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Impact of COVID-19 on Guillain-Barre Syndrome in India: A Multicenter Ambispective Cohort Study
Yareeda Sireesha1, Ritu Shree2, Madhu Nagappa3
1Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
Insights
Guillain-Barre syndrome (GBS) incidence decreased during the COVID-19 pandemic, likely due to reduced antecedent infections from lockdowns and improved hygiene. Clinical outcomes and mortality rates remained similar between pandemic and pre-pandemic periods.
Area of Science:
- Neurology
- Infectious Diseases
- Epidemiology
Background:
- The coronavirus disease 2019 (COVID-19) pandemic has been associated with varied reports on Guillain-Barre syndrome (GBS) incidence.
- Understanding GBS epidemiology during the pandemic is crucial for public health preparedness.
Purpose of the Study:
- To investigate and compare the demographic, clinical features, management, and outcomes of GBS patients during the COVID-19 pandemic versus the preceding year.
- To analyze the impact of pandemic-related factors on GBS presentation and progression.
Main Methods:
- A multicenter, ambispective cohort study involving 26 centers across India.
- Data collected retrospectively for the pre-COVID-19 period (March-August 2019) and ambispectively for the COVID-19 period (March-August 2020).
- Analysis included 555 patients (334 pre-COVID-19, 221 during COVID-19).
Main Results:
- A reduction in GBS frequency was observed during the COVID-19 pandemic.
- Males were predominantly affected (2:1 ratio).
- Fever was the most common antecedent event during COVID-19 (10.7%), compared to gastroenteritis pre-pandemic (17.4%). Paraparesis and sensory involvement were more common during the pandemic, while back pain and bowel symptoms were more frequent pre-pandemic. No significant differences in GBS disability scores or mortality rates were found between the periods.
Conclusions:
- The COVID-19 pandemic was associated with a reduced incidence of Guillain-Barre syndrome.
- Lockdowns and associated public health measures likely decreased the risk of antecedent infections, contributing to the lower GBS frequency.
- Despite changes in antecedent events and some clinical features, overall GBS outcomes and mortality did not significantly differ between the pandemic and pre-pandemic periods.
Introduction/Aims:
Studies conducted during the coronavirus disease 2019 (COVID-19) pandemic have reported varied data regarding the incidence of Guillain-Barre syndrome (GBS). The present study investigated demographic and clinical features, management, and outcomes of patients with GBS during a specified period of the COVID-19 pandemic, and compared these features to those of GBS in the previous year.
Methods:
A multicenter, ambispective cohort study including 26 centers across India was conducted. Data from a pre-COVID-19 period (March 1 to August 31, 2019) were collected retrospectively and collected ambispectively for a specified COVID-19 period (March 1 to August 31, 2020). The study was registered with the Clinical Trial Registry India (CTRI/2020/11/029143).
Results:
Data from 555 patients were included for analysis: pre-COVID-19 (n = 334) and COVID-19 (n = 221). Males were more commonly affected during both periods (male:female, 2:1). Gastroenteritis was the most frequent antecedent event in 2019 (17.4%), whereas fever was the most common event in 2020 (10.7%). Paraparesis (21.3% versus [vs.] 9.3%, P = 0.001) and sensory involvement (51.1% vs. 41.3%; P = 0.023) were more common during COVID-19 in 2020, whereas back pain (26.3% vs. 18.4%; P = 0.032) and bowel symptoms (20.7% vs. 13.7%; P = 0.024) were more frequent in the pre-COVID period. There was no difference in clinical outcomes between the two groups in terms of GBS disability score at discharge and 3 months after discharge. Independent predictors of disability in the pre-COVID period included areflexia/hyporeflexia, the requirementfor intubation, and time to bulbar weakness; in the COVID-19 period, independent predictors included time from onset to admission, intubation, and intubation requirement. The mortality rate was 2.3% during the entire study period (13/555 cases).
Discussion:
Results of this study revealed an overall reduction in the frequency of GBS during the pandemic. The lockdown likely reduced the risk for antecedent infections due to social distancing and improved hygiene, which may have resulted in the reduction of the frequency of GBS.
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