A Review on Gullian Barre Syndrome and its Association with COVID 19

  • Subin sam Post Graduate Student, Department of Pharmacy Practice, J.K.K. Nattraja College of Pharmacy, Namakkal (Dt), Kumarapalayam- 638 183, Tamil Nadu, India.
  • R Sambath Kumar Professor and Head, Department of Pharmaceutics, J.K.K. Nattraja College of Pharmacy, Namakkal (Dt), Kumarapalayam- 638 183, Tamil Nadu, India. https://orcid.org/0000-0003-1454-9582
  • N. Venkateswaramurthy Professor and Head, Department of Pharmacy Practice, J.K.K. Nattraja College of Pharmacy, Namakkal (Dt), Kumarapalayam- 638 183, Tamil Nadu, India. https://orcid.org/0000-0002-8623-7898


Guillain-Barré syndrome (GBS) is an immune-mediated disease that affects peripheral nerves and can lead to life-threatening consequences. It affects around 10000 people per year worldwide. Since the outbreak of acute respiratory syndrome coronavirus-2 (sar-cov-2) the incidence of GBS has been increased with a fatality rate of 4-7%. The exact association between the Sar-cov-2 and GBS is still unknown. GBS commonly presents after viral infections such as influenza virus, campylobacter jejuni, and zika virus. Clinical recognition of SC2-GBS is required in order to administer appropriate treatment on time and enhance the overall output of the infection. In most of the conditions patient was treated with intravenous immunoglobulins and outcome was seen within eight weeks of treatment. less outcome was seen in older age in line with previous findings for both GBS and COVID-19. Studies should be conducted to compare patients associated with GBS to those with concurrent non-COVID-19 GBS to see if the incidence of GBS is higher in those with COVID-19.

Keywords: Guillian-Barre syndrome, COVID-19, SAR-COV2

Keywords: Guillian-Barre syndrome, COVID-19, SAR-COV2


Download data is not yet available.

Author Biographies

Subin sam, Post Graduate Student, Department of Pharmacy Practice, J.K.K. Nattraja College of Pharmacy, Namakkal (Dt), Kumarapalayam- 638 183, Tamil Nadu, India.

Post Graduate Student, Department of Pharmacy Practice, J.K.K. Nattraja College of Pharmacy, Namakkal (Dt), Kumarapalayam- 638 183, Tamil Nadu, India.

R Sambath Kumar, Professor and Head, Department of Pharmaceutics, J.K.K. Nattraja College of Pharmacy, Namakkal (Dt), Kumarapalayam- 638 183, Tamil Nadu, India.

Professor and Head, Department of Pharmaceutics, J.K.K. Nattraja College of Pharmacy, Namakkal (Dt), Kumarapalayam- 638 183, Tamil Nadu, India.

N. Venkateswaramurthy, Professor and Head, Department of Pharmacy Practice, J.K.K. Nattraja College of Pharmacy, Namakkal (Dt), Kumarapalayam- 638 183, Tamil Nadu, India.

Professor and Head, Department of Pharmacy Practice, J.K.K. Nattraja College of Pharmacy, Namakkal (Dt), Kumarapalayam- 638 183, Tamil Nadu, India.


1. Li X, Zai J, Zhao Q, et al., Evolutionary history, potential intermediate animal host, and cross-species analyses of SARS-CoV-2. J Med Virol. 2020; 92(6):602-611. https://doi.org/10.1002/jmv.25731
2. WHO Director-General's opening remarks at the media briefing on COVID-19 (2020). Available online at: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-themedia-briefing-on-covid-19 (accessed August 24, 2021).
3. Huang C, Wang Y, Li X, et al., Clinical features of patients infected with 2019 novel Coronavirus in Wuhan, China. Lancet. 2020; 395(10223):497-506. https://doi.org/10.1016/S0140-6736(20)30183-5
4. Zhou P, Yang X-L, Wang X-G, et al., A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020; 579(7798):270-273. https://doi.org/10.1038/s41586-020-2012-7
5. Mao L, Jin H, Wang M, et al., Neurologic manifestations of hospitalized patients with Coronavirus Disease 2019 IN WUHAN, CHINA. JAMA Neurol. 2020; 77(6):683. https://doi.org/10.1001/jamaneurol.2020.1127
6. Orlikowski D, Porcher R, Sivadon TV, et al., Guillain-Barre syndrome following Primary Cytomegalovirus Infection: A prospective cohort study. Clin. Infect. Dis. 2011; 52(7):837-844. https://doi.org/10.1093/cid/cir074
7. Wakerley BR, Yuki N. Infectious and non-infectious triggers in Guillain-Barre syndrome. Expert Rev. Clin. Immunol.2013;9:627-639. https://doi.org/10.1586/1744666X.2013.811119
8. Cao-Lormeau VM, Blake A, Mons S, et al., Guillain-Barre syndrome outbreak associated with Zika virus infection in French Polynesia: a case-control study. Lancet.2016; 387(10027):1531-1539. https://doi.org/10.1016/S0140-6736(16)00562-6
9. Uncini A, González BDC, Acosta AYY, et al., Clinical and nerve conduction features in Guillain-Barre syndrome associated with Zika virus infection in Cúcuta, Colombia. Eur. J. Neurol.2018; 25:644-650. https://doi.org/10.1111/ene.13552
10. Hughes RAC, Cornblath DR. Guillain-Barré syndrome. Lancet. 2005; 366(9497):1653-1666. https://doi.org/10.1016/S0140-6736(05)67665-9
11. Sejvar JJ, Baughman AL, Wise M, Morgan OW. Population incidence of Guillain Barré syndrome: a systematic review and meta-analysis. Neuroepidemiology.2011; 36:123-133. https://doi.org/10.1159/000324710
12. Jacobs BC, Rothbarth PH, van der Meché FG, et al., The spectrum of antecedent infections in Guillain-Barré syndrome: a case-control study. Neurology.1998; 51(4):1110-5. https://doi.org/10.1212/WNL.51.4.1110
13. Patanik UJ. Review article On COVID-19 and GUILLAIN-BARRÉ SYNDROME. Front. Biosci. 2021; 13(1):97. doi:10.52586/s555 https://doi.org/10.52586/S555
14. Nguyen TP, Taylor RS. Guillain Barre syndrome. 2021 July 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021. Jan-. [last accessed 17 August 2021] Available at https://www.ncbi.nlm.nih.gov/books/NBK532254/
15. Finsterer J, Scorza FA. Guillain-Barre syndrome in 220 patients With covid-19. The Egypt. J. Neurol. Psychiatry Neurosurg. 2021; 57(1). https://doi.org/10.1186/s41983-021-00310-7
16. Webb AJ, Brain SA, Wood R, Rinaldi S, Turner MR. Seasonal variation in Guillain-Barré syndrome: a systematic review, meta-analysis and Oxfordshire cohort study. J. Neurol Neurosurg Psychiatry.2015; 86:1196-1201. https://doi.org/10.1136/jnnp-2014-309056
17. Filosto M, Cotti Piccinelli S, Gazzina S, et al., Guillain-Barré syndrome and COVID-19: An observational Multicentre study from two italian hotspot regions. J. Neurol. Neurosurg Psychiatry. 2020; 92(7):751-756. https://doi.org/10.1136/jnnp-2020-324837
18. van Doorn PA, Ruts L, Jacobs BC. Clinical features, pathogenesis, and treatment of Guillain-Barré Syndrome. Lancet Neurol. 2008; 7(10):939-950. https://doi.org/10.1016/S1474-4422(08)70215-1
19. Parry GJ. Guillain-Barré Syndrome 42-55 (Thieme Medical Publishers, 1993).
20. Hughes RA. Guillain-Barré Syndrome 124-130 (Springer-Verlag, 1990). https://doi.org/10.1007/978-1-4471-3175-5
21. Ropper AH, Wijdicks EF, Truaxm BT. Guillain- Barré Syndrome 175-224 (F. A. Davis, 1991).
22. Camdessanche JP, Morel J, Pozzetto B, Paul S, Tholance Y, Botelho NE. COVID-19 may induce Guillain-Barré syndrome. Rev Neurol.2020; 176(6): 516-518. https://doi.org/10.1016/j.neurol.2020.04.003
23. Parasher A. COVID-19: Current understanding of its Pathophysiology, Clinical presentation and Treatment. Postgrad Med. J. 2020; 97(1147):312-320. https://doi.org/10.1136/postgradmedj-2020-138577
24. Fokke C, van den Berg B, Drenthen J, Walgaard C, van Doorn PA, Jacobs BC. Diagnosis of Guillain-Barré syndrome and validation of Brighton criteria. Brain. 2014; 137(1):33-43. https://doi.org/10.1093/brain/awt285
25. Devos D, Magot A, Perrier BJ, et al., Guillain-Barré syndrome during childhood: Particular clinical and electrophysiological features. Muscle Nerve. 2013; 48(2):247-251. https://doi.org/10.1002/mus.23749
26. Korinthenberg R, Schessl J, Kirschner J. Clinical Presentation and Course of Childhood Guillain-Barré Syndrome: A Prospective Multicentre Study. Neuropediatrics. 2007; 38(1):10-17. https://doi.org/10.1055/s-2007-981686
27. Roodbol J, Wit M, Walgaard C, Hoog M, Catsman BC, Jacobs B. Recognizing Guillain-Barre syndrome in preschool children. Neurology. 2011; 76(9):807-810. https://doi.org/10.1212/WNL.0b013e31820e7b62
28. Ryan MM. Guillain-Barré syndrome in childhood. J. Paediatr Child Health.2005; 41(5-6):237-241. https://doi.org/10.1111/j.1440-1754.2005.00602.x
29. Wit MC, Roodbol J, Hoog M, Catsman-B, Jacobs, BC. Imminent respiratory insufficiency in children resulting from Guillain-Barré syndrome [Dutch]. Nederlands Tijdschrift voor Geneeskunde.2011; 155:A3808.
30. Carod-Artal FJ. Neurological complications of coronavirus and COVID-19. Revista de Neurologia.2020; 70(9):311-322. https://doi.org/10.33588/rn.7009.2020179
31. Helms J, Kremer S, Merdji H, Clere-Jehl R, Schenck et.al., Neurologic features in severe SARSCoV-2 infection. N. Engl. J. Med. 2020; 382(23):2268-2270 https://doi.org/10.1056/NEJMc2008597
32. Sedaghat Z, Karimi N. Guillain Barre syndrome associated with COVID-19 infection: a case report. J. clin. Neurosci.2020;76:233-239. https://doi.org/10.1016/j.jocn.2020.04.062
33. Bae JS, Kim YJ, Kim JK. Diabetes mellitus exacerbates the clinical and electrophysiological features of Guillain-Barré syndrome. Eur. J. Neurol. 2016; 23(3):439-46. https://doi.org/10.1111/ene.12885
34. Rahimi K. Guillain-Barre syndrome during COVID-19 pandemic: an overview of the reports. Neurol. Sci.2020; 41:3149-3156. https://doi.org/10.1007/s10072-020-04693-y
35. Martín-Aguilar L, Camps-Renom P, Lleixà C, Díaz-Manera J, Rojas-García R, et al. Serum neurofilament light chain predicts long-term prognosis in Guillain-Barré syndrome patients. J. Neurol. Neurosurg. Psychiatry. 2021; 92:70-77. https://doi.org/10.1136/jnnp-2020-323899
36. Arcila-Londono X, Lewis RA. Guillain-Barré syndrome. Seminars in Neurology. 2020; 32(3):179-186. https://doi.org/10.1055/s-0032-1329196
37. Van den Berg, B.; Walgaard, C.; Drenthen, J.; Fokke, C.; Jacobs, B.C.; van Doorn, P.A. Guillain-Barré syndrome: Pathogenesis, diagnosis, treatment, and prognosis. Nat. Rev. Neurol. 2014; 10(8):469-482. https://doi.org/10.1038/nrneurol.2014.121
38. Finsterer J, Scorza FA. Guillain-Barre syndrome in 220 patients with covid-19. Egypt. J. Neurol. Psychiatr. Neurosurg. 2021; 57(1) 1-7. https://doi.org/10.1186/s41983-021-00310-7
39. Andrea A, Luana B, Silvia DM, Erika S, Massimo DS. New clinical manifestation of COVID 19 related Guillain Barrè syndrome highly responsive to intravenous immunoglobulins: Two Italian cases. J. Neurol. Sci. 2020; 41:1657-1668. https://doi.org/10.1007/s10072-020-04484-5
40. Frontera J, Mainali S, Fink E et al. Global Consortium Study of Neurological Dysfunction in COVID-19 (GCS-NeuroCOVID): Study Design and Rationale. J. Neurocrit Care. 2020; 33(1):25-34. https://doi.org/10.1007/s12028-020-00995-3
41. Research C for BE and. Safety & Availability (Biologics) - FDA Safety Communication: New boxed warning for thrombosis related to human immune globulin products. Accessed April 22, 2020. http://wayback.archiveit.org/7993/20170112095644/http://www.fda.gov/biologicsbloodvaccines/safetyavailability/ucm37 5096.html
42. Hess DC, Eldahshan W, Rutkowski E. COVID-19-Related Stroke. Transl. Stroke Res. 2020; 11(3):322- 325. https://doi.org/10.1007/s12975-020-00818-9
43. Hughes RAC, Swan AV, Raphaël J-C, et al. Immunotherapy for Guillain-Barré syndrome: a systematic review. Brain.2007; 130(9):2245-2257. https://doi.org/10.1093/brain/awm004
44. Raphael, J. C., Chevret, S., Hughes, R. A. & Annane, D. Plasma exchange for Guillain-Barré syndrome.Cochrane Database of Systematic Reviews. 2012; 7:CD001798. https://doi.org/10.1002/14651858.CD001798.pub2
45. [No authors listed] Plasmapheresis and acute Guillain-Barré syndrome. The Guillain-Barré syndrome Study Group. Neurology.1985; 35(8);1096-1104. https://doi.org/10.1212/WNL.35.8.1096
46. [No authors listed] Efficiency of plasma exchange in Guillain-Barré syndrome: role of replacement fluids. French Cooperative Group on Plasma Exchange in Guillain-Barré syndrome. Ann. Neurol.1987; 22(6):753-761. https://doi.org/10.1002/ana.410220612
47. Hughes, R. A. & van Doorn, P. A. Corticosteroids for Guillain-Barré syndrome. Cochrane Database of Systematic Reviews, Issue 8. Art. No.: CD001446.
48. Van Koningsveld R, Schmitz P, van der Meché F, Visser L, Meulstee J, van Doorn P. Effect of methylprednisolone when added to standard treatment with intravenous immunoglobulin for Guillain-Barré syndrome: randomised trial. Lancet. 2004; 363(9404):192-196. https://doi.org/10.1016/S0140-6736(03)15324-X
49. Willison HJ, Jacobs BC, van Doorn PA. Guillain-Barré syndrome. Lancet 2016; 388(10045):717-27. https://doi.org/10.1016/S0140-6736(16)00339-1
50. Rodnitzky RL, Goeken JA. Complications of Plasma Exchange in Neurological Patients. Arch. Neurol. 1982; 39(6):350-354. https://doi.org/10.1001/archneur.1982.00510180028007
51. Jin PH, Shin SC, Dhamoon MS. Risk of thrombotic events after inpatient intravenous immunoglobulin or plasma exchange for neurologic disease: A case-crossover study. Muscle Nerve.2020:62(3); 327-332. https://doi.org/10.1002/mus.26884
52. Abu-Rumeileh S, Abdelhak A, Foschi M, Tumani H, Otto M. Guillain-Barré syndrome spectrum associated with COVID-19: An up-to-date systematic review of 73 cases. J. Neurol. 2020; 268(4):1133-1170. https://doi.org/10.1007/s00415-020-10124-x
53. Winer JB. Treatment of Guillain-Barré syndrome. Monthly J. Assoc. Physicians. 2002; 95(11):717-721. https://doi.org/10.1093/qjmed/95.11.717
54. Gajjar, M D. et al. Efficacy and cost effectiveness of therapeutic plasma exchange in patient of Guillain-Barré syndrome-a prospective study. SEJCRR.2013; 2(4):218-228.
55. Winters JL., Brown D., Hazard E., Chainani A. Andrzejewski, C. Jr. Cost-minimization analysis of the direct costs of TPE and IVIg in the treatment of Guillain-Barré syndrome. BMC Health Ser.Res. 2011; 11(1). https://doi.org/10.1186/1472-6963-11-101
56. van den Berg B, Bunschoten C, van Doorn PA, Jacobs BC. Mortality in Guillain-Barre syndrome. Neurology. 2013; 80(18):1650-1654. https://doi.org/10.1212/WNL.0b013e3182904fcc
57. Willison HJ, Jacobs BC, van Doorn PA. Guillain-Barré syndrome. Lancet. 2016; 388(10045):717- 727. https://doi.org/10.1016/S0140-6736(16)00339-1
58. Hardy TA, Blum S, McCombe PA, Reddel SW. Guillain-Barré syndrome: modern theories of etiology. Curr. Allergy. Asthma. Rep. 2011; 11(3):197-204. https://doi.org/10.1007/s11882-011-0190-y
59. Ottaviani D, Boso F, Tranquillini E, Gapeni I, Pedrotti G, Cozzio S, Guarrera GM, Giometto B. Early Guillain-Barré syndrome in coronavirus disease 2019 (COVID-19): a case report from an Italian COVID-hospital. Neurol. Sci. 2020; 41(6):1351-1354. https://doi.org/10.1007/s10072-020-04449-8
60. Parra B, Lizarazo J, Jiménez-Arango JA, Zea-Vera AF, GonzálezManrique G, Vargas J, Angarita JA, Zuñiga G, Lopez-Gonzalez R, Beltran CL, Rizcala KH, Morales MT, Pacheco O, Ospina ML, Kumar A, Cornblath DR, Muñoz LS, Osorio L, Barreras P, Pardo CA. Guillain-Barré syndrome associated with Zika virus infection in Colombia. N. Engl. J. Med. 2016; 375(16):1513-1523 https://doi.org/10.1056/NEJMoa1605564
61. Finsterer J, Scorza FA, Ghosh R, COVID-19 polyradiculitis in 24 patients without SARS-CoV-2 in the cerebro-spinal fluid. J. Med. Virol. 2020; 93(1): 66-68. https://doi.org/10.1002/jmv.26121
62. Domingues R, Fernandes G, Leite F et al. The cerebrospinal fluid in multiple sclerosis: far beyond the bands. Einstein (São Paulo). 2017; 15(1):100-104. https://doi.org/10.1590/s1679-45082017rw3706
63. Willison HJ, Jacobs BC, van Doorn PA. Guillain-Barré syndrome. Lancet. 2016; 388(10045):717-727. https://doi.org/10.1016/S0140-6736(16)00339-1
64. Walgaard C, Lingsma HF, Ruts L et al. Prediction of respiratory insufficiency in Guillain-Barré syndrome. Ann. Neurol.2010; 67(6):781-787. https://doi.org/10.1002/ana.21976
65. van K R, Steyerberg E, Hughes R, Swan A, van D P, Jacobs B. A clinical prognostic scoring system for Guillain-Barré syndrome. Lancet Neurol. 2007; 6(7):589-594. https://doi.org/10.1016/S1474-4422(07)70130-8
66. Liu Y, Mao B, Liang S et al. Association between age and clinical characteristics and outcomes of COVID-19. Eur. Respir. J. 2020; 55(5):2001112. https://doi.org/10.1183/13993003.01112-2020
67. Khanlou H, Valdes-Sueiras M, Farthing C. Peripheral Neuropathy Induced by Lopinavir-Saquinavir-Ritonavir Combination Therapy in an HIV-Infected Patient. J. Intern Ass. Physicians AIDS Care. 2007; 6(3):155-155. https://doi.org/10.1177/1545109707302756
68. Sugiura F, Kojima T, Oguchi T, Urata S, Yuzawa Y, Sakakibara A, et al. A case of peripheral neuropathy and skin ulcer in a patient with rheumatoid arthritis after a single infusion of tocilizumab. Mod Rheumatol. 2009; 19(2): 199-203. https://doi.org/10.3109/s10165-008-0132-2
52 Views | 0 Downloads
How to Cite
sam S, Sambath Kumar R, Venkateswaramurthy N. A Review on Gullian Barre Syndrome and its Association with COVID 19. JDDT [Internet]. 15Nov.2021 [cited 1Dec.2021];11(6):188-93. Available from: https://jddtonline.info/index.php/jddt/article/view/5115