SARS-CoV-2-associated Guillain-Barré syndrome: a descriptive and comparative analysis

The recent coronavirus disease (COVID-19) pandemic has placed an unprecedented burden on health care systems around the world, with extensive research directed on understanding its systemic implications in the human body. Comparative analysis of cerebrospinal fluid parameters and clinical batteries of patients with SARS-CoV-2-related and unrelated Guillain-Barré syndrome Variable Total population (n = 17) SC2-GBS (n = 5) Non-SC2-GBS (n = 12) p CSF cellularity, median (range)* 0 (0–8) 0 (0–5) 0 (0–8) 0.45 CSF Protein level, mean (SD)** 905 (692) 1160 (606) 863 (746) 0.70 CSF glucose levels, mean (SD)*** 3.6 (0.63) 3.4 (0.82) 3.5 (0.54) 0.36 CSF/serum glucose ratio 0.64 (0.0) 0.6 (0.0) 0.64 (0.1) 0.91 Hughes scoring system at nadir, median (range) 4 (4–5) 4 (4–5) 4 (4–5) 0.80 Hughes scoring system at discharge, median (range) 4 (2–6) 4 (2–6) 4 (2–4) 0.89 EGRIS, median (range) 4 (0–7) 3 (0–6) 4 (3–7) 0.15 mEGOS at admission, median (range) 6 (0–9) 5 (0–7) 6 (2–9) 0.14 mEGOS at day 7 of admission, median (range) 7 (0–12) 4 (0–10) 7.5 (0–12) 0.33 MRC sum score at admission, median (range) 28 (3–60) 36 (18–52) 28 (3–60) 0.25 MRC sum score at discharge, median (range) 36 (0–55) 44 (12–54) 35.5 (0–55) 0.51 SC2-GBS = SARS-CoV-2-related Guillain-Barré syndrome; CSF = cerebrospinal fluid; EGRIS = Erasmus GBS Respiratory Insufficiency Score; mEGOS= modified Erasmus GBS Outcome Score; MRC = Medical Research Council; SD = standard deviation. * cells/mm3. ** mg/L. *** mmol/L. Rather than using the former as suggestive evidence for a non-association between COVID-19 and GBS, we believe this slight reduction in cases might be attributed to the effect of increased hand hygiene, social distancing, and the lockdown, as previously reported.7 Various systematic reviews of case reports regarding SC2-GBS have been published.2,3 Two of these support our findings, demonstrating a resemblance between the SC2-GBS and the non-SC2-GBS presentation.2,3 Nonetheless, the most recent review, which included 61 patients mostly of high- to middle-income countries, observed a high percentage (75.6%) of the classical demyelinating subtype, with most (65.3%) having a good outcome at discharge (Hughes ≤ 2).3 Contrastingly, in our study, the most common electrophysiological findings in this population belonged to AMAN and AMSAN (80%) variants of GBS, with only 1 SC2-GBS patient with a AIDP variant (20%). A distinctive feature observed in systematic reviews of reported cases is the worse outcomes i