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Sah BK, Fatima Z, Sah RK, Syed B, Garg T, Chowdhury S, Ghosh B, Kunwar B, Shree A, Sah VK, Raut A. Guillain-Barre syndrome following COVID-19 vaccination: a study of 70 case reports. Ann Med Surg (Lond) 2024; 86:2067-2080. [PMID: 38576928 PMCID: PMC10990410 DOI: 10.1097/ms9.0000000000001915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 02/25/2024] [Indexed: 04/06/2024] Open
Abstract
Background and objective Guillain-Barre syndrome (GBS) has been found to have some interesting association with vaccinations. This paper mainly focuses on exploring different associations between COVID-19 vaccination and GBS. Methods Electronic databases such as PubMed, Google Scholar, Cochrane, and Embase were searched using MESH terms for case reports published till 1 August 2023 from which 70 case reports were documented involving 103 individuals from 23 different countries. Result and discussion The case reports were from a wide range of individuals aged from 13 to 87 years with an average age of 53±20 interquartile range years along with male predominance. The average time between receiving the vaccine and the onset of symptoms was 13.08±2.14 days. Prominent clinical features included back pain, facial diplegia, weakness, and paraesthesia whereas the main diagnostic studies were cerebrospinal fluid (CSF) analysis and electromagnetic studies. The principal diagnostic clue was albumin-cytological dissociation in CSF while being negative for anti-ganglioside antibodies or SARS-CoV-2. Available treatment options consisted of intravenous immunoglobulin and Plasmapheresis. Patients with comorbidities such as diabetes mellitus, hypertension, dyslipidemia, permanent atrial fibrillation, hypothyroidism, Hashimoto's thyroiditis, Chronic Obstructive Pulmonary Disease, asthma, osteoporosis, migraine, rheumatoid arthritis, osteoarthritis, ulcerative colitis, coeliac disease, seizures, bipolar disorder, endometriosis, multiple sclerosis, bell's palsy, squamous cell carcinoma, prostate cancer were included in our study. Conclusion Overall, this review evaluated innovative and clinically relevant associations between COVID-19 vaccination and GBS. Understanding of this uncommon potential side effect of COVID-19 vaccination is crucial for prompt diagnosis and appropriate treatment. Importantly, GBS should not be considered a contraindication to vaccination. This underscores the importance of ongoing research to enhance the safety and efficacy of COVID-19 vaccination efforts.
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Affiliation(s)
| | - Zahra Fatima
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Bushra Syed
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Tulika Garg
- Government Medical College and Hospital, Chandigarh
| | | | - Bikona Ghosh
- Government Medical College and Hospital, Chandigarh
| | | | - Anagha Shree
- SGT Medical college and research institute, Gurgaon, India
| | - Vivek Kumar Sah
- Universal College of Medical Sciences and Teaching Hospital, Bhairahawa
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Abuawwad MT, Taha MJJ, Taha AJ, Kozaa YA, Falah O, Abuawwad IT, Hammad EM, Mahmoud AA, Aladawi M, Serhan HA. Guillain-Barré syndrome after COVID-19 vaccination: A systematic review and analysis of case reports. Clin Neurol Neurosurg 2024; 238:108183. [PMID: 38401232 DOI: 10.1016/j.clineuro.2024.108183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 02/16/2024] [Accepted: 02/17/2024] [Indexed: 02/26/2024]
Abstract
INTRODUCTION Cases of Guillain-Barré Syndrome (GBS) have been believed to be associated with the novel COVID-19 infection, and also with the following vaccines developed against the infection. Our work aims to investigate the incidence of GBS after COVID-19 vaccination, and describe its clinical characteristics and potential confounders. METHODS An electronic search was conducted through four databases: PubMed, Scopus, medRxiv, and Google Scholar for all case reports and case series describing after COVID-19 vaccine administration. All published articles from inception until November 1st, 2022 were included. Differences between groups were assessed using Pearson chi-square test. Modified Erasmus GBS Outcome Score (mEGOS) for the ability to walk after GBS was calculated for all cases with sufficient clinical data, and Kaplan-Meier survival analysis was performed to study the effect of vaccine type on the relationship between vaccination time and complication of GBS. RESULTS About 103 studies describing 175 cases of GBS following COVID-19 vaccination were included. The Acute Inflammatory Demyelinating Polyradiculoneuropathy subtype was the most reported subtype with 74 cases (42.29%). The affected age group averaged around 53.59 ±18.83 years, with AMSAN occurring in a rather older group (63.88 ±20.87 years, p=0.049). The AstraZeneca vaccine was associated with AIDP (n=38, 21.71%) more than other vaccines, p=0.02. The bilateral facial palsy subtype was mostly linked to adenoviral vector vaccinations, accounting for an average of 72% of the total BFP cases. Dysesthesias was the most reported sensory complication (60%, p=0.349). Most GBS patients survived (96%, p=0.036), however, most patients had low mEGOS scores (4 ±3.57, p<0.01). On average, patients developed GBS at 13.43 ±11.45 days from vaccination (p=0.73), and survival analysis for complication of GBS into mechanical ventilation or walking impairment yielded a severely increased probability of complication after 25 days (p<0.01). Intravenous immunoglobulins (p=0.03) along with rehabilitation (p=0.19) were the most commonly used treatment. CONCLUSION This work investigates the incidence of Guillain-Barré Syndrome after COVID-19 vaccination. Most cases occurred after receiving the AstraZeneca or Pfizer vaccines, and despite low mortality rates, ambulation was compromised in most patients. A higher risk of GBS complication is associated with an onset later than 12-13 days, particularly with Pfizer, AstraZeneca, and Moderna vaccines. No specific predisposing or prognostic factor was identified, and the relation between the COVID-19 vaccines and GBS remain unclear.
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Affiliation(s)
- Mohammad T Abuawwad
- Department of Clinical Medicine, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohammad J J Taha
- Department of Clinical Medicine, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmad J Taha
- Department of Clinical Medicine, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yasmeena Abdelall Kozaa
- Mansoura Manchester Programme For Medical Education, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Obaida Falah
- Department of Clinical Medicine, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ibrahim T Abuawwad
- Department of Clinical Medicine, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Elsayed Mohamed Hammad
- Department of Clinical Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ayman A Mahmoud
- Rheumatology and Clinical Immunology Unit, Internal Medicine Department, Faculty of Medicine, Cairo University, Egypt
| | - Mohammad Aladawi
- Department of Neurological Sciences, University of Nebraska Medical Center, Nebraska, USA
| | - Hashem Abu Serhan
- Department of Ophthalmology, Hamad Medical Corporations, Doha, Qatar.
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Tayebi A, Samimisedeh P, Jafari Afshar E, Mahmoudnia S, Milan N, Ayati A, Madady A, Rastad H. Neuromuscular diseases associated with COVID-19 vaccines: a systematic review and pooled analysis of 258 patients. BMC Neurol 2023; 23:437. [PMID: 38082244 PMCID: PMC10712145 DOI: 10.1186/s12883-023-03486-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/04/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Neuromuscular diseases (NMD) emerged as one of the main side effects of the COVID-19 vaccination. We pooled and summarized the evidence on the clinical features and outcomes of NMD associated with COVID-19 vaccination. METHODS We comprehensively searched three databases, Medline, Embase, and Scopus, using the key terms covering "Neuromuscular disease" AND "COVID-19 vaccine", and pooled the individual patient data extracted from the included studies. RESULTS A total of 258 NMD cases following COVID-19 have been reported globally, of which 171 cases were Guillain-Barré syndrome (GBS), 40 Parsonage-Turner syndrome (PTS), 22 Myasthenia Gravis (MG), 19 facial nerve palsy (FNP), 5 single fiber neuropathy, and 1 Tolosa-Hunt syndrome. All (100%) SFN patients and 58% of FNP patients were female; in the remaining NMDs, patients were predominantly male, including MG (82%), GBS (63%), and PTS (62.5%). The median time from vaccine to symptom was less than 2 weeks in all groups. Symptoms mainly appeared following the first dose of vector vaccine, but there was no specific pattern for mRNA-based. CONCLUSION COVID-19 vaccines might induce some NMDs, mainly in adults. The age distribution and gender characteristics of affected patients may differ based on the NMD type. About two-thirds of the cases probably occur less than 2 weeks after vaccination.
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Affiliation(s)
- Amirhossein Tayebi
- Cardiovascular Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Parham Samimisedeh
- Cardiovascular Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Elmira Jafari Afshar
- Cardiovascular Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Saeideh Mahmoudnia
- Department of Neurology, Shahid Rajaei Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Nesa Milan
- Center of Orthopedic Trans-Disciplinary Applied Research (COTAR), Department of Orthopedics, Tehran university of medical sciences, Tehran, Iran
| | - Aryan Ayati
- Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Aryan Madady
- Department of Neurology, Shahid Rajaei Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Hadith Rastad
- Cardiovascular Research Center, Alborz University of Medical Sciences, Karaj, Iran.
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Wali S, Gutte S, Yadav S, Gurjar M, Paliwal VK, Singh V, Azim A, Poddar B. Quadriparesis with different diagnoses after COVID-19 vaccination: Case series and literature review. J Family Med Prim Care 2023; 12:1724-1729. [PMID: 37767414 PMCID: PMC10521858 DOI: 10.4103/jfmpc.jfmpc_2274_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 09/29/2023] Open
Abstract
Following vaccination with adenoviral vector-based ChAdOx1 nCoV-19, serious neurological adverse events have been reported. Here we report two cases who presented with quadriparesis following the adenoviral vector-based ChAdOx1 nCoV-19 vaccine. A 55-year-old male patient presented with quadriparesis after 8 days of the second dose of ChAdOx1 nCoV-19 vaccination. Imaging showed features of stroke with right basilar artery thrombosis; he was started on anticoagulation following which the patient's neurological status improved and he was discharged during the 7th week of hospital stay. A 19-year-old male patient presented with quadriparesis after 16 days of the first dose of ChAdOx1 nCoV-19 vaccination. Cerebral spinal fluid and nerve conduction study was suggestive of Guillain-Barre syndrome (GBS). Two doses of intravenous immunoglobulin were given, following which the patient's neurological status improved and he was discharged in the 11th week of his hospital stay. Awareness of neurological adverse effects and emphasis on the underlying mechanism of vaccine-induced thrombotic thrombocytopenia (VITT) and molecular mimicry in patients presenting with quadriparesis following ChAdOx1 nCoV-19 vaccination is important.
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Affiliation(s)
- Sachin Wali
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Shreyas Gutte
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Shubham Yadav
- Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Mohan Gurjar
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Vimal K. Paliwal
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Vivek Singh
- Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Afzal Azim
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Banani Poddar
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
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Shaheen N, Ramadan A, Nashwan AJ, Shaheen A, Ahmad S, Motawea KR, Mohamed S, Mohamed RS, Swed S, Aiash H. Guillain-Barré syndrome following COVID-19 vaccination: An updated systematic review of cases. Clin Case Rep 2023; 11:e7456. [PMID: 37305891 PMCID: PMC10248205 DOI: 10.1002/ccr3.7456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 05/03/2023] [Accepted: 05/18/2023] [Indexed: 06/13/2023] Open
Abstract
Key Clinical Message Guillain-Barré syndrome (GBS) is a rare but possible complication that may occur after COVID-19 vaccination. In this systematic review, we found that GBS presented in patients with an average age of 58. The average time for symptoms to appear was 14.4 days. Health care providers should be aware of this potential complication. Abstract Most instances of Guillain-Barré syndrome (GBS) are caused by immunological stimulation and are discovered after vaccinations for tetanus toxoid, oral polio, and swine influenza. In this systematic study, we investigated at GBS cases that were reported after receiving the COVID-19 vaccination. Based on PRISMA guidelines, we searched five databases (PubMed, Google Scholar, Ovid, Web of Science, and Scopus databases) for studies on COVID-19 vaccination and GBS on August 7, 2021. To conduct our analysis, we divided the GBS variants into two groups, acute inflammatory demyelinating polyneuropathy and non-acute inflammatory demyelinating polyneuropathy (AIDP and non-AIDP), and compared the two groups with mEGOS and other clinical presentation In this systematic review, 29 cases were included in 14 studies. Ten cases belonged to the AIDP variant, 17 were non-AIDP (one case had the MFS variant, one AMAN variant, and 15 cases had the BFP variant), and the two remaining cases were not mentioned. Following COVID-19 vaccination, GBS cases were, on average, 58 years of age. The average time it took for GBS symptoms to appear was 14.4 days. About 56 percent of the cases (56%) were classified as Brighton Level 1 or 2, which defines the highest level of diagnostic certainty for patients with GBS. This systematic review reports 29 cases of GBS following COVID-19 vaccination, particularly those following the AstraZeneca/Oxford vaccine. Further research is needed to assess all COVID-19 vaccines' side effects, including GBS.
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Affiliation(s)
- Nour Shaheen
- Faculty of MedicineAlexandria UniversityAlexandriaEgypt
- Department of Neurosurgery and Brain RepairUniversity of South FloridaTampaFloridaUSA
| | | | | | - Ahmed Shaheen
- Faculty of MedicineAlexandria UniversityAlexandriaEgypt
| | - Shahzaib Ahmad
- King Edward Medical College: King Edward Medical UniversityLahorePakistan
| | | | | | | | - Sarya Swed
- Faculty of MedicineAleppo UniversityAleppoSyria
| | - Hani Aiash
- Cardiovascular Perfusion DepartmentUpstate Medical UniversitySyracuseNew YorkUSA
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Reddy YM, Murthy JMK, Osman S, Jaiswal SK, Gattu AK, Pidaparthi L, Boorgu SK, Chavan R, Ramakrishnan B, Yeduguri SR. Guillain-Barré syndrome associated with SARS-CoV-2 vaccination: how is it different? a systematic review and individual participant data meta-analysis. Clin Exp Vaccine Res 2023; 12:143-155. [PMID: 37214140 PMCID: PMC10193105 DOI: 10.7774/cevr.2023.12.2.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/20/2023] [Accepted: 03/31/2023] [Indexed: 05/24/2023] Open
Abstract
Purpose An association between Guillain-Barré syndrome (GBS) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccination has been reported. We aimed to summarize the clinical features of GBS associated with SARS-CoV-2 vaccination and determine the contrasting features from coronavirus disease-19 (COVID-19) associated GBS and GBS following other causes. Materials and Methods We performed PubMed search for articles published between 1 December 2020 and 27 January 2022 using search terms related to "SARS-CoV-2 vaccination" and "GBS". Reference searching of the eligible studies was performed. Sociodemographic and vaccination data, clinical and laboratory features, and outcomes were extracted. We compared these findings with post-COVID-19 GBS and International GBS Outcome Study (IGOS) (GBS from other causes) cohorts. Results We included 100 patients in the analysis. Mean age was 56.88 years, and 53% were males. Six-eight received non-replicating virus vector and 30 took messenger RNA (mRNA) vaccines. The median interval between the vaccination and the GBS onset was 11 days. Limb weakness, facial palsy, sensory symptoms, dysautonomia, and respiratory insufficiency were seen in 78.65%, 53.3%, 77.4%, 23.5%, and 25%, respectively. The commonest clinical and electrodiagnostic subtype were sensory-motor variant (68%) and acute inflammatory demyelinating polyneuropathy (61.4%), respectively. And 43.9% had poor outcome (GBS outcome score ≥3). Pain was common with virus vector than mRNA vaccine, and the latter had severe disease at presentation (Hughes grade ≥3). Sensory phenomenon and facial weakness were common in vaccination cohort than post-COVID-19 and IGOS. Conclusion There are distinct differences between GBS associated with SARS-CoV-2 vaccination and GBS due to other causes. Facial weakness and sensory symptoms were commonly seen in the former and outcomes poor.
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Affiliation(s)
| | | | - Syed Osman
- Department of Neurology, CARE Hospital, Hyderabad, India
| | | | | | | | | | - Roshan Chavan
- Department of Neurology, CARE Hospital, Hyderabad, India
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Ogunjimi OB, Tsalamandris G, Paladini A, Varrassi G, Zis P. Guillain-Barré Syndrome Induced by Vaccination Against COVID-19: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e37578. [PMID: 37193456 PMCID: PMC10183219 DOI: 10.7759/cureus.37578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 04/14/2023] [Indexed: 05/18/2023] Open
Abstract
Guillain-Barré syndrome (GBS) is a rare but serious immune-mediated neurological condition characterized by damage to the peripheral nervous system. Two-thirds of cases of GBS are diagnosed following infection; however, vaccination has also been linked to GBS pathogenesis. The aim of this systematic review and meta-analysis was to establish the prevalence of GBS following vaccination against the SARS-CoV-2 virus, which causes COVID-19, describe the clinical and neurophysiological characteristics, and identify potential determinants. A systematic review of the literature regarding post-vaccination GBS was conducted using the PubMed database. Seventy papers were included. The pooled prevalence of GBS after vaccination against COVID-19 per has been established to be 8.1 (95% CI 30-220) per 1,000,000 vaccinations. Vaccination with vector vaccines - but not mRNA - has been associated with an increased risk of GBS. More than 80% of the patients developed GBS within 21 days following the first dose of the vaccination. The interval between the vaccination and GBS was shorter in patients who were vaccinated with mRNA versus vector vaccines (9.7±6.7 days versus 14.2±6.6 days). Epidemiological findings regarding post-vaccination GBS revealed a higher prevalence in males and people between the ages of 40 and 60 years, with a mean age of 56.8±16.1 years. The most common type was the acute inflammatory demyelinating polyneuropathy type. Most cases responded well to treatment. In conclusion, vaccination against COVID-19 with vector vaccines seems to increase the risk of GBS. GBS occurring following vaccination does differ in characteristics from GBS during the pre-COVID-19 era.
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Acute and Chronic Demyelinating Neuropathies After COVID-19 Vaccination: A Report of 4 Cases. J Clin Neuromuscul Dis 2023; 24:147-156. [PMID: 36809202 DOI: 10.1097/cnd.0000000000000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVES To report demyelinating neuropathies after COVID-19 vaccination. METHODS Case report. RESULTS Four cases of demyelinating neuropathies after COVID-19 vaccination were identified at the University of Nebraska Medical Center from May to September 2021. Three were male and 1 was a female, ages 26-64 years. Three cases received Pfizer-BioNTech vaccine and 1 Johnson & Johnson. Symptom onset ranged from 2 to 21 days after vaccination. Two cases had progressive limb weakness, 3 had facial diplegia, and all had sensory symptoms and areflexia. The diagnosis was acute inflammatory demyelinating polyneuropathy in 1 case and chronic inflammatory demyelinating polyradiculoneuropathy in 3. All cases received treatment with intravenous immunoglobulin, with significant improvement in 3 of 4 who had a long-term outpatient follow-up. CONCLUSIONS Continued identification and reporting of cases of demyelinating neuropathies after COVID-19 vaccination is essential to determine whether a causative association is present.
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Albakri K, Khaity A, Atwan H, Saleh O, Al-Hajali M, Cadri S, Diab RA, Albazee E, Negida A. Bell's Palsy and COVID-19 Vaccines: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2023; 11:vaccines11020236. [PMID: 36851114 PMCID: PMC9961047 DOI: 10.3390/vaccines11020236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Once the COVID-19 pandemic was declared, the world was waiting for the clue that would be able to cut down the progression of the disease. Vaccines play a crucial role in reducing the disease and saving many people worldwide. However, there are several side effects of these vaccines, like pain, fatigue, fever, and neurological defects like Bell's palsy. In this systematic review, we presented evidence about the occurrence of Bell's palsy followed by COVID-19 vaccination. METHODS We searched PubMed, SCOPUS, EBSCO, and Web of Science (WOS) from inception till October 2022. The quality assessment was conducted using the Joanna Briggs Institute, National Institute of Health, and Newcastle-Ottawa. The analysis was conducted on SPSS. RESULTS Thirty-five records were involved in our study. The results of our cases revealed that most of the patients (62.8%) experienced unilateral facial paralysis. Also, the majority of the cases were reported after the first dose, and most cases were after Pfizer, AstraZeneca, and Sputnik V vaccines, respectively. The patients who were treated with corticosteroids, IVIG, and anti-viral drugs, showed marked recovery afterward. CONCLUSION The rate ratio of Bell's palsy after COVID-19 vaccination was 25.3 per 1,000,000. The ratio was higher after the first dose compared to the second dose and was higher among those who took Oxford/AstraZeneca vaccine compared to other vaccines. However, this condition was reported in a small number of cases among a large number of vaccinated people worldwide. It is important to note that the benefits of getting vaccinated far outweigh any potential risks.
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Affiliation(s)
- Khaled Albakri
- Department of Surgery, Faculty of Medicine, The Hashemite University, Zarqa 13133, Jordan
- Medical Research Group of Egypt (MRGE), Cairo 11511, Egypt
| | - Abdulrhman Khaity
- Medical Research Group of Egypt (MRGE), Cairo 11511, Egypt
- Department of Surgery, Faculty of Medicine, Elrazi University, Khartoum 1115, Sudan
| | - Hany Atwan
- Medical Research Group of Egypt (MRGE), Cairo 11511, Egypt
- Department of Surgery, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Othman Saleh
- Department of Surgery, Faculty of Medicine, The Hashemite University, Zarqa 13133, Jordan
| | - Momen Al-Hajali
- Department of Surgery, Faculty of Medicine, The Hashemite University, Zarqa 13133, Jordan
| | - Shirin Cadri
- Medical Research Group of Egypt (MRGE), Cairo 11511, Egypt
- Department of Dermatology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Lasi, Romania
| | - Rehab Adel Diab
- Medical Research Group of Egypt (MRGE), Cairo 11511, Egypt
- Department of Surgery, Faculty of Medicine, Al-Azhar University, Cairo 11651, Egypt
| | - Ebraheem Albazee
- Medical Research Group of Egypt (MRGE), Cairo 11511, Egypt
- Department of Internship, Kuwait Institute for Medical Specializations (KIMS), Kuwait City 13109, Kuwait
- Correspondence:
| | - Ahmed Negida
- Medical Research Group of Egypt (MRGE), Cairo 11511, Egypt
- Department of Surgery, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt
- Department of Global Health, Harvard Medical School, Boston, MA 02115, USA
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Hromić-Jahjefendić A, Barh D, Uversky V, Aljabali AA, Tambuwala MM, Alzahrani KJ, Alzahrani FM, Alshammeri S, Lundstrom K. Can COVID-19 Vaccines Induce Premature Non-Communicable Diseases: Where Are We Heading to? Vaccines (Basel) 2023; 11:vaccines11020208. [PMID: 36851087 PMCID: PMC9960675 DOI: 10.3390/vaccines11020208] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/05/2023] [Accepted: 01/13/2023] [Indexed: 01/20/2023] Open
Abstract
According to the WHO, as of January 2023, more than 850 million cases and over 6.6 million deaths from COVID-19 have been reported worldwide. Currently, the death rate has been reduced due to the decreased pathogenicity of new SARS-CoV-2 variants, but the major factor in the reduced death rates is the administration of more than 12.8 billion vaccine doses globally. While the COVID-19 vaccines are saving lives, serious side effects have been reported after vaccinations for several premature non-communicable diseases (NCDs). However, the reported adverse events are low in number. The scientific community must investigate the entire spectrum of COVID-19-vaccine-induced complications so that necessary safety measures can be taken, and current vaccines can be re-engineered to avoid or minimize their side effects. We describe in depth severe adverse events for premature metabolic, mental, and neurological disorders; cardiovascular, renal, and autoimmune diseases, and reproductive health issues detected after COVID-19 vaccinations and whether these are causal or incidental. In any case, it has become clear that the benefits of vaccinations outweigh the risks by a large margin. However, pre-existing conditions in vaccinated individuals need to be taken into account in the prevention and treatment of adverse events.
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Affiliation(s)
- Altijana Hromić-Jahjefendić
- Department of Genetics and Bioengineering, Faculty of Engineering and Natural Sciences, International University of Sarajevo, Hrasnicka Cesta 15, 71000 Sarajevo, Bosnia and Herzegovina
| | - Debmalya Barh
- Department of Genetics, Ecology and Evolution, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
- Institute of Integrative Omics and Applied Biotechnology (IIOAB), Nonakuri, Purba Medinipur 721172, India
- Correspondence: (D.B.); (K.L.)
| | - Vladimir Uversky
- Department of Molecular Medicine and USF Health Byrd Alzheimer's Institute, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
| | - Alaa A. Aljabali
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Yarmouk University, P.O. Box 566, Irbid 21163, Jordan
| | - Murtaza M. Tambuwala
- Lincoln Medical School, Brayford Pool Campus, University of Lincoln, Lincoln LN6 7TS, UK
| | - Khalid J. Alzahrani
- Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Fuad M. Alzahrani
- Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Saleh Alshammeri
- Department of Optometry, College of Applied Medical Sciences, Qassim University, Buraydah 51452, Saudi Arabia
| | - Kenneth Lundstrom
- PanTherapeutics, Route de Lavaux 49, CH1095 Lutry, Switzerland
- Correspondence: (D.B.); (K.L.)
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Yu M, Nie S, Qiao Y, Ma Y. Guillain-Barre syndrome following COVID-19 vaccines: A review of literature. Front Immunol 2023; 14:1078197. [PMID: 36875094 PMCID: PMC9975597 DOI: 10.3389/fimmu.2023.1078197] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/03/2023] [Indexed: 02/17/2023] Open
Abstract
Objective This study aimed to retrospectively analyze reported Guillain-Barré syndrome (GBS) cases that occurred after COVID-19 vaccination. Methods Case reports of GBS following COVID-19 vaccination that were published before May 14, 2022, were retrieved from PubMed. The cases were retrospectively analyzed for their basic characteristics, vaccine types, the number of vaccination doses before onset, clinical manifestations, laboratory test results, neurophysiological examination results, treatment, and prognosis. Results Retrospective analysis of 60 case reports revealed that post-COVID-19 vaccination GBS occurred mostly after the first dose of the vaccination (54 cases, 90%) and was common for DNA vaccination (38 cases, 63%), common in middle-aged and elderly people (mean age: 54.5 years), and also common in men (36 cases, 60%). The mean time from vaccination to onset was 12.3 days. The classical GBS (31 cases, 52%) was the major clinical classification and the AIDP subtype (37 cases, 71%) was the major neurophysiological subtype, but the positive rate of anti-ganglioside antibodies was low (7 cases, 20%). Bilateral facial nerve palsy (76% vs 18%) and facial palsy with distal paresthesia (38% vs 5%) were more common for DNA vaccination than for RNA vaccination. Conclusion After reviewing the literature, we proposed a possible association between the risk of GBS and the first dose of the COVID-19 vaccines, especially DNA vaccines. The higher rate of facial involvement and a lower positive rate of anti-ganglioside antibodies may be a characteristic feature of GBS following COVID-19 vaccination. The causal relationship between GBS and COVID-19 vaccination remains speculative, more research is needed to establish an association between GBS and COVID-19 vaccination. We recommend surveillance for GBS following vaccination, because it is important in determining the true incidence of GBS following COVID-19 vaccination, as well as in the development of a more safer vaccine.
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Affiliation(s)
- Miao Yu
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China.,Department of Neurology, Shenyang First People's Hospital, Shenyang, China
| | - Shuang Nie
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yue Qiao
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ying Ma
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
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12
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Tsai PF, Chen YJ. Case report: Early onset Marin-Amat syndrome after receiving ChAdOx1 nCoV-19 vaccination. Front Med (Lausanne) 2022; 9:894755. [DOI: 10.3389/fmed.2022.894755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
While vaccination against COVID-19 is still ongoing, some rare adverse events temporally related to vaccinations have been reported, particularly with ChAdOx1 nCoV-19. Here, a 77-year-old male presented to our outpatient department with persistent ptosis of his left eye for 1 month. He initially received vaccination with ChAdOx1 nCoV-19 and developed symptoms of Bell's palsy 3 days later. He received a 14-day course of prednisolone, but the ptosis persisted. Marin-Amat syndrome was compatible with his symptoms of ptosis exacerbation during orbicularis oris exertion. A temporal correlation between ChAdOx1 nCoV-19 vaccination and Bell's palsy without infectious or autoimmune diseases was delineated. Further studies are needed to clarify the possible relationship between these two events.
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13
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Castillo RA, Castrillo JCM. [NEUROLOGICAL MANIFESTATIONS ASSOCIATED WITH COVID-19 VACCINE]. Neurologia 2022:S0213-4853(22)00187-6. [PMID: 36245941 PMCID: PMC9554338 DOI: 10.1016/j.nrl.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) has spread rapidly, giving rise to a pandemic, causing significant morbidity and mortality. In this context, many vaccines have emerged to try to deal with this disease. OBJECTIVE To review the reported cases of neurological manifestations after the application of COVID-19 vaccines, describing clinical, analytical and neuroimaging findings and health outcomes. METHODS We carried out a review through bibliographic searches in PubMed. RESULTS We found 86 articles, including 13,809 patients with a wide spectrum of neurological manifestations temporally associated with COVID-19 vaccination. Most occurred in women (63.89%), with a median age of 50 years. The most frequently reported adverse events were Bell's palsy 4936/13809 (35.7%), headache (4067/13809), cerebrovascular events 2412/13809 (17.47%), Guillain-Barré syndrome 868/13809 (6.28%), central nervous system demyelination 258/13809 (1.86%) and functional neurological disorder 398/13809 (2.88%). Most of the published cases occurred in temporal association with the Pfizer vaccine (BNT162b2), followed by the AstraZeneca vaccine (ChAdOX1 nCoV-19). CONCLUSIONS It is not possible to establish a causal relationship between these adverse events and COVID-19 vaccines with the currently existing data, nor to calculate the frequency of appearance of these disorders. However, it is necessary for health professionals to be familiar with these events, facilitating their early diagnosis and treatment. Large controlled epidemiological studies are necessary to establish a possible causal relationship between vaccination against COVID-19 and neurological adverse events.
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Affiliation(s)
- Rocío Alonso Castillo
- Servicio de Neurología. Hospital Universitario Ramón y Cajal. Universidad de Alcalá, Spain
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14
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Development of facial palsy following COVID-19 vaccination: A systematic review. Ann Med Surg (Lond) 2022; 82:104758. [PMID: 36212732 PMCID: PMC9530738 DOI: 10.1016/j.amsu.2022.104758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 01/09/2023] Open
Abstract
Objective Reports of facial palsy occurring after the receipt of COVID-19 vaccines have raised concerns but are rare. The purpose of this study is to systematically assess the association between COVID-19 vaccination and facial palsy. Methods Our systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist and compiled all the reported cases of facial palsy post-COVID-19 vaccination. We discussed the probable pathophysiology behind facial palsy as a consequence of COVID-19 vaccination and measures to be taken for future reference. Furthermore, we conducted a detailed assessment of characteristics, clinical courses, treatment, and recovery of patients with facial palsy after receiving a COVID-19 vaccine. Results We included 37 studies providing data on 58 individuals in our review. Over half (51.72%) of the patients complained of facial paralysis following the Oxford-AstraZeneca vaccination. Out of 51 cases, most (88.24%) occurred after the 1st dose. The majority (53.45%) of cases had bilateral facial palsy. Intravenous immunoglobin (IVIg), corticosteroids, and plasmapheresis were the first line of treatment with 75.93% of patients partially recovered, including those undergoing treatment or a lack of follow-up till the end while 22.22% had complete symptomatic recovery. Conclusions Our review shows that Bell's palsy can be a plausible non-serious adverse effect of COVID-19 vaccination. However, the association observed between COVID-19 vaccination and Bell's palsy is less threatening than the COVID-19 infection. Hence, vaccination should be encouraged because facial palsy, if it occurs, has shown favourable outcomes with treatment.
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15
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Guillain-Barré syndrome in association with COVID-19 vaccination: a systematic review. Immunol Res 2022; 70:752-764. [PMID: 36098903 PMCID: PMC9469827 DOI: 10.1007/s12026-022-09316-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/01/2022] [Indexed: 12/02/2022]
Abstract
Since the beginning of worldwide vaccination against coronavirus disease 2019 (COVID-19), studies have reported a possible association between vaccination and Guillain-Barré syndrome (GBS). In this regard, we conducted a systematic review assessing different demographic, clinical, and neurophysiological aspects of patients with GBS following immunization with COVID-19 vaccines. A comprehensive search of PubMed, Web of Science, Scopus, and Google Scholar was performed. Articles in English between January 2020 and November 2021 were included. Data on demographics, clinical characteristics, vaccines information, treatment approaches, and outcomes were extracted. The data of a total of 88 patients out of 41 studies was included. The mean age of patients was 58.7 ± 16.6 years and 55 cases (62.5%) were male. AstraZeneca was the most-reported vaccine associated with GBS with 52 cases (59.1%) followed by Pfizer with 20 cases (22.7%). GBS occurred after the first dose of vaccination in 70 cases (79.5%). The mean time interval between vaccination and symptom onset was 13.9 ± 7.4 days. Limb weakness (47.7%), sensory disturbance (38.6%), and facial weakness (27.3%) were the most common reported symptoms, respectively. Albuminocytologic dissociation was seen in 65% of patients who underwent lumbar puncture (n = 65). Acute inflammatory demyelinating polyradiculopathy was the most common GBS subtype, which was reported in 38 patients (43.2%). While one-fifth of patients underwent intubation (n = 17), a favorable outcome was achieved in the majority of subjects (n = 46, 63%). Overall, a small rise in GBS incidence, following various COVID-19 vaccines, was observed. Notably, 85% of affected individuals experienced at least a partial recovery.
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16
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Otero-Losada M, Petrovsky N, Alami A, Crispo JAG, Mattison D, Capani F, Goetz C, Krewski D, Perez-Lloret S. Disproportionality analysis of adverse neurological and psychiatric reactions with the ChAdOx1 (Oxford-AstraZeneca) and BNT162b2 (Pfizer-BioNTech) COVID-19 vaccines in the United Kingdom. Expert Opin Drug Saf 2022; 22:343-349. [PMID: 36043937 DOI: 10.1080/14740338.2022.2120607] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Information on neurological and psychiatric adverse events following immunization (AEFIs) with COVID-19 vaccines is limited. RESEARCH DESIGN & METHODS We examined and compared neurological and psychiatric AEFIS reports related to BNT162b2 (Pfizer-BioNTech) and ChAdOx1 (Oxford-AstraZeneca) COVID-19 vaccines and recorded in the United Kingdom Medicines and Healthcare products Regulatory Agency between 9/DEC/2020 and 30/JUN/2021. RESULTS As of 30/JUN/2021, 53.2 million doses of ChAdOx1 and 46.1 million doses of BNT162b2 had been administered. The most frequently reported AEFI was headache with 1,686 and 575 cases per million doses of ChAdOx1 and BNT162b2, respectively. AEFIs more frequently reported after CHAdOx1 compared with BNT162b2 vaccination were Guillain-Barré syndrome (OR, 95% CI= 2.53, 1.82-3.51), freezing (6.66, 3.12-14.22), cluster headache (1.53, 1.28-1.84), migraine (1.23,1.17-1.30), postural dizziness (1.24,1.13-1.37), tremor (2.86, 2.68-3.05), headache (1.40, 1.38-1.43), paresthesia (1.11, 1.06-1.16), delirium (1.85, 1.45-2.36), hallucination (2.20, 1.82-2.66), poor quality sleep (1.53, 1.26-1.85), and nervousness (1.54, 1.26-1.89) Reactions less frequently reported with ChAdOx1 than with BNT162b2 were Bell's palsy (0.47, 0.41-0.55), anosmia (0.58, 0.47-0.71), facial paralysis (0.35, 0.29-0.41), dysgeusia (0.68, 0.62-0.73), presyncope (0.48, 0.42-0.55), syncope (0.63, 0.58-0.67), and anxiety (0.75 (0.67-0.85). CONCLUSION Neurological and psychiatric AEFIs were relatively infrequent, but each vaccine was associated with a distinctive toxic profile.
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Affiliation(s)
- Matilde Otero-Losada
- Universidad Abierta Interamericana-Centro de Altos Estudios en Ciencias Humanas y de La Salud, Consejo Nacional de Investigaciones Científicas y Técnicas, UAI-CAECIHS CONICET, Buenos Aires, Argentina
| | - Nikolai Petrovsky
- Flinders University, Bedford Park, Australia.,Vaxine, Bedford Park, Australia
| | - Abdallah Alami
- McLaughlin Centre for Population Health Risk Assessment, Faculty of Medicine University of Ottawa, Ottawa, Canada.,Risk Sciences International, Ottawa, Canada
| | - James A G Crispo
- School of Mathematics and Statistics, Carleton University, Ottawa, Canada.,Human Sciences Division, Northern Ontario School of Medicine, Sudbury, Canada.,Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Donald Mattison
- McLaughlin Centre for Population Health Risk Assessment, Faculty of Medicine University of Ottawa, Ottawa, Canada.,Risk Sciences International, Ottawa, Canada.,Arnold School of Public Health, University of South Carolina, Columbia, USA.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Francisco Capani
- Universidad Abierta Interamericana-Centro de Altos Estudios en Ciencias Humanas y de La Salud, Consejo Nacional de Investigaciones Científicas y Técnicas, UAI-CAECIHS CONICET, Buenos Aires, Argentina.,Departamento de Biología, Universidad Argentina John F. Kennedy, Buenos Aires, Argentina.,Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago de Chile, Chile
| | - Christopher Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Daniel Krewski
- McLaughlin Centre for Population Health Risk Assessment, Faculty of Medicine University of Ottawa, Ottawa, Canada.,Risk Sciences International, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Santiago Perez-Lloret
- Laboratorio de Investigación en Ciencia de Datos, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina.,Department of Physiology, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
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17
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Safety of COVID-19 Vaccines: Spotlight on Neurological Complications. Life (Basel) 2022; 12:life12091338. [PMID: 36143376 PMCID: PMC9502976 DOI: 10.3390/life12091338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/21/2022] Open
Abstract
The COVID-19 pandemic has led to unprecedented demand on the global healthcare system. Remarkably, at the end of 2021, COVID-19 vaccines received approvals for human use in several countries worldwide. Since then, a solid base for response in the fight against the virus has been placed. COVID-19 vaccines have been shown to be safe and effective drugs. Nevertheless, all kinds of vaccines may be associated with the possible appearance of neurological complications, and COVID-19 vaccines are not free from neurological side effects. Neurological complications of COVID-19 vaccination are usually mild, short-duration, and self-limiting. However, severe and unexpected post-vaccination complications are rare but possible events. They include the Guillain-Barré syndrome, facial palsy, other neuropathies, encephalitis, meningitis, myelitis, autoimmune disorders, and cerebrovascular events. The fear of severe or fatal neurological complications fed the “vaccine hesitancy” phenomenon, posing a vital communication challenge between the scientific community and public opinion. This review aims to collect and discuss the frequency, management, and outcome of reported neurological complications of COVID-19 vaccines after eighteen months of the World Health Organization’s approval of COVID-19 vaccination, providing an overview of safety and concerns related to the most potent weapon against the SARS-CoV-2.
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18
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Bilateral Facial Weakness with Distal Paresthesia Following COVID-19 Vaccination: A Scoping Review for an Atypical Variant of Guillain-Barré Syndrome. Brain Sci 2022; 12:brainsci12081046. [PMID: 36009109 PMCID: PMC9406009 DOI: 10.3390/brainsci12081046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 07/29/2022] [Accepted: 08/04/2022] [Indexed: 12/04/2022] Open
Abstract
Background and Purpose: Recent population-based studies from the US and UK have identified an increase in the occurrence of Guillain–Barré syndrome (GBS) following coronavirus disease 2019 (COVID-19) vaccination. However, the localized variant of GBS might be underestimated due to its rarity and atypical features. We aimed to identify and characterize bilateral facial weakness with distal paresthesia (BFWdp) as a GBS variant following COVID-19 vaccination. Materials and Methods: Relevant studies published during the COVID-19 pandemic were searched and identified in the MEDLINE, Embase, and other databases. Results: This review found that 18 BFWdp cases presented characteristics similar to previous BFWdp cases as defined in the literature: male dominance, frequent albuminocytological dissociation, and acute inflammatory demyelinating neuropathy pattern. In contrast, facial nerve enhancement on brain MRI and antiganglioside antibody positivity were often observed in BFWdp following COVID-19 vaccination. Conclusions: The mechanism of BFWdp following COVID-19 vaccination appears to be somewhat different from that of sporadic BFWdp. Neurological syndromes with rare incidence and difficulty in diagnosis should be considered adverse events of COVID-19 vaccination.
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19
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Azali MA, Mohamed S, Harun A, Hussain FA, Shamsuddin S, Johan MF. Application of Baculovirus Expression Vector system (BEV) for COVID-19 diagnostics and therapeutics: a review. J Genet Eng Biotechnol 2022; 20:98. [PMID: 35792966 PMCID: PMC9259773 DOI: 10.1186/s43141-022-00368-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/20/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND The baculovirus expression vector system has been developed for expressing a wide range of proteins, including enzymes, glycoproteins, recombinant viruses, and vaccines. The availability of the SARS-CoV-2 genome sequence has enabled the synthesis of SARS-CoV2 proteins in a baculovirus-insect cell platform for various applications. The most cloned SARS-CoV-2 protein is the spike protein, which plays a critical role in SARS-CoV-2 infection. It is available in its whole length or as subunits like S1 or the receptor-binding domain (RBD). Non-structural proteins (Nsps), another recombinant SARS-CoV-2 protein generated by the baculovirus expression vector system (BEV), are used in the identification of new medications or the repurposing of existing therapies for the treatment of COVID-19. Non-SARS-CoV-2 proteins generated by BEV for SARS-CoV-2 diagnosis or treatment include moloney murine leukemia virus reverse transcriptase (MMLVRT), angiotensin converting enzyme 2 (ACE2), therapeutic proteins, and recombinant antibodies. The recombinant proteins were modified to boost the yield or to stabilize the protein. CONCLUSION This review covers the wide application of the recombinant protein produced using the baculovirus expression technology for COVID-19 research. A lot of improvements have been made to produce functional proteins with high yields. However, there is still room for improvement and there are parts of this field of research that have not been investigated yet.
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Affiliation(s)
- Muhammad Azharuddin Azali
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.,School of Agriculture Science and Biotechnology, Faculty of Bioresources and Food Industry, Universiti Sultan Zainal Abidin, 22200, Besut, Terengganu, Malaysia
| | - Salmah Mohamed
- School of Agriculture Science and Biotechnology, Faculty of Bioresources and Food Industry, Universiti Sultan Zainal Abidin, 22200, Besut, Terengganu, Malaysia
| | - Azian Harun
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Faezahtul Arbaeyah Hussain
- Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Shaharum Shamsuddin
- School of Health Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Muhammad Farid Johan
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.
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20
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Andreozzi V, D'arco B, Pagliano P, Toriello A, Barone P. Bilateral facial palsy after COVID-19 vaccination. Neurol Sci 2022; 43:4069-4079. [PMID: 35364768 PMCID: PMC8973678 DOI: 10.1007/s10072-022-05982-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/24/2022] [Indexed: 12/16/2022]
Abstract
Guillain-Barrè syndrome (GBS) is an acute immune-mediated neuropathy, possibly triggered by a recent infection or vaccination, and driven by an immune attack targeting the peripheral nervous system. GBS typically leads to ascending limb weakness, often with sensory and cranial nerve involvement 1-2 weeks after immune stimulation, but emergency and neurology physicians should be aware of its important clinical heterogeneity. In rare cases, bilateral facial nerve palsy can be the main clinical manifestation, as the case of the variant formerly known as bilateral facial weakness with paresthesias. An increasing number of case reports of GBS in patients receiving COVID-19 vaccination have been reported both during the pre-clinical phase and after large-scale authorities' approval. We report two cases of bifacial palsy with paresthesias, a rare variant of GBS, both occurring after the first dose of COVID-19 vaccine Vaxzevria™ (formerly COVID-19 vaccine AstraZeneca), showing a favorable outcome after high-dose immunoglobulin therapy, and discuss the literature of GBS post-COVID-19 vaccination.
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Affiliation(s)
- Valentina Andreozzi
- Neurology Unit, Department of Medicine and Surgery, "Scuola Medica Salernitana", University of Salerno, Fisciano, Italy
| | - Beatrice D'arco
- Neurology Unit, Department of Medicine and Surgery, "Scuola Medica Salernitana", University of Salerno, Fisciano, Italy
| | - Pasquale Pagliano
- Infective Disease Unit, Department of Medicine and Surgery, Scuola Medica Salernitana", University of Salerno, Fisciano, Italy
| | - Antonella Toriello
- Neurology Unit, Department of Medicine and Surgery, "Scuola Medica Salernitana", University of Salerno, Fisciano, Italy
| | - Paolo Barone
- Neurology Unit, Department of Medicine and Surgery, "Scuola Medica Salernitana", University of Salerno, Fisciano, Italy.
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21
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Improved Symptoms of Peripheral Facial Nerve Palsy in ChAdOx1 nCoV-19 Vaccine Recipients Following Complex Korean Medicine Treatment. JOURNAL OF ACUPUNCTURE RESEARCH 2022. [DOI: 10.13045/jar.2021.00283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Peripheral facial nerve palsy is a neurological condition/disease characterized by unilateral paralysis of the facial muscles. We report the effects of complex Korean medicine treatment in 2 patients diagnosed with Bell’s palsy who developed symptoms 3-4 days following vaccination with ChAdOx1 nCoV-19 and who received oral steroids and antiviral medications. Complex Korean medicine treatments including acupuncture, electroacupuncture, bee venom acupuncture, cupping therapy, herbal medicine, and physical therapy were performed. Symptom improvement was evaluated daily using the Numerical Rating Scale, House- Brackmann Grade, and Yanagihara’s Score. Patient 1 was hospitalized for 22 days and Patient 2 visited the outpatient clinic 20 times. In both cases, postauricular pain caused by Bell’s palsy disappeared, and symptoms of facial paralysis improved following completion of treatment. These findings could suggest that combined Korean medicine treatment may improve symptoms of peripheral facial nerve palsy.
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22
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Chua SKK, Soh QY, Saffari SE, Tan EK. Prognosis of Guillain–Barré Syndrome Linked to COVID-19 Vaccination. Brain Sci 2022; 12:brainsci12060711. [PMID: 35741597 PMCID: PMC9220921 DOI: 10.3390/brainsci12060711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/16/2022] [Accepted: 05/30/2022] [Indexed: 11/27/2022] Open
Abstract
There have been increasing reports of Guillain–Barré syndrome (GBS), a rare but debilitating neurological disease, occurring post-COVID-19 vaccination. However, the outcomes and relationships between patient demographics and clinical outcomes of post-COVID-19 vaccination GBS remain unclear. To bridge this gap, our study investigates the outcomes and clinical factors associated with poorer GBS outcomes following COVID-19 vaccination. We conducted a review and pooled analysis of detailed data extracted from 57 published cases with the relevant search strategies and criteria. The groups compared included male versus female patients, 1st dose versus 2nd dose and early onset versus late onset of GBS. Multivariate regression analysis was performed to compare the vaccine type, clinical severity and post-treatment outcomes between these groups of patients. Our results highlight for the first time that females were significantly more likely to have severe clinical presentation and poorer outcomes compared to males. Additionally, viral vector vaccines were the predominant vaccine type administered in early-onset post-COVID-19-vaccination GBS and GBS occurring after the 1st vaccination dose. It was also shown that reported cases of post-vaccination GBS generally displayed a positive response to conventional treatment and had favourable post-treatment outcomes. Through this study, we have established important links and provided assuring evidence for treatment response and post-treatment outcomes of GBS occurring post-COVID-19 vaccination. While the COVID-19 vaccination brings about much greater benefits than risks, our findings provide further impetus for greater vigilance in certain patient groups and more studies to explore the mechanisms behind these links.
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Affiliation(s)
- Shaun Kai Kiat Chua
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Rd, Singapore 30832, Singapore; (S.K.K.C.); (Q.Y.S.)
| | - Qian Ying Soh
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Rd, Singapore 30832, Singapore; (S.K.K.C.); (Q.Y.S.)
| | - Seyed Ehsan Saffari
- National Neuroscience Institute, Duke NUS Medical School, Outram Rd, Singapore 169608, Singapore;
| | - Eng-King Tan
- National Neuroscience Institute, Duke NUS Medical School, Outram Rd, Singapore 169608, Singapore;
- Correspondence:
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23
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ElSawi HA, Elborollosy A. Immune-mediated adverse events post-COVID vaccination and types of vaccines: a systematic review and meta-analysis. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2022; 34:44. [PMID: 35607386 PMCID: PMC9117608 DOI: 10.1186/s43162-022-00129-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/18/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In late 2019, Coronavirus disease 2019 has been declared as a global emergency by World Health Organization. Hopefully, recent reports of effective and safe vaccines were welcomed, and approved on emergency base. Millions of recipients had received one of the approved COVID 19 vaccines, with lots of adverse events recorded global wide.
Objective
To assess post-COVID vaccination immune-mediated adverse events and evaluate its association to specific type of vaccine global wide.
Methods
Systematic literature review and meta-analysis of published reports (since December 2020 till December 2021) on immune-mediated adverse events post-COVID vaccination.
Results
We evaluated 34 published studies; 460 cases with various adverse events post-COVID vaccination. Studies in current literature are primarily retrospective case series, isolated case reports or narrative studies. Different COVID vaccines were involved. Results’ data was subcategorized according to associated vaccine. Adverse effects of COVID-19 vaccinations included thrombotic, neurological, myocarditis, ocular, dermatological, renal, hematological events timely linked to inoculation. Each vaccine type was linked to adverse profile that differ from others.
Conclusion
High suspicion of post-vaccination adverse events is mandatory to provoke earlier detection, better understanding, optimum prevention, and management. Specific vaccine/patient risk profile is needed to selectively categorize target population to reduce morbidity and mortality post-vaccination.
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24
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Hot Topics on COVID-19 and Its Possible Association with Guillain-Barré Syndrome. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2022. [DOI: 10.3390/ctn6010007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
As the COVID-19 pandemic progresses, reports of neurological manifestations are increasing. However, despite a high number of case reports and case series on COVID-19 and Guillain-Barré-Syndrome (GBS), a causal association is still highly debated, due to the lack of case-control studies. In this opinion paper, we focus on a few clinically relevant questions regarding the possible link between GBS and SARS-CoV-2 infection or vaccination based on our personal clinical experience and literature review.
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Vaccine Hesitancy with a History of Guillain Barre Syndrome: Weighing the Risks and Benefits of SARS-CoV-2 Vaccination. IDCases 2022; 28:e01467. [PMID: 35284232 PMCID: PMC8897196 DOI: 10.1016/j.idcr.2022.e01467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 03/04/2022] [Indexed: 12/15/2022] Open
Abstract
Since the beginning of the COVID-19 pandemic, great hesitancies regarding the COVID-19 immunization have existed. The most striking adverse events reported include thrombosis with thrombocytopenia syndrome (TTS), myocarditis, and Guillain Barre Syndrome (GBS). Post-vaccination GBS is known since the time of Influenza vaccination, but several cases of GBS have also been reported in the current COVID-19 vaccination era. As a result, our patient with a history of GBS post-Influenza vaccination, went unvaccinated for SARS-CoV-2, due to fear of GBS re-activation. Consequently, he contracted COVID-19 pneumonitis complicated with deep venous thrombosis, requiring a prolonged hospitalization. Weighing the risks and benefits of vaccination to COVID-19 is difficult, especially for people with a previous history of GBS related to Influenza vaccination. We reviewed and analyzed the reported cases of GBS temporary related to COVID-19 vaccination to determine the safety of their administration in those with a history of GBS.
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Guillain-Barré syndrome associated with BNT162b2 COVID vaccination: a first case report from South Korea. Neurol Sci 2022; 43:1491-1493. [PMID: 34981285 PMCID: PMC8723705 DOI: 10.1007/s10072-021-05849-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 12/20/2021] [Indexed: 12/31/2022]
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Chang A, Yu J. Fighting Fire with Fire: Immunogenicity of Viral Vectored Vaccines against COVID-19. Viruses 2022; 14:380. [PMID: 35215973 PMCID: PMC8874888 DOI: 10.3390/v14020380] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/09/2022] [Accepted: 02/09/2022] [Indexed: 11/16/2022] Open
Abstract
The persistent expansion of the coronavirus disease 2019 (COVID-19) global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requires the rapid development of safe and effective countermeasures to reduce transmission, morbidity, and mortality. Several highly efficacious vaccines are actively being deployed around the globe to expedite mass vaccination and control of COVID-19. Notably, viral vectored vaccines (VVVs) are among the first to be approved for global distribution and use. In this review, we examine the humoral, cellular, and innate immune responses elicited by viral vectors, and the immune correlates of protection against COVID-19 in preclinical and clinical studies. We also discuss the durability and breadth of immune response induced by VVVs and boosters. Finally, we present challenges associated with VVVs and offer solutions for overcoming certain limitations of current vaccine regimens. Collectively, this review provides the rationale for expanding the portfolio of VVVs against SARS-CoV-2.
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MESH Headings
- Animals
- Antibodies, Neutralizing/blood
- Antibodies, Neutralizing/immunology
- Antibodies, Viral/blood
- Antibodies, Viral/immunology
- COVID-19/immunology
- COVID-19/prevention & control
- COVID-19 Vaccines/genetics
- COVID-19 Vaccines/immunology
- Clinical Trials as Topic
- Disease Models, Animal
- Genetic Vectors/immunology
- Immunity, Cellular
- Immunity, Humoral
- Immunity, Innate
- Immunization, Secondary
- Immunogenicity, Vaccine
- SARS-CoV-2/immunology
- Spike Glycoprotein, Coronavirus/genetics
- Vaccination
- Viral Vaccines/classification
- Viral Vaccines/genetics
- Viral Vaccines/immunology
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Affiliation(s)
- Aiquan Chang
- Beth Israel Deaconess Medical Center, Center for Virology and Vaccine Research, Harvard Medical School, Boston, MA 02115, USA
| | - Jingyou Yu
- Beth Israel Deaconess Medical Center, Center for Virology and Vaccine Research, Harvard Medical School, Boston, MA 02115, USA
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Chang YL, Chang ST. The effects of intravascular photobiomodulation on sleep disturbance caused by Guillain-Barré syndrome after Astrazeneca vaccine inoculation: Case report and literature review. Medicine (Baltimore) 2022; 101:e28758. [PMID: 35147100 PMCID: PMC8830854 DOI: 10.1097/md.0000000000028758] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/17/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Sleep disturbance is commonly noted after Guillain-Barré syndrome (GBS) and is often caused by persistent discomfort after disease survival. Intravascular laser irradiation of blood (ILIB) has been shown to be effective in pain modulation owing to the influence of nociceptive signals in the peripheral nervous system. We investigated the application of ILIB on post-Oxford -AstraZeneca vaccination GBS and evaluated its effect on sleep quality. PATIENT CONCERNS A 48-year-old woman was subsequently diagnosed with GBS after Oxford-AstraZeneca vaccination. The patient was discharged after a 5-day course of intravenous immunoglobulin administration. However, 1 week after discharge, the previously relieved symptoms flared with accompanying sleep disturbance. DIAGNOSIS AND INTERVENTIONS The patient was diagnosed with post-vaccination GBS, and persistent pain and sleep disturbances persisted after disease survival. ILIB was performed. OUTCOMES We used the Pittsburgh Sleep Quality Index before and after intravascular laser irradiation. There was a marked improvement in the sleep duration, efficiency, and overall sleep quality. The initial score was 12 out of 21 and the final score was 7 out of 21. LESSONS We found that ILIB was effective in pain modulation in post-vaccination GBS and significantly improved sleep quality.
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Affiliation(s)
- Yuan-Ling Chang
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Anesthesiology, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd., Lingya Dist., Kaohsiung, Taiwan
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Shin-Tsu Chang
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Taga A, Lauria G. COVID-19 and the Peripheral Nervous System. A 2-year review from the pandemic to the vaccine era. J Peripher Nerv Syst 2022; 27:4-30. [PMID: 35137496 PMCID: PMC9115278 DOI: 10.1111/jns.12482] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 01/31/2022] [Accepted: 01/31/2022] [Indexed: 11/29/2022]
Abstract
Increasing literature has linked COVID‐19 to peripheral nervous system (PNS) diseases. In addition, as we move from the pandemic to the vaccination era, literature interest is shifting towards the potential association between COVID‐19 vaccines and PNS manifestations. We reviewed published literature on COVID‐19, COVID‐19 vaccines and PNS manifestations between 1 January 2020 and 1 December 2021. For Guillain‐Barré syndrome (GBS), isolated cranial neuropathy (ICN) and myositis associated with COVID‐19, the demographic, clinical, laboratory, electrophysiological and imaging features were included in a narrative synthesis. We identified 169 studies on COVID‐19‐associated complications, including 63 papers (92 patients) on GBS, 29 papers (37 patients) on ICN and 11 papers (18 patients) on myositis. Additional clinical phenotypes included chronic inflammatory demyelinating polyneuropathy, vasculitic neuropathies, neuralgic amyotrophy, critical care‐related complications, and myasthenia gravis. PNS complications secondary to COVID‐19 vaccines have been reported during randomized clinical trials, in real‐world case reports, and during large‐scale surveillance programs. These mainly include cases of GBS, Bell's palsy, and cases of neuralgic amyotrophy. Based on our extensive review of the literature, any conclusion about a pathophysiological correlation between COVID‐19 and PNS disorders remains premature, and solely supported by their temporal association, while epidemiological and pathological data are insufficient. The occurrence of PNS complications after COVID‐19 vaccines seems limited to a possible higher risk of facial nerve palsy and GBS, to a degree that widespread access to the ongoing vaccination campaign should not be discouraged, while awaiting for more definitive data from large‐scale surveillance studies.
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Affiliation(s)
- Arens Taga
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Giuseppe Lauria
- Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan.,Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
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COVID-19 vaccine and autoimmunity. A new case of autoimmune hepatitis and review of the literature. J Transl Autoimmun 2022; 5:100140. [PMID: 35013724 PMCID: PMC8730708 DOI: 10.1016/j.jtauto.2022.100140] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/02/2022] [Indexed: 12/19/2022] Open
Abstract
Autoimmunity following COVID-19 vaccination has been reported. Herein, a 79-year-old man with clinical and immunological features of autoimmune hepatitis type 1 after ChAdOx1 nCoV-19 vaccination is presented. Clinical manifestations rapidly remitted after the instauration of immunomodulatory management. This case, together with a comprehensive review of the literature, illustrates the association between COVID-19 vaccines and the development of autoimmune conditions.
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Garg RK, Paliwal VK. Spectrum of neurological complications following COVID-19 vaccination. Neurol Sci 2022; 43:3-40. [PMID: 34719776 PMCID: PMC8557950 DOI: 10.1007/s10072-021-05662-9] [Citation(s) in RCA: 122] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/08/2021] [Indexed: 12/12/2022]
Abstract
COVID-19 vaccines have brought us a ray of hope to effectively fight against deadly pandemic of COVID-19 and hope to save lives. Many vaccines have been granted emergency use authorizations by many countries. Post-authorization, a wide spectrum of neurological complications is continuously being reported following COVID-19 vaccination. Neurological adverse events following vaccination are generally mild and transient, like fever and chills, headache, fatigue, myalgia and arthralgia, or local injection site effects like swelling, redness, or pain. The most devastating neurological post-vaccination complication is cerebral venous sinus thrombosis. Cerebral venous sinus is frequently reported in females of childbearing age, generally following adenovector-based vaccination. Another major neurological complication of concern is Bell's palsy that was reported dominantly following mRNA vaccine administration. Acute transverse myelitis, acute disseminated encephalomyelitis, and acute demyelinating polyneuropathy are other unexpected neurological adverse events that occur as result of phenomenon of molecular mimicry. Reactivation of herpes zoster in many persons, following administration of mRNA vaccines, has been also recorded. Considering the enormity of recent COVID-19-vaccinated population, the number of serious neurological events is miniscule. Large collaborative prospective studies are needed to prove or disprove causal association between vaccine and neurological adverse events occurring vaccination.
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Affiliation(s)
- Ravindra Kumar Garg
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh India PIN-226003
| | - Vimal Kumar Paliwal
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli road, Lucknow, India
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Acute-onset chronic inflammatory demyelinating polyneuropathy complicating SARS-CoV-2 infection and Ad26.COV2.S vaccination: report of two cases. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022; 58:116. [PMID: 36212671 PMCID: PMC9532814 DOI: 10.1186/s41983-022-00515-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background The spectrum of reported neurological sequelae associated with SARS-CoV-2 is continuously expanding, immune mediated neuropathies like Guillain-Barre syndrome (GBS) and exacerbations of preexisting chronic inflammatory demyelinating polyneuropathy (CIDP) being among them. However, respective cases of acute onset CIDP (A-CIDP) are rare. Case presentation We hereby report two cases of A-CIDP after COVID-19 infection and Ad26.COV2.S vaccination that presented with flaccid paraparesis and acroparesthesias (Case presentation 1; female, 52) and facial diplegia accompanied by acroparesthesias (Case presentation 2; male, 62), respectively. In both instances clinical, neurophysiological and CSF findings were indicative of acute inflammatory demyelinating polyneuropathy, thus both patients were initially treated with intravenous immunoglobulins resulting in clinical improvement. Nevertheless, the first patient relapsed 5 weeks after the initial episode, thus was diagnosed with GBS with treatment related fluctuations (GBS-TRF) and treated successfully with seven plasma exchange (PLEX) sessions. However, 11 weeks from symptom onset she relapsed again. Taking into account that the second relapse occurred more than 8 weeks after the first episode, the potential diagnosis of A-CIDP was reached and oral dexamethasone 40 mg/d for 4 consecutive days every 4 weeks was administered. With regards to the second patient, he relapsed > 8 weeks after the initial episode, thus was also diagnosed with A-CIDP and treated with 7 PLEX sessions followed by similar to the aforementioned corticosteroid therapy. On 2 month follow-up both patients exhibited remarkable clinical improvement. Conclusions Close surveillance of patients presenting with immune neuropathies in the context of SARS-CoV-2 infection or immunization is crucial for timely implementation of appropriate treatment. Prompt A-CIDP distinction from GBS-TRF is of paramount importance as treatment approach and prognosis between these two entities differ. Supplementary Information The online version contains supplementary material available at 10.1186/s41983-022-00515-4.
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Matovu D, Scorza FA, Scorza CA, Fiorini AC, Finsterer J. SARS-CoV-2 Infection- or Vaccination-Related Neurological Disease Requires Careful Investigation. Ann Indian Acad Neurol 2022; 25:939-940. [PMID: 36560992 PMCID: PMC9764884 DOI: 10.4103/aian.aian_304_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 04/03/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Daniel Matovu
- Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo, Brazil
| | - Fulvio A. Scorza
- Disciplina de Neurociência Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Carla A. Scorza
- Disciplina de Neurociência Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Ana C. Fiorini
- Departamento de Fonoaudiologia, Programa de Estudos Pós-Graduado em Fonoaudiologia, Pontifícia Universidade Católica de São Paulo (PUC-SP), Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - Josef Finsterer
- Neurology and Neurophysiology Center, Vienna, Austria,Address for correspondence: Prof. Josef Finsterer, Postfach 20, 1180 Vienna, Austria. E-mail:
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Chronic Inflammatory Demyelinating Polyneuropathy after ChAdOx1 nCoV-19 Vaccination. Vaccines (Basel) 2021; 9:vaccines9121502. [PMID: 34960248 PMCID: PMC8706382 DOI: 10.3390/vaccines9121502] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 11/29/2021] [Accepted: 12/07/2021] [Indexed: 12/17/2022] Open
Abstract
Recently several patients, who developed Guillain–Barré syndrome characterized by prominent bifacial weakness after ChAdOx1 nCoV-19 vaccination, were described from different centers. We recently observed a patient who developed a similar syndrome, later in the follow up he showed worsening of the neuropathy two months after the initial presentation. Repeat EMG showed reduced nerve sensory and motor conduction velocities of both upper and lower limbs, and a diagnosis of chronic inflammatory demyelinating polyneuropathy (typical CIDP) was made according to established criteria. Our report expands on the possible outcomes in patients who develop Guillain–Barrè syndrome after COVID-19 vaccinations and suggest that close monitoring after the acute phase is needed in these patients to exclude a chronic evolution of the disease, which has important implications for long-term treatment.
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Bouattour N, Hdiji O, Sakka S, Fakhfakh E, Moalla K, Daoud S, Farhat N, Damak M, Mhiri C. Guillain-Barré syndrome following the first dose of Pfizer-BioNTech COVID-19 vaccine: case report and review of reported cases. Neurol Sci 2021; 43:755-761. [PMID: 34796417 PMCID: PMC8601771 DOI: 10.1007/s10072-021-05733-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/10/2021] [Indexed: 12/03/2022]
Abstract
Background Since the SARS-CoV-2 pandemic has started in December 2019, millions of people have been infected all over the world. Vaccination is the most efficient tool to end this pandemic, but vaccine surveillance is necessary to identify side effects. Some studies have shown that neurological complications after COVID-19 vaccination are rare and dominated by demyelinating disease. Case presentation We present a case of a 67-year-old man who presented 7 days following his first dose of Pfizer-BioNTech COVID-19 vaccine a rapidly progressive ascending muscle weakness. The diagnosis of Guillain-Barré syndrome (GBS) was confirmed according to the clinical features, the albumino-cytological dissociation in the cerebrospinal fluid, and the electroneuromyography findings. The workup for all known infections associated with immune-mediated GBS was negative. The patient received treatment with intravenous immunoglobulin. Neurological examination 1 month after discharge showed full recovery and he regained his baseline functional status. Conclusions As far as we know, this is the first reported case in Tunisia. Although extremely rare, neurologists should remain vigilant for acute inflammatory demyelinating polyradiculoneuropathy after COVID-19 vaccination.
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Affiliation(s)
- Nadia Bouattour
- Neurology's Department, Habib Bourguiba Hospital, Ferdaous Street, 3029, Sfax, Tunisia. .,Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), University of Sfax, Sfax, Tunisia.
| | - Olfa Hdiji
- Neurology's Department, Habib Bourguiba Hospital, Ferdaous Street, 3029, Sfax, Tunisia.,Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), University of Sfax, Sfax, Tunisia
| | - Salma Sakka
- Neurology's Department, Habib Bourguiba Hospital, Ferdaous Street, 3029, Sfax, Tunisia.,Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), University of Sfax, Sfax, Tunisia
| | - Emna Fakhfakh
- Neurology's Department, Habib Bourguiba Hospital, Ferdaous Street, 3029, Sfax, Tunisia.,Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), University of Sfax, Sfax, Tunisia
| | - Khadija Moalla
- Neurology's Department, Habib Bourguiba Hospital, Ferdaous Street, 3029, Sfax, Tunisia.,Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), University of Sfax, Sfax, Tunisia
| | - Sawsan Daoud
- Neurology's Department, Habib Bourguiba Hospital, Ferdaous Street, 3029, Sfax, Tunisia.,Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), University of Sfax, Sfax, Tunisia
| | - Nouha Farhat
- Neurology's Department, Habib Bourguiba Hospital, Ferdaous Street, 3029, Sfax, Tunisia.,Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), University of Sfax, Sfax, Tunisia
| | - Mariem Damak
- Neurology's Department, Habib Bourguiba Hospital, Ferdaous Street, 3029, Sfax, Tunisia.,Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), University of Sfax, Sfax, Tunisia
| | - Chokri Mhiri
- Neurology's Department, Habib Bourguiba Hospital, Ferdaous Street, 3029, Sfax, Tunisia.,Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), University of Sfax, Sfax, Tunisia
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Nishiguchi Y, Matsuyama H, Maeda K, Shindo A, Tomimoto H. Miller Fisher syndrome following BNT162b2 mRNA coronavirus 2019 vaccination. BMC Neurol 2021; 21:452. [PMID: 34789193 PMCID: PMC8598937 DOI: 10.1186/s12883-021-02489-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/10/2021] [Indexed: 02/06/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), began in late 2019. One of the vaccines approved against COVID-19 is the BNT162b2 mRNA COVID-19 vaccine (Pfizer/BioNTech). Case presentation We present the case of a 71-year-old man with no history of the SARS-CoV-2 infection or any recent viral or bacterial illnesses who presented with bilateral oculomotor palsy and limb ataxia after BNT162b2 mRNA COVID-19 vaccination. The diagnosis of Miller Fisher syndrome (MFS) was established based on physical examination, brain magnetic resonance imaging (MRI), cerebrospinal fluid analysis (CSF), and positron emission tomography (PET). There was no evidence of other predisposing infectious or autoimmune factors, and the period from COVID-19 vaccination to the appearance of neurological symptoms was similar to that of other vaccines and preceding events, such as infection. Conclusion Guillain–Barré syndrome (GBS) and its variants after COVID-19 vaccination are extremely rare. Note that more research is needed to establish an association between MFS and COVID-19 vaccines. In our opinion, the benefits of COVID-19 vaccination largely outweigh its risks.
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Affiliation(s)
- Yamato Nishiguchi
- Department of Neurology, Graduate School of Medicine, Mie University, Tsu, Mie, 514-8507, Japan.
| | - Hirofumi Matsuyama
- Department of Neurology, Graduate School of Medicine, Mie University, Tsu, Mie, 514-8507, Japan
| | - Kuniko Maeda
- Department of Ophthalmology, Mie Prefectural Shima Hospital, Shima, Mie, 517-0595, Japan
| | - Akihiro Shindo
- Department of Neurology, Graduate School of Medicine, Mie University, Tsu, Mie, 514-8507, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Graduate School of Medicine, Mie University, Tsu, Mie, 514-8507, Japan
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Szewczyk AK, Skrobas U, Jamroz-Wiśniewska A, Mitosek-Szewczyk K, Rejdak K. Facial Diplegia-Complication or Manifestation of SARS-CoV-2 Infection? A Case Report and Systemic Literature Review. Healthcare (Basel) 2021; 9:healthcare9111492. [PMID: 34828542 PMCID: PMC8618007 DOI: 10.3390/healthcare9111492] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 12/24/2022] Open
Abstract
Since the outbreak of the new coronavirus, healthcare systems around the world have witnessed not only COVID-19 symptoms but also long-term complications of the aforementioned, including neurological problems. We report a clinical case of an adult patient with bilateral facial nerve palsy and progressive ascending paresis of the limbs after contracting the novel coronavirus (COVID-19). Additionally, the systematic review aimed to identify and summarize specific clinical features, outcomes and complications of the studies focusing on bilateral facial diplegia as a sequela of COVID-19 infection. The total number of analyzed patients was 15. Only one patient was diagnosed with isolated bilateral palsy; the rest had Guillain-Barré Syndrome (GBS). With one exception, all the presented cases had favorable outcomes, with facial palsy recovery from slight to almost complete. In patients with a confirmed COVID-19 diagnosis, bilateral facial palsy may be an isolated symptom as well as a variant of GBS. Symptoms of cranial nerve damage during a COVID-19 infection may explain the appearance of facial nerve damage. In order to clarify the spectrum of neurological manifestations and a causal relation between SARS-CoV-2, COVID-19 vaccination and neurological symptoms, direct attention towards the study of this virus is crucial. It seems reasonable to recognize human coronavirus as another potential GBS trigger.
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Affiliation(s)
- Anna K. Szewczyk
- Department of Neurology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland; (U.S.); (A.J.-W.); (K.R.)
- Correspondence:
| | - Urszula Skrobas
- Department of Neurology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland; (U.S.); (A.J.-W.); (K.R.)
| | - Anna Jamroz-Wiśniewska
- Department of Neurology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland; (U.S.); (A.J.-W.); (K.R.)
| | - Krystyna Mitosek-Szewczyk
- Department of Child Neurology, Medical University of Lublin, ul. Profesora Antoniego Gębali 6, 20-093 Lublin, Poland;
| | - Konrad Rejdak
- Department of Neurology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland; (U.S.); (A.J.-W.); (K.R.)
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AZD-1222. REACTIONS WEEKLY 2021. [PMCID: PMC8617001 DOI: 10.1007/s40278-021-06024-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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39
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Kripalani Y, Lakkappan V, Parulekar L, Shaikh A, Singh R, Vyas P. A Rare Case of Guillain-Barré Syndrome following COVID-19 Vaccination. Eur J Case Rep Intern Med 2021; 8:002707. [PMID: 34671572 DOI: 10.12890/2021_002797] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/13/2021] [Indexed: 01/28/2023] Open
Abstract
Various vaccines against COVID-19 have been developed since SARS-CoV-2 emerged at the end of 2019. Their emergency administration in healthcare settings has been accompanied by numerous adverse effects. A case of Guillain-Barré syndrome following vaccination with Covishield is presented here to highlight this possible adverse condition. LEARNING POINTS Guillain-Barré Syndrome (GBS) is a very rare complication after vaccination against SARS-CoV-2.The key concepts related to the understanding, management and outcomes of patients with GBS are discussed.
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Affiliation(s)
- Yash Kripalani
- Department of Critical Care Medicine, Holy Family Hospital, Bandra, Mumbai, India
| | - Vidyadhara Lakkappan
- Department of Critical Care Medicine, Holy Family Hospital, Bandra, Mumbai, India
| | - Lipeeka Parulekar
- Department of General Internal Medicine, Holy Family Hospital, Bandra, Mumbai, India
| | - Anjum Shaikh
- Department of Critical Care Medicine, Holy Family Hospital, Bandra, Mumbai, India
| | - Rakesh Singh
- Department of Neurology, Holy Family Hospital, Bandra, Mumbai, India
| | - Pradeep Vyas
- Department of Critical Care Medicine, Holy Family Hospital, Bandra, Mumbai, India
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Kanabar G, Wilkinson P. Guillain-Barré syndrome presenting with facial diplegia following COVID-19 vaccination in two patients. BMJ Case Rep 2021; 14:14/10/e244527. [PMID: 34649856 PMCID: PMC8522664 DOI: 10.1136/bcr-2021-244527] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
In March 2020, the WHO declared COVID‐19 to be a global pandemic and since December 2020, millions of vaccines have been administered. To date, cases of Guillain‐Barré syndrome (GBS) following a COVID vaccine (Pfizer, Johnson & Johnson, Janssen, AstraZeneca) have been reported. A 61-year-old woman developed bilateral asymmetrical lower motor neuron (LMN) facial weakness followed by limb symptoms, 10 days after receiving the first dose of AstraZeneca COVID vaccine. The second patient was a 56-year-old man who, 9 days after receiving first dose of AstraZeneca COVID vaccine, developed bilateral asymmetrical LMN facial weakness with limb symptoms. Intravenous immunoglobulin was administered with rapid recovery. These cases of GBS following the AstraZeneca COVID vaccine add to cohort of patients reported. We flag up to raise awareness of this condition post‐COVID‐19 vaccine and highlight the prominent bifacial involvement. Early diagnosis and prompt treatment with intravenous immunoglobulin led to rapid recovery.
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Affiliation(s)
- Gorande Kanabar
- Department of Clinical Neurophysiology, East and North Hertfordshire NHS Trust, Stevenage, UK .,Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children, London, UK
| | - Phil Wilkinson
- Department of Neurology, East and North Hertfordshire NHS Trust, Stevenage, UK
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