Incidence and characteristics of Guillain-Barré syndrome in Taiwan before and during the COVID-19 pandemic: A 12-year single-center experience.

Abstract

Background: There is substantial regional disparity in the presentation of Guillain-Barré syndrome (GBS), and coronavirus disease 2019 (COVID-19) possibly influences the development of GBS, but the association remains uncertain. This study aimed to investigate the incidence of GBS before and during the COVID-19 pandemic and delineate the clinical profile of GBS in Taiwanese patients.

Methods: Medical records of 185 ascertained GBS cases at Taipei Veterans General Hospital between 2011 and 2022 were reviewed. Patients were analyzed based on age, clinical subtypes, and electrophysiological findings. A multivariable ordinal logistic regression was conducted to identify factors related to outcomes measured by the GBS disability scale (GBS-DS), which ranges from 0 to 6, with higher scores indicating greater disability.

Results: The single-center incidence (SCI) of GBS, defined as the number of GBS cases relative to the total number of outpatient and emergency department visits per year, remained stable during the COVID-19 pandemic (14.3 cases per year) compared with the prepandemic period (15.8 cases per year). COVID-19 infection or vaccination was reported as a preceding event in six cases, five of which had good outcomes (GBS-DS ≤2). In our cohort, 12% were diagnosed with Miller-Fisher syndrome (MFS), 13% had GBS/MFS overlap, and the remaining patients had typical GBS. One-third had axonal GBS, associated with significantly worse outcomes compared with demyelinating GBS. The overall mortality rate was 1.1%. Old age, low Medical Research Council sum score, ventilator dependency, and autonomic dysfunction were independent predictors of high GBS-DS scores.

Conclusion: This single-center study found no increase in GBS occurrence during the COVID-19 pandemic. In Taiwan, GBS is characterized by a higher occurrence of MFS and GBS/MFS overlap and more frequent axonal GBS, highlighting geographical variations in GBS features between Asian and Western countries.