tetano
Editor, Senior Moderator
Brain
. 2020 Dec 14;awaa433.
doi: 10.1093/brain/awaa433. Online ahead of print.
Epidemiological and cohort study finds no association between COVID-19 and Guillain-Barr? syndrome
Stephen Keddie[SUP] 1 2 [/SUP], Julia Pakpoor[SUP] 3 [/SUP], Christina Mousele[SUP] 2 [/SUP], Menelaos Pipis[SUP] 1 2 [/SUP], Pedro M Machado[SUP] 1 2 [/SUP], Mark Foster[SUP] 2 [/SUP], Christopher J Record[SUP] 4 [/SUP], Ryan Y S Keh[SUP] 5 [/SUP], Janev Fehmi[SUP] 6 [/SUP], Ross W Paterson[SUP] 2 7 [/SUP], Viraj Bharambe[SUP] 8 [/SUP], Lisa M Clayton[SUP] 9 [/SUP], Claire Allen[SUP] 10 [/SUP], Olivia Price[SUP] 11 [/SUP], Jasmine Wall[SUP] 5 [/SUP], Annamaria Kiss-Csenki[SUP] 12 [/SUP], Dipa P Rathnasabapathi[SUP] 13 [/SUP], Ruth Geraldes[SUP] 6 14 [/SUP], Tatyana Yermakova[SUP] 15 [/SUP], Joshua King-Robson[SUP] 16 [/SUP], Maya Zosmer[SUP] 17 [/SUP], Sanjeev Rajakulendran[SUP] 2 17 [/SUP], Sheetal Sumaria[SUP] 2 [/SUP], Simon F Farmer[SUP] 2 [/SUP], Ross Nortley[SUP] 2 14 [/SUP], Charles R Marshall[SUP] 9 [/SUP], Edward J Newman[SUP] 18 [/SUP], Niranjanan Nirmalananthan[SUP] 4 [/SUP], Guru Kumar[SUP] 7 [/SUP], Aswin A Pinto[SUP] 13 [/SUP], James Holt[SUP] 8 [/SUP], Tim M Lavin[SUP] 19 [/SUP], Kathryn M Brennan[SUP] 18 [/SUP], Michael S Zandi[SUP] 2 [/SUP], Dipa L Jayaseelan[SUP] 2 20 [/SUP], Jane Pritchard[SUP] 21 [/SUP], Robert D M Hadden[SUP] 16 [/SUP], Hadi Manji[SUP] 1 2 [/SUP], Hugh J Willison[SUP] 18 [/SUP], Simon Rinaldi[SUP] 6 [/SUP], Aisling S Carr[SUP] 2 [/SUP], Michael P Lunn[SUP] 1 2 [/SUP]
Affiliations
Abstract
Reports of Guillain-Barr? syndrome (GBS) have emerged during the Coronavirus disease 2019 (COVID-19) pandemic. This epidemiological and cohort study sought to investigate any causative association between COVID-19 infection and GBS. The epidemiology of GBS cases reported to the UK National Immunoglobulin Database was studied from 2016 to 2019 and compared to cases reported during the COVID-19 pandemic. Data were stratified by hospital trust and region, with numbers of reported cases per month. UK population data for COVID-19 infection were collated from UK public health bodies. In parallel, but separately, members of the British Peripheral Nerve Society prospectively reported incident cases of GBS during the pandemic at their hospitals to a central register. The clinical features, investigation findings and outcomes of COVID-19 (definite or probable) and non-COVID-19 associated GBS cases in his cohort were compared. The incidence of GBS treated in UK hospitals from 2016 to 2019 was 1.65-1.88 per 100 000 individuals per year. In 2020, GBS and COVID-19 incidences varied between regions and did not correlate with one another (r = 0.06, 95% confidence interval: -0.56 to 0.63, P = 0.86). GBS incidence fell between March and May 2020 compared to the same months of 2016-19. In an independent cohort study, 47 GBS cases were reported (COVID-19 status: 13 definite, 12 probable, 22 non-COVID-19). There were no significant differences in the pattern of weakness, time to nadir, neurophysiology, CSF findings or outcome between these groups. Intubation was more frequent in the COVID-19 affected cohort (7/13, 54% versus 5/22, 23% in COVID-19-negative) likely related to COVID-19 pulmonary involvement. Although it is not possible to entirely rule out the possibility of a link this study finds no epidemiological or phenotypic clues of SARS-CoV-2 being causative of GBS. GBS incidence has fallen during the pandemic, which may be the influence of lockdown measures reducing transmission of GBS inducing pathogens such as Campylobacter jejuni and respiratory viruses.
Keywords: COVID-19; Guillain-Barr? syndrome; SARS-CoV-2.
. 2020 Dec 14;awaa433.
doi: 10.1093/brain/awaa433. Online ahead of print.
Epidemiological and cohort study finds no association between COVID-19 and Guillain-Barr? syndrome
Stephen Keddie[SUP] 1 2 [/SUP], Julia Pakpoor[SUP] 3 [/SUP], Christina Mousele[SUP] 2 [/SUP], Menelaos Pipis[SUP] 1 2 [/SUP], Pedro M Machado[SUP] 1 2 [/SUP], Mark Foster[SUP] 2 [/SUP], Christopher J Record[SUP] 4 [/SUP], Ryan Y S Keh[SUP] 5 [/SUP], Janev Fehmi[SUP] 6 [/SUP], Ross W Paterson[SUP] 2 7 [/SUP], Viraj Bharambe[SUP] 8 [/SUP], Lisa M Clayton[SUP] 9 [/SUP], Claire Allen[SUP] 10 [/SUP], Olivia Price[SUP] 11 [/SUP], Jasmine Wall[SUP] 5 [/SUP], Annamaria Kiss-Csenki[SUP] 12 [/SUP], Dipa P Rathnasabapathi[SUP] 13 [/SUP], Ruth Geraldes[SUP] 6 14 [/SUP], Tatyana Yermakova[SUP] 15 [/SUP], Joshua King-Robson[SUP] 16 [/SUP], Maya Zosmer[SUP] 17 [/SUP], Sanjeev Rajakulendran[SUP] 2 17 [/SUP], Sheetal Sumaria[SUP] 2 [/SUP], Simon F Farmer[SUP] 2 [/SUP], Ross Nortley[SUP] 2 14 [/SUP], Charles R Marshall[SUP] 9 [/SUP], Edward J Newman[SUP] 18 [/SUP], Niranjanan Nirmalananthan[SUP] 4 [/SUP], Guru Kumar[SUP] 7 [/SUP], Aswin A Pinto[SUP] 13 [/SUP], James Holt[SUP] 8 [/SUP], Tim M Lavin[SUP] 19 [/SUP], Kathryn M Brennan[SUP] 18 [/SUP], Michael S Zandi[SUP] 2 [/SUP], Dipa L Jayaseelan[SUP] 2 20 [/SUP], Jane Pritchard[SUP] 21 [/SUP], Robert D M Hadden[SUP] 16 [/SUP], Hadi Manji[SUP] 1 2 [/SUP], Hugh J Willison[SUP] 18 [/SUP], Simon Rinaldi[SUP] 6 [/SUP], Aisling S Carr[SUP] 2 [/SUP], Michael P Lunn[SUP] 1 2 [/SUP]
Affiliations
- PMID: 33313649
- DOI: 10.1093/brain/awaa433
Abstract
Reports of Guillain-Barr? syndrome (GBS) have emerged during the Coronavirus disease 2019 (COVID-19) pandemic. This epidemiological and cohort study sought to investigate any causative association between COVID-19 infection and GBS. The epidemiology of GBS cases reported to the UK National Immunoglobulin Database was studied from 2016 to 2019 and compared to cases reported during the COVID-19 pandemic. Data were stratified by hospital trust and region, with numbers of reported cases per month. UK population data for COVID-19 infection were collated from UK public health bodies. In parallel, but separately, members of the British Peripheral Nerve Society prospectively reported incident cases of GBS during the pandemic at their hospitals to a central register. The clinical features, investigation findings and outcomes of COVID-19 (definite or probable) and non-COVID-19 associated GBS cases in his cohort were compared. The incidence of GBS treated in UK hospitals from 2016 to 2019 was 1.65-1.88 per 100 000 individuals per year. In 2020, GBS and COVID-19 incidences varied between regions and did not correlate with one another (r = 0.06, 95% confidence interval: -0.56 to 0.63, P = 0.86). GBS incidence fell between March and May 2020 compared to the same months of 2016-19. In an independent cohort study, 47 GBS cases were reported (COVID-19 status: 13 definite, 12 probable, 22 non-COVID-19). There were no significant differences in the pattern of weakness, time to nadir, neurophysiology, CSF findings or outcome between these groups. Intubation was more frequent in the COVID-19 affected cohort (7/13, 54% versus 5/22, 23% in COVID-19-negative) likely related to COVID-19 pulmonary involvement. Although it is not possible to entirely rule out the possibility of a link this study finds no epidemiological or phenotypic clues of SARS-CoV-2 being causative of GBS. GBS incidence has fallen during the pandemic, which may be the influence of lockdown measures reducing transmission of GBS inducing pathogens such as Campylobacter jejuni and respiratory viruses.
Keywords: COVID-19; Guillain-Barr? syndrome; SARS-CoV-2.