Guillain-Barré syndrome after SARS-CoV-2 infection in an international prospective cohort study
Authors: Luijten Linda W G , Leonhard Sonja E , van der Eijk Annemiek A , Doets Alex Y , Appeltshauser Luise , Arends Samuel , Attarian Shahram , Benedetti Luana , Briani Chiara , Casasnovas Carlos , Castellani Francesca , Dardiotis Efthimios , Echaniz-Laguna Andoni , Garssen Marcel P J , Harbo Thomas , Huizinga Ruth , Humm Andrea M , Jellema Korné , van der Kooi Anneke J , Kuitwaard Krista , Kuntzer Thierry , Kusunoki Susumu , Lascano Agustina M , Martinez-Hernandez Eugenia , Rinaldi Simon , Samijn Johnny P A , Scheidegger Olivier , Tsouni Pinelopi , Vicino Alex , Visser Leo H , Walgaard Christa , Wang Yuzhong , Wirtz Paul W , Ripellino Paolo , Jacobs Bart C ,   the IGOS consortium, Jacobs Bart C , Hughes Richard A C , Cornblath David R , Gorson Kenneth C , Hartung Hans-Peter , Kusunoki Susumu , van Doorn Pieter A , Willison Hugh J , van den Berg Bianca , Verboon Christine , Roodbol Joyce , Doets Alex Y , Leonhard Sonja E , Luijten Linda W G , de Koning Laura C , Mandarakas Melissa , van Woerkom Marieke , Arends Samuel , Reisin Ricardo C , Reddel Stephen W , Islam Zhahirul , Mohammad Quazi Deen , van den Bergh Peter , Feasby Tom E , Wang Yuzhong , Harbo Thomas , Péréon Yann , Lehmann Helmar C , Dardiotis Efthimios , Nobile-Orazio Eduardo , Shahrizaila Nortina , Bateman Kathleen , Illa Isabel , Querol Luis , Ripellino Paolo , Hsieh Sung-Tsang , Chavada Govindsinh , Davidson Amy , Addington James M , Andersen Henning , Antonini Giovanni , Ajroud-Driss Senda , Attarian Shahram , Badrising Umesh A , Balducci Claudia , Barroso Fabio A , Bella Isabelita R , Benedetti Luana , Bertorini Tulio E , Bhavaraju-Sanka Ratna , Brannagan Thomas H , Briani Chiara , Bürmann Jan , Busby Mark , Butterworth Stephen , Casasnovas Carlos , Castellani Francesca , Cavaletti Guido , Chao Chi-Chao , Chen Shan , Claeys Kristl G , Conti Maria Eugenia , Cosgrove Jeremy S , Dalakas Marinos C , Derejko Miroslawa A , Dimachkie Mazen M , de la Cour Charlotte Dornonville , Echaniz-Laguna Andoni , Eftimov Filip , Faber Karin G , Fazio Raffaella , Fokke Chris , Fujioka Toshiki , Fulgenzi Ernesto A , Galassi Giuliana , García-Sobrino Tania , Garssen Marcel P J , Gentile Francesco , Gijsbers Cees J , Gilchrist James M , Job Gilhuis H , Goldstein Jonathan M , Goyal Namita A , Granit Volkan , Grapperon Aude-Marie , Grisanti Stefano , Gutiérrez-Gutiérrez Gerardo , Gutmann Lauri , Hadden Robert D M , Holbech Jakob V , Holt James K L , Htut Min , Humm Andrea , Hundsberger Thomas , Jellema Korné , Pascual Ivonne Jericó , Jimeno Montero Maria C , Kaida Kenichi , Karafiath Summer , Katzberg Hans D , Khoshnoodi Mohammad , Kiers Lynette , Kimpinski Kurt , Kleyweg Ruud P , Kokubun Norito , Kolb Noah , Kuitwaard Krista , Kuntzer Thierry , Kuwabara Satoshi , Kuwahara Motoi , Kwan Justin Y , Ladha Shafeeq S , Lassen Lisbeth Landschoff , Lascano Agustina M , Lawson Victoria , Pan Edward Lee , Cejas Luciana León , Magot Armelle , Manji Hadi , Marfia Gerola A , Márquez-Infante Celedonio , Aguilar Lorena Martin , Hernandez Eugenia Martinez , Sanchez Pilar Massaro , Mataluni Giorgia , Mattiazzi Marcelo G , McDermott Chris J , Meekins Gregg D , Miller James A L , Monges Maria Soledad , de la Tassa Germán Morís , Nascimbene Caterina , Nedkova-Hristova Velina , Nowak Richard J , Osei-Bonsu Michael , Pardo Julio , Pascuzzi Robert M , Pritchard Jane , Pulley Michael , Rinaldi Simon , Roberts Rhys C , Rojas-Marcos Iñigo , Rudnicki Stacy A , Sachs George M , Samijn Johnny P A , Santoro Lucio , Scheidegger Olivier , Schenone Angelo , Schwindling Lenka , Sedano Tous Maria J , Sheikh Kazim A , Silvestri Nicholas J , Sindrup Soren H , Sommer Claudia L , Song Yan , Stein Beth , Stino Amro M , Tan Cheng-Yin , Tankisi Hatice , Tsouni Pinelopi , Twydell Paul T , Van Damme Philip , van der Kooi Anneke J , van der Meulen Willem , van der Ree Taco C , van Dijk Gert W , van Koningsveld Rinske , Varrato Jay D , Vermeij Frederique H , Verschuuren Jan J G M , Vicino Alex , Visser Leo H , Vytopil Michal , Waheed Waqar , Walgaard Christa , Wirtz Paul W , Xing Chunye , Yamagishi Yuko , Zhou Lan , Zivkovic Sasha 
Published: July 2021

Abstract
In the wake of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, an increasing number of patients with neurological disorders, including Guillain-Barré syndrome (GBS), have been reported following this infection. It remains unclear, however, if these cases are coincidental or not, as most publications were case reports or small regional retrospective cohort studies. The International GBS Outcome Study is an ongoing prospective observational cohort study enrolling patients with GBS within 2 weeks from onset of weakness. Data from patients included in this study, between 30 January 2020 and 30 May 2020, were used to investigate clinical and laboratory signs of a preceding or concurrent SARS-CoV-2 infection and to describe the associated clinical phenotype and disease course. Patients were classified according to the SARS-CoV-2 case definitions of the European Centre for Disease Prevention and Control and laboratory recommendations of the World Health Organization. Forty-nine patients with GBS were included, of whom eight (16%) had a confirmed and three (6%) a probable SARS-CoV-2 infection. Nine of these 11 patients had no serological evidence of other recent preceding infections associated with GBS, whereas two had serological evidence of a recent Campylobacter jejuni infection. Patients with a confirmed or probable SARS-CoV-2 infection frequently had a sensorimotor variant 8/11 (73%) and facial palsy 7/11 (64%). The eight patients who underwent electrophysiological examination all had a demyelinating subtype, which was more prevalent than the other patients included in the same time window [14/30 (47%), P = 0.012] as well as historical region and age-matched control subjects included in the International GBS Outcome Study before the pandemic [23/44 (52%), P = 0.016]. The median time from the onset of infection to neurological symptoms was 16 days (interquartile range 12–22). Patients with SARS-CoV-2 infection shared uniform neurological features, similar to those previously described in other post-viral GBS patients. The frequency (22%) of a preceding SARS-CoV-2 infection in our study population was higher than estimates of the contemporaneous background prevalence of SARS-CoV-2, which may be a result of recruitment bias during the pandemic, but could also indicate that GBS may rarely follow a recent SARS-CoV-2 infection. Consistent with previous studies, we found no increase in patient recruitment during the pandemic for our ongoing International GBS Outcome Study compared to previous years, making a strong relationship of GBS with SARS-CoV-2 unlikely. A case-control study is required to determine if there is a causative link or not.