Table_1_Guillain–Barré Syndrome and Variants Following COVID-19 Vaccination: Report of 13 Cases.DOCX

BackgroundAmidst growing concern about an increased risk of Guillain–Barré syndrome (GBS) following COVID-19 vaccination, clinical and electrodiagnostic features have not been fully characterized.MethodsWe retrospectively reviewed medical records of the patients diagnosed with GBS and its variants following COVID-19 vaccination at four referral hospitals during the period of the mass vaccination program in South Korea (February to October 2021).ResultsWe identified 13 patients with GBS and variants post COVID-19 vaccination: AstraZeneca vaccine (Vaxzevria) in 8, and Pfizer-BioNTech vaccine (Comirnaty) in 5. The mean time interval from vaccination to symptom onset was 15.6 days (range 4–30 days). Electrodiagnostic classification was demyelinating in 7, axonal in 4 and normal in 2 cases. Clinical manifestations were diverse with varying severity: classical GBS in 8 cases, paraparetic variant in 3, Miller-Fisher syndrome in 1 and acute cervicobrachial weakness in 1. Four patients developed respiratory failure, and 2 of them showed treatment-related fluctuations.ConclusionOur observations suggest that COVID-19 vaccines may be associated with GBS of distinctive clinical features characterized by severe quadriplegia, disproportionately frequent bilateral facial palsy or atypical incomplete variants. Continuous surveillance and further studies using robust study designs are warranted to fully assess the significance of the association.

背景：随着对COVID-19疫苗接种后 Guillain-Barré 综合征（GBS）风险增加的担忧日益加剧，临床及电生理诊断特征尚未得到全面描述。方法：我们回顾性分析了韩国大规模疫苗接种计划期间（2021年2月至10月），在四家转诊医院被诊断为GBS及其变异型并在COVID-19疫苗接种后出现的患者的病历。结果：我们确定了13名在COVID-19疫苗接种后出现GBS及其变异型的患者：其中8例为阿斯利康疫苗（Vaxzevria），5例为辉瑞-生物科技公司疫苗（Comirnaty）。疫苗接种至症状出现的中位时间间隔为15.6天（范围4-30天）。电生理诊断分类中，7例为脱髓鞘病变，4例为轴索病变，2例为正常。临床表现为多样化，严重程度不一：8例为经典GBS，3例为截瘫变异型，1例为Miller-Fisher 综合征，1例为急性颈肩部无力。4名患者出现呼吸衰竭，其中2名患者出现治疗相关的波动。结论：我们的观察结果表明，COVID-19疫苗可能与具有显著临床特征的GBS相关，这些特征包括严重的四肢瘫痪、不成比例的高频双侧面部瘫痪或非典型的不完全变异型。持续的监测以及采用稳健研究设计的进一步研究，对于全面评估这种关联的重要性是必要的。