERS sensitivity. The clinical characteristics included: age, sex, comorbidities, type of vaccine, administered dose, clinical onset, deaths, cerebrospinal fluid (CSF), and electromyography (EMG) pattern. We found 43 cases, considering the risk of GBSfCV19v lower than GBSfIv (160-320 cases). The patients had a mean age of 54 years and 23 (56%) were male. The types of vaccines used: Pfizer (22), Moderna (9), AstraZeneca (3), Janssen (3), and Johnson & Johnson (1). 24 cases of GBS occurred after the first dose, with clinical onset of 7 days. CSF albuminocytological dissociation was reported in 7 patients, and EMG revealed a predominant demyelinating pattern. GBSfCV19v risk appears to be lower than what was expected from other respiratory virus vaccines. Most cases of GBS were middle-aged males within a week following the first dose of the COVID-19 vaccine, showing a typical demyelinating neuropathy with albuminocytological dissociation.
Collapse
Affiliation(s)
| | | | | | | | - Ingrid Caroline Freitas Barboza
- Department of Neurology Syrian Lebanese Hospital São Paulo Brazil
- Department of Neurology Federal University of São Paulo São Paulo Brazil
| | - Coralia Gabrielle Vieira Silveira
- Department of Neurology Syrian Lebanese Hospital São Paulo Brazil
- Department of Neurology State Civil Servant Hospital of São Paulo São Paulo Brazil
| | - Guilherme Diogo Silva
- Department of Neurology Syrian Lebanese Hospital São Paulo Brazil
- Department of Neurology University of São Paulo São Paulo Brazil
| | - Paula Marzorati Kuntz Puglia
- Department of Neurology Syrian Lebanese Hospital São Paulo Brazil
- Department of Neurology Federal University of São Paulo São Paulo Brazil
| | - Eduardo Genaro Mutarelli
- Department of Neurology Syrian Lebanese Hospital São Paulo Brazil
- Department of Neurology University of São Paulo São Paulo Brazil
| |
Collapse
|
37
|
Pari H, Amalnath SD, Dhodapkar R. Guillain-Barre Syndrome and Antibodies to Arboviruses (Dengue, Chikungunya and Japanese Encephalitis): A Prospective Study of 95 Patients Form a Tertiary Care Centre in Southern India. Ann Indian Acad Neurol 2022; 25:203-206. [PMID: 35693657 PMCID: PMC9175438 DOI: 10.4103/aian.aian_589_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/06/2021] [Indexed: 11/04/2022] Open
Abstract
Objective The aim of this study was to detect the presence of IgM antibodies against dengue (DEN), chikungunya (CHIK) and Japanese encephalitis (JE) in the serum and CSF of patients with Guillaine-Barre syndrome (GBS). Methods GBS patients (>12 years of age) were included after informed consent. Data on history, clinical manifestations, treatment details, and outcome were collected. Serum and CSF were tested for IgM antibodies against DEN, CHIK, and JE. Results From April 2018 to December 2019, 95 patients were included in this study. Anti-arboviral IgM antibodies were detected in 30 patients (31.5%) (CSF 11, serum 13, both CSF and serum 6). Serum IgM antibody was present in 19 patients (JE 8, DEN 5, CHIK 2, more than 1 virus 4). Of the 66 patients who underwent CSF studies, antibodies were present in 17 (CHIK 14, DEN 1, more than 1 virus 2). Antibody positivity did not affect the outcome of GBS. Conclusion One-third of the GBS patients had evidence of recent infection by arboviruses. This suggests that DEN, CHIK, and JE could be the inciting event for GBS in endemic regions.
Collapse
Affiliation(s)
- Hariswar Pari
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - S. Deepak Amalnath
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Rahul Dhodapkar
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| |
Collapse
|
38
|
Bonifacio GB, Patel D, Cook S, Purcaru E, Couzins M, Domjan J, Ryan S, Alareed A, Tuohy O, Slaght S, Furby J, Allen D, Katifi HA, Kinton L. Bilateral facial weakness with paraesthesia variant of Guillain-Barré syndrome following Vaxzevria COVID-19 vaccine. J Neurol Neurosurg Psychiatry 2022; 93:341-342. [PMID: 34261746 DOI: 10.1136/jnnp-2021-327027] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/28/2021] [Indexed: 11/03/2022]
Affiliation(s)
| | - Dharmini Patel
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sarah Cook
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Elena Purcaru
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Department of Neurology, Poole Hospital, Poole, UK
| | - Michael Couzins
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Department of Neurology, Queen Alexandra Hospital, Portsmouth, UK
| | - Janine Domjan
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Department of Neurology, Queen Alexandra Hospital, Portsmouth, UK
| | - Suzanne Ryan
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ahmad Alareed
- Department of Neurology, Queen Alexandra Hospital, Portsmouth, UK
| | - Orla Tuohy
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Department of Neurology, Queen Alexandra Hospital, Portsmouth, UK
| | - Sean Slaght
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Department of Neurology, Queen Alexandra Hospital, Portsmouth, UK
| | - Julian Furby
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Department of Neurology, Isle of Wight NHS Trust, Newport, UK
| | - David Allen
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Haider A Katifi
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Lucy Kinton
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| |
Collapse
|
39
|
Carpentier VT, Le Guennec L, Fall SAA, Viala K, Demeret S, Weiss N. [Pathophysiological and diagnostic aspects of Guillain-Barré syndrome]. Rev Med Interne 2022:S0248-8663(21)01146-2. [PMID: 34998626 DOI: 10.1016/j.revmed.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/23/2021] [Indexed: 11/22/2022]
Abstract
Guillain-Barré syndrome (GBS) is the most common cause of acute neuropathy. It usually onset with a rapidly progressive ascending bilateral weakness with sensory disturbances, and patients may require intensive treatment and close monitoring as about 30% have a respiratory muscle weakness and about 10% have autonomic dysfunction. The diagnosis of GBS is based on clinical history and examination. Complementary examinations are performed to rule out a differential diagnosis and to secondarily confirm the diagnosis. GBS is usually preceded by an infectious event in ≈ 2/3 of cases. Infection leads to an immune response directed against carbohydrate antigens located on the infectious agent and the formation of anti-ganglioside antibodies. By molecular mimicry, these antibodies can target structurally similar carbohydrates found on host's nerves. Their binding results in nerve conduction failure or/and demyelination which can lead to axonal loss. Some anti-ganglioside antibodies are associated with particular variants of GBS: the Miller-Fisher syndrome, facial diplegia and paresthesias, the pharyngo-cervico-brachial variant, the paraparetic variant, and the Bickerstaff brainstem encephalitis. Their semiological differences might be explained by a distinct expression of gangliosides among nerves. The aim of this review is to present pathophysiological aspects and the diagnostic approach of GBS and its variants.
Collapse
|
40
|
Chauhan L, Matthews E, Piquet AL, Henao-Martinez A, Franco-Paredes C, Tyler KL, Beckham D, Pastula DM. Nervous System Manifestations of Arboviral Infections. Curr Trop Med Rep 2022; 9:107-18. [PMID: 36124288 DOI: 10.1007/s40475-022-00262-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 01/11/2023]
Abstract
Purpose of Review Complex environmental factors and human intervention influence the spread of arthropod vectors and the cycle of transmission of arboviruses. The spectrum of clinical manifestations is diverse, ranging from serious presentations like viral hemorrhagic fever (e.g., dengue, yellow fever, rift valley fever) or shock syndromes (e.g., dengue virus) to organ-specific illness like meningoencephalitis. Recent Findings A spectrum of clinical neurologic syndromes with potential acute devastating consequences or long-term sequelae may result from some arboviral infections. Summary In this review, we describe some of the most frequent and emerging neuro-invasive arboviral infections, spectrum of neurologic disorders including encephalitis, meningitis, myelitis or poliomyelitis, acute demyelinating encephalomyelitis, Guillain-Barré syndrome, and ocular syndromes.
Collapse
|
41
|
KHOSROSHAHI N, HABIBI ZOHAM M, KHAYATZADEH KAKHKI S. Guillain-Barre Syndrome Deterioration After an Abdominal Surgery. Iran J Child Neurol 2022; 16:155-159. [PMID: 35497102 PMCID: PMC9047845 DOI: 10.22037/ijcn.v15i3.30815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 11/18/2020] [Indexed: 11/18/2022]
Abstract
Guillain-Barre syndrome (GBS) is an acute ascending paralysis accompanied by autonomic symptoms like abdominal pain. Here, we presented a 13-year-old boy suffering from lower extremities pain and sensory disturbances with a presumptive diagnosis of GBS who experienced severe disease progression after receiving general anesthesia due to an appendectomy. Whether the progression was due to the natural history of GBS, immunosuppression induced by surgical stress, or usage of anesthetic medications remained unclear.
Collapse
Affiliation(s)
- Nahid KHOSROSHAHI
- Division of Pediatric Neurology, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojdeh HABIBI ZOHAM
- Division of Pediatric Intensive Care Unit, Tehran University of Medical Sciences, Tehran, Iran
| | - Simin KHAYATZADEH KAKHKI
- Division of Pediatric Neurology, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
42
|
Malamud E, Otallah SI, Caress JB, Lapid DJ. Guillain-Barré Syndrome After COVID-19 Vaccination in an Adolescent. Pediatr Neurol 2022; 126:9-10. [PMID: 34717201 PMCID: PMC8498800 DOI: 10.1016/j.pediatrneurol.2021.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/29/2021] [Accepted: 10/04/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Emily Malamud
- Division of Pediatric Neurology, Department of Neurology, Wake Forest University/Brenner Children's Hospital, Winston-Salem, North Carolina.
| | - Scott I. Otallah
- Division of Pediatric Neurology, Department of Neurology, Wake Forest University/Brenner Children's Hospital, Winston-Salem, North Carolina
| | - James B. Caress
- Division of Neuromuscular Disease, Department of Neurology, Wake Forest University, Winston-Salem, North Carolina
| | - Daniel J. Lapid
- Division of Pediatric Neurology, Department of Neurology, Wake Forest University/Brenner Children's Hospital, Winston-Salem, North Carolina
| |
Collapse
|
43
|
Boender TS, Bartmeyer B, Coole L, Wichmann O, Harder T. Risk of Guillain-Barré syndrome after vaccination against human papillomavirus: a systematic review and meta-analysis, 1 January 2000 to 4 April 2020. Euro Surveill 2022; 27:2001619. [PMID: 35086611 PMCID: PMC8796292 DOI: 10.2807/1560-7917.es.2022.27.4.2001619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 02/01/2021] [Indexed: 12/15/2022] Open
Abstract
BackgroundGuillain-Barré syndrome (GBS) is a rare autoimmune disease that can follow viral infections and has in a few cases been linked to vaccinations. Pre-licensure clinical trials did not observe an association between human papillomavirus (HPV) vaccination and GBS, a post-marketing study from 2017 reported an increased relative risk.AimWe assessed the risk of GBS after HPV vaccination through a systematic literature review and meta-analysis.MethodsWe searched Embase, MEDLINE and Cochrane for studies reporting on the risk of GBS after HPV vaccination in individuals aged ≥ 9 years, published between 1 January 2000 and 4 April 2020, excluding studies without a comparator group. Seven studies reporting relative effect sizes were pooled using random-effects meta-analysis. We assessed quality of evidence using the GRADE approach. Study protocol was registered (PROSPERO No. #CRD42019123533).ResultsOf 602 identified records, we included 25 studies. Based on over 10 million reports, cases of GBS were rare. In 22 studies no increased risk was observed, while in three studies a signal of increased risk of GBS after HPV vaccination was identified. Meta-analysis yielded a pooled random-effects ratio of 1.21 (95% CI: 0.60-2.43); I2 = 72% (95% CI: 36-88). This translates to a number needed to harm of one million to be vaccinated to generate one GBS case. Quality of evidence was very low.ConclusionsThe absolute and relative risk of GBS after HPV vaccination is very low and lacks statistical significance. This is reassuring for the already implemented vaccination programmes and should be used in respective communication activities.
Collapse
Affiliation(s)
- T Sonia Boender
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
- Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Barbara Bartmeyer
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Louise Coole
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- Field Service, UK Health Security Agency, Leeds, United Kingdom
| | - Ole Wichmann
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Thomas Harder
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| |
Collapse
|
44
|
Mosora O, Barcutean L, Balasa R, Fodor R, Maier S, Bajko Z, Stoian A, Motataianu A. Severe Acute Motor Axonal Neuropathy associated with Influenza-A (H1N1) Infection and Prolonged Respiratory Failure - A Case Report. J Crit Care Med (Targu Mures) 2021; 7:302-7. [PMID: 34934821 DOI: 10.2478/jccm-2021-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 07/29/2021] [Indexed: 11/20/2022] Open
Abstract
Acute Motor Axonal Neuropathy (AMAN) is an immune-mediated disorder of the peripheral nervous system, part of the spectrum of the Guillain-Barre syndrome (GBS). An infectious event most often triggers it reported a few weeks before the onset. The reported case is of a 56 years-old woman who developed acute motor axonal neuropathy three weeks after respiratory infection with influenza A virus subtype H1N1. Despite early treatment with plasmapheresis and intravenous immunoglobulins, the patient remained tetraplegic, mechanically ventilated for five months, with repetitive unsuccessful weaning trails. The probable cause was considered to be phrenic nerve palsy in the context of acute motor axonal neuropathy. This case highlights that acute motor axonal neuropathy is a severe and life-threatening form of Guillain-Barre syndrome associated with significant mortality and morbidity. Neurological and physical recovery strongly depend on the inter-professional effort in an intensive care unit and neurology professionals.
Collapse
|
45
|
Finsterer J, Scorza FA, Scorza CA. Neuro-COVID due to response against the virus. Neurol Neurochir Pol 2021; 56:103-104. [PMID: 34939661 DOI: 10.5603/pjnns.a2021.0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/02/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Josef Finsterer
- Klinik Landstrasse, Messerli Institute, Vienna, Austria. .,Disciplina de Neurociência. Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM). São Paulo, Brazilil.
| | - Fulvio A Scorza
- Disciplina de Neurociência. Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM). São Paulo, Brazilil
| | - Carla A Scorza
- Disciplina de Neurociência. Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM). São Paulo, Brazilil
| |
Collapse
|
46
|
Zhu J, Zhang Y, Li R, Lin Y, Fu Y, Yan Y, Zhu W, Wang N, Zhang Z, Xu G. Anti-ganglioside Antibodies in Guillain-Barre Syndrome: A Novel Immunoblotting-Panel Assay. Front Neurol 2021; 12:760889. [PMID: 34899578 PMCID: PMC8654804 DOI: 10.3389/fneur.2021.760889] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: This study aimed to determine the diagnostic efficiency of a novel immunoblotting detection assay for anti-ganglioside antibodies (AGAs) in the Guillain–Barre syndrome (GBS). Method: Serum immunoglobulin (IgG and IgM) of AGAs were measured in 121 participants from a registered cohort study of immune-mediated neuropathies and 29 healthy controls by immunoblotting panel assay. Sensitivity, specificity, and positive predictive value (PPV) of the assay were compared to calculate the diagnostic accuracy. Result: In our cohort, any of the AGAs were positive in 42.4% of the GBS patients. The sensitivity and specificity of AGAs (both IgG and IgM) in the diagnosis of GSB were 42 and 76% while for IgG-AGAs were 35 and 87%. AGAs positivity had a significant association with the AMAN subtype (P = 0.0004), and the sensitivity, specificity of AGAs in AMAN were 86, 69%, respectively with high (AUC = 0.78, p = 0.002) discriminative powers. GM1-IgG AGA was more common and specific to AMAN patients than other GBS forms (p = 0.008). Conclusion: Our novel immunoblotting detection assay could complement GBS diagnosis. IgG-AGAs were more likely to be detected in GBS, and GM1-IgG AGA could assist AMAN diagnosis.
Collapse
Affiliation(s)
- Jiting Zhu
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yuanyuan Zhang
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Runyun Li
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yi Lin
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Ying Fu
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yaping Yan
- National Engineering Laboratory for Resource Development of Endangered Crude Drugs in Northwest of China, College of Life Sciences, Shaanxi Normal University, Xi'an, China
| | - Wenli Zhu
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Ning Wang
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zaiqiang Zhang
- Department of Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guorong Xu
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| |
Collapse
|
47
|
Cheng K, Wang Y, Zhou Y, Xia R, Tang L, Liu J. Neurological Adverse Events Induced by Immune Checkpoint Inhibitors in Non-Small Cell Lung Cancer: Current Perspectives and New Development. Clin Med Insights Oncol 2021; 15:11795549211056261. [PMID: 34866959 PMCID: PMC8637700 DOI: 10.1177/11795549211056261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 10/10/2021] [Indexed: 02/05/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of multiple malignancies, especially in non-small cell lung cancer (NSCLC). With the extensive application of ICIs in clinical practice, clinicians have to manage their toxicities, which are often termed immune-related adverse events (irAEs). Several ICIs, such as nivolumab, pembrolizumab, atezolizumab, and durvalumab, have been approved by the US Food and Drug Administration (FDA) to treat advanced NSCLC, accompanied by a broad spectrum of toxicity reactions. However, ICIs-associated neurological toxicities, regarding polyneuropathy, Bell palsy, encephalopathy, and myasthenia gravis, as uncommon emerging toxicities have not been well recognized, present a challenge for clinicians to improve awareness of supervision, recognition, and management before death from them. Herein, we have summarized the incidence, diagnosis, clinical manifestations, potential mechanisms, treatments, and outcomes of ICIs-related neurotoxicity and optimized the management approach for NSCLC patients. Prompt recognition and proper management are indispensable to reduce the morbidity of these patients with immune-related neurological toxicities.
Collapse
Affiliation(s)
- Ke Cheng
- Department of Abdominal Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yuqing Wang
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Yuwen Zhou
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Ruolan Xia
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Liansha Tang
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Jiyan Liu
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
48
|
Duong CH, Mueller JE, Tubert-Bitter P, Escolano S. Estimation of mid-and long-term benefits and hypothetical risk of Guillain-Barre syndrome after human papillomavirus vaccination among boys in France: A simulation study. Vaccine 2021:S0264-410X(21)01502-4. [PMID: 34865876 DOI: 10.1016/j.vaccine.2021.11.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The burden of human papillomavirus (HPV) infection can be substantially reduced through vaccination of girls, and gender-neutral policies are being adopted in many countries to accelerate disease control among women and expand direct benefits to men. Clinical direct benefit of boys HPV vaccination has been established for ano-genital warts and anal cancer. HPV vaccines are considered safe, but an association with Guillain-Barre syndrome has been found in French reimbursement and hospital discharge data. METHODS We conducted a Monte-Carlo simulation assuming a stable French population of 11- to 14-year-old boys, adult men and men having sex with men. We modelled and quantified the mid-term benefits as the annually prevented ano-genital warts among the 8.72 M men aged 15-35 years and the long-term benefits as the annually prevented anal cancer cases among the 17.4 M men aged 25-65 years. We also estimated the number of Guillain-Barre syndrome cases hypothetically induced by vaccination. RESULTS With a vaccine coverage of 30%, an annual number of 9310 (95% uncertainty interval [7050-11,200]) first ano-genital warts episodes among the 8.72 M men aged 15-35 years are prevented. According to more or less optimistic hypotheses on the proportion of HPV cancers covered by the vaccine, between 15.1 [11.7-17.7] and 19.2 [15.0-22.6] cases of anal cancer among the 17.4 M men aged 25-65 years would be annually avoided. Among men having sex with men, the corresponding figures were 1907 (1944-2291) for ano-genital warts and between 2.0 [0.23-4.5] and 2.6 [0.29-5.7] for anal cancer. Among 11- to 14-year-old boys, 0.82 (0.15-2.3) Guillain-Barre syndrome cases would be induced annually. INTERPRETATION A long-term program of HPV vaccination among boys in France would avoid substantially more cancer cases than hypothetically induce Guillain-Barre syndrome cases, in the general and specifically the homosexual population. Additional benefits may arise with the possible vaccine protection against oro-laryngeal and -pharyngeal cancer.
Collapse
|
49
|
Law D, Morgan M. Listening to patients in intensive care. Pract Neurol 2021; 22:96-97. [PMID: 34845099 DOI: 10.1136/practneurol-2021-003255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Daniel Law
- Adult Critical Care, University Hospital of Wales, Cardiff, UK
| | - Matthew Morgan
- Adult Critical Care, University Hospital of Wales, Cardiff, UK
| |
Collapse
|
50
|
Abstract
The emergence of the coronavirus 2019 (COVID-19) pandemic has presented an unprecedented global challenge. Vaccines against COVID have been developed to date. Covid-19 has been linked with the development of Guillain-Barre Syndrome (GBS), a rare immune-mediated demyelinating neuropathy. We report three cases of Guillain-Barre Syndrome and one case of Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), presenting to a Tasmanian hospital, and review 15 other reported cases and discuss likely immunopathology. Nearly all reported cases of post-COVID-19 vacciation inflammatory demyelinating polyneuropathy are linked to AstraZeneca vaccination and a variant with bifacial weakness is the most reported form of GBS globally.
Collapse
Affiliation(s)
- Wai M Oo
- Department of Medicine, Launceston General Hospital, Tasmania, Australia; Department of Neurology, Launceston General Hospital, Tasmania, Australia; Faculty of Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Pradeep Giri
- Department of Medicine, Launceston General Hospital, Tasmania, Australia; Department of Infectious Diseases, Launceston General Hospital, Tasmania, Australia
| | - Aaron de Souza
- Department of Neurology, Launceston General Hospital, Tasmania, Australia; Faculty of Medicine, University of Tasmania, Launceston, Tasmania, Australia
| |
Collapse
|