Covid-19 could trigger Guillain-Barré syndrome in survivors

The ordeal might not yet be over for Covid-19 survivors since the coronavirus could be responsible for the recent surge in Guillain-Barré syndrome (GBS) cases across the world, according to some medical experts and neurologists.

Multiple medical experts told Happiest Health that they have been noticing a sudden spike in the number of such cases reported following the global outbreak of Covid-19 more than two years ago. Neurologists claim that the coronavirus, responsible for the pandemic, could also be behind the rise in Guillain-Barré syndrome cases in recent months.

Guillain-Barré syndrome is a disorder in which the body’s immune system attacks the nerves, according to Dr Anuradha HK, consultant, neurology, Aster CMI Hospital, Bengaluru.

It is being suspected that the coronavirus compromises the immune system and affects the nervous system of the affected individual, making them susceptible to various neurological complications, including GBS. Covid infection is believed to affect the functioning of the cranial nerves that transmit electrical signals between the brain, face, neck and torso. These nerves play a major part in making us feel various sensations including taste, smell, sound and touch. This disruption in the functioning of the cranial nerves is believed to triggering Guillain-Barré syndrome among Covid survivors.

“Post covid infection, several neurological complications have been reported and studied across the globe,” said Dr Anuradha. “GBS is one of the neurological complications following Covid-19 infection. It occurs after any viral diseases or any recent infections. Hence, any illnesses, fever, diarrhoea, URTI, etc. can trigger GBS. Viruses such as cytomegalovirus, Epstein-Barr, influenza, Zika and Hepatitis E are also known to trigger Guillain-Barré syndrome. During a viral infection, the immune cells of the body are prompted to attack and destroy the insulation of the nerve cells. Sometimes, the nerve cell bodies (the axon) are targeted too.”

Dr Vinit Suri, senior consultant, neurology, Indraprastha Apollo Hospitals, New Delhi, said any viral infection might result in GBS. “Covid-19 is a viral infection that affects the immune system,” he said. “The virus induces an immune response which affects the peripheral and cranial nerves which leads to Guillain-Barré syndrome. Due to the higher number of virus infection cases on account of Covid, a higher number of GBS [cases] are being observed.”

Neurological symptoms of Guillain-Barré syndrome

Just like severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), Covid too has neurological symptoms, according to ‘Guillain-Barré syndrome during COVID-19 pandemic: an overview of the reports’, a study published in September 2020. Covid-19 patients have such clinical symptoms as headache, vomiting, nausea, dizziness, myalgia, anosmia, ageusia and disorder of consciousness. These symptoms confirm that the nervous system is involved in the Covid infection.

GBS is a heterogeneous disorder which often follows a viral infection. According to the assessment case reports from the beginning of the Covid-19 infection, it is possible that Guillain-Barré syndrome is linked to the Covid-19 infection.

Ananth Rao, 54, a general manager with a private company in Bengaluru, was infected with Covid in May 2021, when he was admitted to a private hospital. Following a week’s treatment in ICU, he was discharged and sent home. “I took about another week to recover completely from Covid-19 and just when I thought I could resume my work, I started sensing weakness in my legs,” he told Happiest Health.

“I was feeling very tired and couldn’t move my body [so] I decided to consult my doctor, suspecting post-Covid complication. After going through routine tests, I returned home and took the prescribed tablets. The next day I had total numbness in my legs and couldn’t move them. My face too started to show symptoms of Bell’s palsy (temporary weakness or paralysis of the facial muscles) when I went to a neurologist who diagnosed me with GBS. The doctor explained that Covid-19 had triggered GBS, an autoimmune disease that can affect anyone. I was again admitted in the ICU and the doctors started with the IVIG (intravenous immune globulin) treatment. I was discharged after a week, and I took almost two months to start walking and resume my daily activities.”

Explaining the correlation between Covid and GBS, Dr Suri said that immune response generated towards the virus acts against the roots, peripheral and cranial nerves resulting in demyelination (damage to the protective covering [myelin sheath] that surrounds nerve fibres in the brain, optic nerves and spinal cord) and axonal injury (nerve cell injury). The patients take six months to three years to get treated and the disease can be fatal if left untreated. It can affect anyone but is more common in adults and older people in both sexes, said Dr Suri.

How to treat GBS in Covid-19 survivors

Dr Anuradha HK said that treatment of GBS typically consists of immunomodulatory therapy with IVIG or plasma exchange (PE therapy removes soluble factors including antibodies from the blood) and supportive treatment. “IVIG is a therapy to help people with weakened immune systems,” she said. “IVIG is prepared from the blood donated by people. It contains antibodies, the natural proteins that our body makes. This helps us to fight infections and to serve other functions for the immune system.”

According to the study ‘Guillain-Barre syndrome spectrum associated with COVID-19: an up-to-date systematic review of 73 cases’, most patients showed respiratory and/or systemic symptoms and developed GBS manifestations after Covid-19. The study, which was published in the Journal of Neurology in August 2020, conducted a systematic review and searched for all published cases until July 20, 2020. It included 73 patients whose cases were reported in 52 publications.

Although Covid-19 primarily affects the respiratory system, central and peripheral neurological manifestations associated with SARS-CoV-2 infection have been increasingly reported from across the world. Several pieces of evidence suggest an association between SARS-CoV-2 infection and the development of GBS.