COVID-19-Associated Guillain-Barre Syndrome: The Early Pandemic Experience.

Guillain-Barre Syndrome (GBS) is an inflammatory polyradiculoneuropathy associated with numerous viral infections. Recently, there have been many case reports describing the association between COVID-19 and GBS but much remains unknown about the strength of the association and the features of GBS in this setting. We reviewed 37 published cases of GBS associated with COVID-19 to summarize this information for clinicians and to determine whether a specific clinical or electrodiagnostic (EDX) pattern is emerging. The mean age (59y), gender (65% male) and COVID-19 features appear to reflect those of hospitalized COVID-19 patients early in the pandemic. The mean time from COVID-19 symptoms to GBS symptoms was 11 days. The clinical presentation and severity of these GBS cases was similar to those with non-COVID-19 GBS. The EDX pattern was considered demyelinating in approximately one half of the cases. Cerebrospinal fluid, when assessed, demonstrated albuminocytologic dissociation in 76% of patients and was negative for SARS-CoV-2 in all. Serum anti-ganglioside antibodies were absent in 15 of 17 patients tested. Most patients were treated with a single course of intravenous immunoglobulin, and improvement was noted within 8 weeks in most. In summary, GBS associated COVID-19 appears to be an uncommon condition with similar clinical and EDX patterns to GBS prior to the pandemic. Future studies should compare patients with COVID-19 associated GBS to those with contemporaneous non-COVID-19 GBS and determine if the incidence of GBS is elevated in those with COVID-19.