Dr. Sandeep Rana, head author of the study and neurologist at Allegheny General Hospital
PITTSBURGH (PRWEB) June 22, 2020
Physicians from Allegheny General Hospital (AGH) in Pittsburgh, part of Allegheny Health Network (AHN), are among the first in the country to document a potential association between the onset of Guillain-Barré Syndrome (GBS) and the novel coronavirus (COVID-19). The case study was just published in the June issue of the Journal of Clinical Neuromuscular Disease.
GBS is a disorder in which the body’s immune system attacks the myelin sheath of the peripheral nervous system, which significantly interrupts signal transmission to the brain. Roughly two thirds of patients with GBS contract the illness shortly after a severe viral, respiratory or bacterial infection.
“Although the number of documented cases internationally is notably small to date, it’s not completely surprising that a COVID-19 diagnosis may lead to a patient developing GBS. In fact, similar connections were made during the 2016 Zika virus outbreak,” said Sandeep Rana, MD, neurologist at AGH and lead author of the case study. “The increase of inflammation and inflammatory cells caused by the infection may trigger an irregular immune response that leads to the hallmark symptoms of this neurological disorder.”
Patients diagnosed with GBS will experience progressive, ascending, symmetrical paralysis of the arms and legs, with or without cranial nerve involvement. For many, the disorder initially presents itself with tingling or numbness in the lower portion of the body and advances upward, with muscles losing complete ability to respond to stimuli. In extremely severe cases, patients may progress to total paralysis.
According to a case study published in April in the Journal of Clinical Neuroscience, COVID-19 stimulates inflammatory cells and produces various inflammatory proteins or “cytokines” and as a result, creates immune-mediated processes. Since GBS is an immune-mediated disorder, the molecular imitation of the body’s response may play a critical factor.
In “Novel Coronavirus (COVID-19) Associated Guillain-Barré Syndrome: Case Report,” (doi: 10.1097/CND.0000000000000309) a 54-year-old man was transferred to AGH with ascending limb weakness and numbness that followed symptoms of a severe respiratory infection. Upon arrival, clinicians noted areflexia and further diagnostic testing showed he was positive for COVID-19.
He was started on a five day regimen of intravenous immunoglobulin for a presumed diagnosis of GBS. However, he continued to progress and experienced complications of elevated heart rate at rest, double vision, and burning sensation throughout the body.
During his follow up neurological examination he was noted to have profound weakness in his legs, moderated weakness in his arms and facial muscles as well as minor weakness in his muscles that control eye movement.
“The electrical abnormalities of this patient were consistent with demyelinating form of GBS syndrome. As we continue to observe COVID-19 and its manifestations, we’re anticipating that the rate of GBS incidents may be higher than initially expected,” continued Dr. Rana.
A series of similar observations have been made by clinicians at three hospitals in northern Italy in April. Published in the New England Journal of Medicine (DOI: 10.1056/NEJMc2009191), “Guillain–Barré Syndrome Associated with SARS-CoV-2,” clinicians examined five patients that developed GBS of an estimated 1,200 cases with COVID-19 infections. Introductory reports of a potential connection were also published in The Lancet from researchers in Wuhan, China (doi: 10.1016/S1474-4422(20)30109-5.)
“Since GBS can significantly affect the respiratory system and other vital organs being pushed into overdrive during a COVID-19 immune response, it will be critically important to further investigate and understand this potential connection,” Rana concluded.
For more information on Allegheny General Hospital and the Neuroscience Institute at Allegheny Health Network, visit ahn.org.
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About the Allegheny Health Network:
Allegheny Health Network (AHN.org), a Highmark Health company, is an integrated healthcare delivery system serving the greater Western Pennsylvania region. The Network is composed of 12 hospitals, ambulatory surgery centers, Health + Wellness Pavilions, an employed physician organization, home and community-based health services, a research institute, and a group purchasing organization. The Network provides patients with access to a complete spectrum of advanced medical services, including nationally recognized programs for primary and emergency care, trauma care, cardiovascular disease, organ transplantation, cancer care, orthopedic surgery, neurology and neurosurgery, women’s health, diabetes, autoimmune disease and more. AHN employs approximately 21,000 people, has more than 2,500 physicians on its medical staff and serves as a clinical campus for Drexel University College of Medicine, Temple University School of Medicine, and the Lake Erie College of Osteopathic Medicine.