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Case reports describe “unusual” Guillain-Barre variants after the COVID-19 vaccination

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Two studies published in Annals of Neurology reported small clusters of “an unusual variant of Guillain-Barre syndrome” after receiving a COVID-19 vaccine, according to an American Neurological Association press release.

The 11 cases of Guillain-Barre syndrome occurred in people who received the vaccine 10 to 22 days before symptoms appeared, the press release said. While the rate of Guillain-Barre syndrome in these clusters was about four to ten times higher than the expected starting frequency, “these incidents” made the “unusually severe” bilateral facial weakness and the timing of receiving the vaccine “suspicious”.

Two studies published in Annals of Neurology reported an atypical variant of Guillain-Barre syndrome as a “rare but specific complication” of COVID-19 vaccines. Source: Adobe Stock

In the first report, Christopher Martin Allen, from the Department of Neurology at Nottingham University Hospitals NHS Trust and the University of Nottingham School of Medicine, and colleagues reported four cases of Guillain-Barre variant presenting as bifacial weakness with paresthesia. All cases occurred after the first dose of AstraZeneca vaccine and developed within 10 days, with symptoms onset 11-22 days after vaccination. The cases included a white male aged 54 years with no relevant medical history; a British-Iranian man aged 20 with a medical history of ulcerative colitis; a white male, 57 years old, with a history of asthma and osteoarthritis, bilateral knee replacement and regular use of steroid and salbutamol inhalers, loratadine, omeprazole and tamsulosin; and a white man aged 55 with a history of high blood pressure and regular use of amlodipine and lisinopril.

All patients presented with marked bifacial weakness and normal facial sensation. All patients also tested negative for COVID-19 infection. Patients received IV immunoglobulin, oral steroids, or no treatment.

Allen and colleagues found that the patients described in their case report had “intermittent” neurological symptoms associated with taking the vaccine, but that “no causality” can be assumed. The results show the need for “robust post-vaccination surveillance,” according to the researchers. Allen and colleagues also noted that “SARS-CoV-2 vaccines are very safe”.

In the second report, Boby Varkey maramattom, MD, DM, FRCP, from the Department of Neurology at Aster Medcity in India, and colleagues examined seven cases of severe Guillain-Barre syndrome that developed within 2 weeks of the first COVID-19 vaccine. Researchers identified these cases during a 4-week period between mid-March and mid-April 2021, at which point about 1.5 million people in three regions of Kerala, India had been vaccinated against COVID-19. More than 80% of these people – or 1.2 million people – received the ChAdOx1-S / nCoV-19 vaccine, according to Maramattom and colleagues.

The rate of Guillain-Barre syndrome observed in this report “was 1.4 to 10 times higher than expected for a population of this size over that period,” the researchers said. In addition, the rate at which bilateral facial weakness occurred, which generally develops in less than 20% of Guillain-Barre syndrome cases, indicated “a pattern related to vaccination,” write Maramattom et al.

More than half of the cases in India (n = 4) involved women between the ages of 40 and 70, most of whom (n = 3) required mechanical ventilation. All reported cases of Guillain-Barre syndrome in India included bilateral facial palsy, according to Maramattom and colleagues, which generally develops in less than 20% of unselected cases. Other cranial neuropathies, including abducens palsy and trigeminal sensory nerve involvement, developed in four patients (57%), which is rare in reports of Guillain-Barre syndrome in India, as it occurs in less than 5% of cases occurs, the researchers found.

Maramattom and colleagues emphasized that a link between COVID-19 infection and Guillain-Barre syndrome has not been established, making an increase in the rate of Guillain-Barre syndrome after COVID-19 vaccination “unlikely”. They also found that the benefits of vaccinating against COVID-19, according to the case report, “far outweigh the risk of this relatively rare outcome.” However, they stated that doctors should be aware of this potential adverse event after receiving the COVID-19 vaccination, as most of the patients in their report require mechanical ventilation assistance.

In a related editorial, Annals of Neurology’s neuromuscular and statistical editors described “one additional similar case” in a patient in the United States who received the Johnson & Johnson COVID-19 vaccine, according to a press release. The editors also examined cases of severe bilateral facial weakness, with or without Guillain-Barre syndrome, that were reported to the U.S. Vaccine Adverse Events Reporting System. More than half of the cases of Guillain-Barre syndrome with bilateral facial weakness in the United States (n = 5 out of 8 cases) occurred in people who received the Johnson & Johnson vaccine, while only 3 such cases occurred in “the many.” larger “observed numbers” of people who received the Pfizer and Moderna vaccines.

These results indicated that Guillain-Barre syndrome with bilateral facial weakness, like the cases of thrombocytopenic thrombosis reported with adenovirus-based vaccines, was “a rare but specific complication,” according to the ANA press release. The press release also noted that it is important for clinicians to be aware of this complication “so that they can identify it and promptly treat it with standard therapy,” such as: B. IV Ig.

References:

Allen CM, et al. Ann Neurol. 2021; doi: 10.1002 / ana.26144.

American Neurological Society. Variant of Guillain-Barré Syndrome that occurs after COVID-19 vaccines, according to two new articles in the Annals of Neurology. Available at: https://myana.org/publications/news/guillain-barr%C3%A9-syndrome-variant-occurring-after-covid-19-vaccines-according-two. Retrieved on June 17, 2021.

Maramattom BV et al. Ann Neurol. 2021; doi: 10.1002 / ana.26143.

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