Table 1.
Clinical features of 13 patients with Guillain–Barré syndrome and variants post COVID-19 vaccination.
| Case | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age | 62 | 73 | 48 | 32 | 38 | 70 | 72 | 84 | 62 | 43 | 18 | 73 | 58 |
| Gender | M | F | F | F | M | F | M | F | F | M | F | F | F |
| Time from vaccination to symptom onset (days) | 11 | 29 | 10 | 11 | 29 | 8 | 30 | 8 | 27 | 11 | 12 | 13 | 4 |
| Vaccine | ChAdOx1-S/nCoV-19 (1st) | ChAdOx1-S/nCoV-19 (1st) | ChAdOx1-S/nCoV-19 (1st) | BNT162b2 (1st) | ChAdOx1-S/nCoV-19 (1st) | ChAdOx1-S/nCoV-19 (1st) | ChAdOx1-S/nCoV-19 (1st) | ChAdOx1-S/nCoV-19 (1st) | ChAdOx1-S/nCoV-19 (2nd) | BNT162b2 (1st) | BNT162b2 (1st) | BNT162b2 (1st) | BNT162b2 (1st) |
| Clinical phenotype | Classic GBS | Classic GBS | Paraparetic GBS | Acute cervicobrachial weakness | Classic GBS | Classic GBS | Classic GBS | Classic MFS | Classic GBS | Classic GBS | Paraparetic GBS | Paraparetic GBS | Classic GBS |
| Antiganglioside antibody* | Negative | Negative | Negative | Negative | Negative | GM1 IgM(+) | NA | GQ1b IgG(+) | Negative | Negative | Negative | Negative | Negative |
| EDX classification† | AMAN | AIDP | AIDP | AIDP | AMAN | AMAN | Undetermined | Normal | Undetermined | AIDP | Normal | Undetermined | AIDP |
| TRF (days from relapse after last day of 1st IVIG) | Yes (7) | Yes (7) | No | No | No | No | No | No | No | No | No | No | No |
| Onset to nadir (days) | 10, 22‡ | 7, NA‡ | 15 | 12 | 1 | 11 | 10 | 5 | 11 | 21 | 9 | 9 | 4 |
| Severity at nadir | |||||||||||||
| Hughes score | 5 | 4 | 2 | 1 | 2 | 3 | 2 | 1 | 4 | 4 | 2 | 3 | 5 |
| MRC sum score | 14 | 28 | 57 | 51 | 56 | 54 | 52 | 60 | 52 | 26 | 56 | 46 | 18 |
| Length of hospital stay | 139 | 42 | 9 | 6 | 6 | 20 | 2 | 17 | 6 | 20 | 3 | 10 | 44 |
| Treatment | First and second IVIG | IVIG | Steroid | IVIG | No | IVIG | No | No | IVIG | IVIG | No | IVIG | IVIG followed by plasmapheresis |
| Onset to improvement (days) | 16, 30∫ | 15, 26∫ | 18 | 17 | 16 | 18 | 25 | 30 | 43 | 23 | 13 | 15 | 6 |
| Prognosis at 2 months | |||||||||||||
| Hughes score | 4 | 3 | 1 | 1 | 0 | 2 | 1 | 1 | 1 | 3 | 1 | 6 | 3 |
| MRC sum score | 26 | 44 | 60 | 60 | 60 | 58 | 60 | 60 | 59 | 48 | 58 | 0 | 35 |
AIDP, acute inflammatory demyelinating polyradiculoneuropathy; AMAN, acute motor axonal neuropathy; EDX, electrodiagnostic study; F, female; IVIG, intravenous immunoglobulin G; GBS, Guillain–Barré syndrome; M, male; MRC, medical research council; NA, not available; TRF, treatment-related fluctuations.
The anti-GM1, GD1b, GQ1b IgG, and IgM panels were checked with ELISA for anti-ganglioside antibody assays.
Electrodiagnostic classification was determined by serial nerve conduction studies according to Uncini's criteria. 11Three patients who did not receive a follow-up nerve conduction study were classified as “undetermined”.
Onset to nadir before and after treatment-related fluctuation, respectively.
Time interval from onset to improvement following the first and second IVIG infusions, respectively.