COVID-19-associated Guillain-Barré syndrome in the early pandemic experience in Lombardia (Italy)

Objective To estimate the incidence and describe clinical characteristics and outcome of GBS in COVID-19 patients (COVID19-GBS) in one of the most hit regions during the frst pandemic wave, Lombardia. Methods Adult patients admitted to 20 Neurological Units between 1/3–30/4/2020 with COVID19-GBS were included as part of a multi-center study organized by the Italian society of Hospital Neuroscience (SNO). Results Thirty-eight COVID19-GBS patients had a mean age of 60.7 years and male frequency of 86.8%. CSF albuminocytological dissociation was detected in 71.4%, and PCR for SARS-CoV-2 was negative in 19 tested patients. Based on neurophysiology, 81.8% of patients had a diagnosis of AIDP, 12.1% of AMSAN, and 6.1% of AMAN. The course was favorable in 76.3% of patients, stable in 10.5%, while 13.2% worsened, of which 3 died. The estimated occurrence rate in Lombardia ranges from 0.5 to 0.05 GBS cases per 1000 COVID-19 infections depending on whether you consider positive cases or estimated seropositive cases. When we compared GBS cases with the pre-pandemic period, we found a reduction of cases from 165 to 135 cases in the 2-month study period in Lombardia. Conclusions We detected an increased incidence of GBS in COVID-19 patients which can refect a higher risk of GBS in COVID-19 patients and a reduction of GBS events during the pandemic period possibly due to a lower spread of more common respiratory infectious diseases determined by an increased use of preventive measures

Platinum-iridium subdermal magnetic resonance imaging-compatible needle electrodes are suitable for intraoperative neurophysiological monitoring during image-guided surgery with high-field intraoperative magnetic resonance imaging: an experimental study.

Neurosurgery aims to achieve maximal tumor resection while preserving neurological function. Tools such as neuronavigation, high-field intraoperative magnetic resonance imaging (iMRI), and intraoperative neurophysiological monitoring (IOM) have consistently helped to achieve this goal, but integration has often been difficult. Surgery of eloquent areas requires IOM, which in an operating theater equipped with high-field (1.5-T) iMRI could present several issues. To identify the electrodes types more suitable for IOM in a high-field iMRI operating theater by performing an experimental study on phantoms, to report our experience with platinum-iridium (Pt/Ir) electrodes during surgery, and to prove that integration between IOM with Pt/Ir electrodes and high-field iMRI is safe and reliable. Electrodes of different materials (gold, Pt/Ir, and stainless steel) were tested on jelly phantom and apples to evaluate their safety and compatibility. Subsequently, electrodes were tested on 5 healthy volunteers before being used on patients. None of the different electrodes presented thermal instability, and no damage to the volunteers' skin occurred. Stainless steel electrodes caused severe imaging distortion. Gold electrodes had no distortion, but their high cost makes their use in routine surgery unaffordable. Pt/Ir electrodes are significantly less expensive than gold electrodes and were completely safe, compatible, and suitable for use in an operating theater with high-field iMRI, providing excellent IOM and mild interference that did not affect the quality of intraoperative imaging. We suggest the use of Pt/Ir electrodes for IOM in 1.5-T iMRI suites. DTI, diffusion tensor imagingiMRI, intraoperative magnetic resonance imagingIOM, intraoperative neurophysiological monitoring

Covid-19-associated Guillain-Barré syndrome in the first wave of COVID-19 pandemic in Lombardia: Increased incidence or increased seroprevalence?

38noembargoed_20221015embargoed_20221015Filippo Martinelli Boneschi; Antonio Colombo; Nereo Bresolin; Maria Sessa; Mattia Pozzato; Giampiero Grampa; Pietro Bassi; Eugenio Magni; Maurizio Versino; Carlo Ferrarese; Davide Zarcone; Alberto Albanese; Giuseppe Micieli; Carla Zanferrari; Antonio Cagnana; Claudio Ferrante; Angelo Zilioli; Davide Locatelli; Maria Calloni; Maria Luisa Delodovici; Camillo Foresti; Barbara Frigeni; Stefania Canella; Rubjona Xhani; Massimo Crabbio; Alessandro Clemenzi; Marco Mauri; Simone Beretta; Isidoro La Spina; Simona Bernasconi; Anna Cavallini; Michela Ranieri; Elisabetta D{ extquotesingle}Adda; Maria Elisa Fruguglietti; Lorenzo Peverelli; Edoardo Agosti; Andrea Rigamonti; Andrea SalmaggiMartinelli Boneschi, Filippo; Colombo, Antonio; Bresolin, Nereo; Sessa, Maria; Pozzato, Mattia; Grampa, Giampiero; Bassi, Pietro; Magni, Eugenio; Versino, Maurizio; Ferrarese, Carlo; Zarcone, Davide; Albanese, Alberto; Micieli, Giuseppe; Zanferrari, Carla; Cagnana, Antonio; Ferrante, Claudio; Zilioli, Angelo; Locatelli, Davide; Calloni, Maria; Luisa Delodovici, Maria; Foresti, Camillo; Frigeni, Barbara; Canella, Stefania; Xhani, Rubjona; Crabbio, Massimo; Clemenzi, Alessandro; Mauri, Marco; Beretta, Simone; La Spina, Isidoro; Bernasconi, Simona; Cavallini, Anna; Ranieri, Michela; D( extquotesingle)Adda, Elisabetta; Elisa Fruguglietti, Maria; Peverelli, Lorenzo; Agosti, Edoardo; Rigamonti, Andrea; Salmaggi, Andre

Guillain-Barr\ue9 syndrome and COVID-19: an observational multicentre study from two Italian hotspot regions

Objective: Single cases and small series of Guillain-Barr\ue9 syndrome (GBS) have been reported during the SARS-CoV-2 outbreak worldwide. We evaluated incidence and clinical features of GBS in a cohort of patients from two regions of northern Italy with the highest number of patients with COVID-19. Methods: GBS cases diagnosed in 12 referral hospitals from Lombardy and Veneto in March and April 2020 were retrospectively collected. As a control population, GBS diagnosed in March and April 2019 in the same hospitals were considered. Results: Incidence of GBS in March and April 2020 was 0.202/100 000/month (estimated rate 2.43/100 000/year) vs 0.077/100 000/month (estimated rate 0.93/100 000/year) in the same months of 2019 with a 2.6-fold increase. Estimated incidence of GBS in COVID-19-positive patients was 47.9/100 000 and in the COVID-19-positive hospitalised patients was 236/100 000. COVID-19-positive patients with GBS, when compared with COVID-19-negative subjects, showed lower MRC sum score (26.3\ub118.3 vs 41.4\ub114.8, p=0.006), higher frequency of demyelinating subtype (76.6% vs 35.3%, p=0.011), more frequent low blood pressure (50% vs 11.8%, p=0.017) and higher rate of admission to intensive care unit (66.6% vs 17.6%, p=0.002). Conclusions: This study shows an increased incidence of GBS during the COVID-19 outbreak in northern Italy, supporting a pathogenic link. COVID-19-associated GBS is predominantly demyelinating and seems to be more severe than non-COVID-19 GBS, although it is likely that in some patients the systemic impairment due to COVID-19 might have contributed to the severity of the whole clinical picture

Guillain-Barré syndrome and COVID-19: A 1-year observational multicenter study

Background and purpose Many single cases and small series of Guillain-Barre syndrome (GBS) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were reported during the coronavirus disease 19 (COVID-19) outbreak worldwide. However, the debate regarding the possible role of infection in causing GBS is still ongoing. This multicenter study aimed to evaluate epidemiological and clinical findings of GBS diagnosed during the COVID-19 pandemic in northeastern Italy in order to further investigate the possible association between GBS and COVID-19. Methods Guillain-Barre syndrome cases diagnosed in 14 referral hospitals from northern Italy between March 2020 and March 2021 were collected and divided into COVID-19-positive and COVID-19-negative. As a control population, GBS patients diagnosed in the same hospitals from January 2019 to February 2020 were considered. Results The estimated incidence of GBS in 2020 was 1.41 cases per 100,000 persons/year (95% confidence interval 1.18-1.68) versus 0.89 cases per 100,000 persons/year (95% confidence interval 0.71-1.11) in 2019. The cumulative incidence of GBS increased by 59% in the period March 2020-March 2021 and, most importantly, COVID-19-positive GBS patients represented about 50% of the total GBS cases with most of them occurring during the two first pandemic waves in spring and autumn 2020. COVID-19-negative GBS cases from March 2020 to March 2021 declined by 22% compared to February 2019-February 2020. Conclusions Other than showing an increase of GBS in northern Italy in the "COVID-19 era" compared to the previous year, this study emphasizes how GBS cases related to COVID-19 represent a significant part of the total, thus suggesting a relation between COVID-19 and GBS