medigraphic.com
ISSN 2225-4676 (Electronic)

2021, Number 2

<< Back Next >>

Rev Cubana Neurol Neurocir 2021; 11 (2)

Systematic review on Guillain-Barré syndrome associated with COVID-19

Céspedes RHR, Rodríguez BDJ, Céspedes RHA, Céspedes RRA, Hernández PA

Language: Spanish
References: 84
Page: 1-23
PDF size: 331.45 Kb.


ABSTRACT

Objective: To analyze the available evidence on the association between COVID-19 and Guillain Barré syndrome.
Acquisition of the evidence: A systematic review was held guided by Prism Declaration. We reviewed articles published in English, in Pubmed database, from January to October 2020, referring to the Guillain Barré Syndrome associated with COVID-19. It was included in the preparation of database 50 articles that met the eligibility criteria.
Results: Patients over 60 years of age (46.6%) and male sex (63.3%) predominated. 60% of the patients showed the neurological clinic, after the resolution of the symptoms of COVID-19 infection. The latency period between the onsets of COVID-19 and Guillain Barré syndrome, and vice versa, was 12.4 ± 6.3 days. Most patients had typical Barré Guillain Syndrome (76.3%) and the most frequent electrophysiological subtype was acute inflammatory demyelinating polyneuropathy (46.6%).
Conclusions: The growing number of cases reported with Guillain Syndrome Barré during the COVID-19 pandemic constitutes the main evidence to point to SARS-COV2 infection as a causal agent. Clinical manifestations, variants and electrophysiological subtypes show no differences with Guillain Syndrome Barré pre-pamdemic. The variability in the temporary relationship between the manifestations of VOCID-19 and the development of Guillain Barré syndrome suggests mechanisms of parainfectious and postinfectious presentation mechanisms.


REFERENCES

  1. Willison HJ, Jacobs BC, van Doorn PA. Guillain-Barré syndrome. Lancet. 2016;388:717-27.

  2. Sejvar JJ, Baughman AL, Wise M, Morgan OW. Population incidence of Guillain-Barré syndrome: a systematic review and meta-analysis. Neuro epidemiology. 2011;36:123-33.

  3. Dimachkie MM, Barohn RJ. Guillain-Barre Syndrome and Variants. Neurol Clin. 2013;31(2):491-510. Doi: 10.1016/j.ncl.2013.01.005.

  4. Instituto Mexicano del Seguro Social. Dirección de Prestaciones Médicas. Diagnóstico y Tratamiento del Síndrome de Guillain Barré en el Segundo y Tercer nivel de Atención. Guía de práctica clínica. Ciudad de México: Instituto Mexicano del Seguro Social; 2016 [citado: 21/11/2020]. Disponible en: http://www.imss.gob.mx/sites/all/statics/guiasclinicas/089GRR.pdf

  5. Leonhard SE, Mandarakas MR, Gondim FAA, Bateman K, Ferreira MLB, Cornblath DR, et al. Diagnosis and management of Guillain-Barré syndrome in ten steps. Evidence-based guidelines. Nat Rev Neurol. 2019;15:271-83.

  6. Hadden RD, Cornblath DR, Hughes RA, Zielasek J, Hartung HP, Toyka KV, et al. Electrophysiological classification of Guillain-Barré syndrome: clinical associations and outcome. Plasma Exchange/Sandoglobulin Guillain-Barré Syndrome Trial Group. Ann Neurol. 1998 Nov;44(5):780-8. Doi: 10.1002/ana.410440512.

  7. Yoon B-A, Bae JS, Kim JK. Electrognostic findings of Guillain-Barré syndrome. Ann Clin Neurophysiol. 2020;22(1):13-8. Doi: 10.14253/acn.2020.22.1.13

  8. Jacobs BC, Rothbarth PH, van der Meché FG, Herbrink P, Schmitz PI, de Klerk MA, et al. The spectrum of antecedent infections in Guillain-Barré syndrome: a case-control study. Neurology. 1998 Oct;51(4):1110-5. Doi: 10.1212/wnl.51.4.1110

  9. Hao Y, Wang W, Jacobs BC, Qiao B, Chen M, Liu D, et al. Antecedent infections in Guillain-Barré syndrome: a single-center, prospective study. Ann Clin Transl Neurol. 2019 Dec;6(12):2510-7. Doi: 10.1002/acn3.50946

  10. Cao-Lormeau VM, Blake A, Mons S, Lastère S, Roche C, Vanhomwegen J, et al. Guillain-Barré Syndrome outbreak associated with Zika virus infection in French Polynesia: a case-control study. Lancet. 2016 Apr 9;387(10027):1531-9. Doi: 10.1016/S0140-6736(16)00562-6

  11. Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020;77(6):683-690. Doi: 10.1001/jamaneurol.2020.1127

  12. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010;8(5):336-41. Doi: 10.1016/j.ijsu.2010.02.007.

  13. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Reviews. 2015;4:1. Disponible en: http://www.systematicreviewsjournal.com/content/4/1/1

  14. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008 Apr 26;336(7650):924-6. Doi: 10.1136/bmj.39489.470347.AD.

  15. Balshem H, Helfand M, Schünemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011 Apr;64(4):401-6. Doi: 10.1016/j.jclinepi.2010.07.015.

  16. Sejvar JJ, Kohl KS, Gidudu J, Amato A, Bakshi N, Baxter R, et al. Brighton Collaboration GBS Working Group. Guillain-Barré syndrome and Fisher syndrome: case definitions and guidelines for collection, analysis, and presentation of immunization safety data. Vaccine. 2011 Jan 10;29(3):599-612. Doi: 10.1016/j.vaccine.2010.06.003.

  17. Rajabally YA, Durand MC, Mitchell J, Orlikowski D, Nicolas G. Electrophysiological diagnosis of Guillain-Barre syndrome subtype: could a single study suffice? J Neurol Neurosurg Psychiatry. 2015;86:115-9. Doi: 10.1136/jnnp-2014-307815

  18. Coen M, Jeanson G, Culebras Almeida A, Hubers A, Stierlin F, Najjar I, et al. Guillain-Barré syndrome as a complication of SARS-CoV-2 infection. Brain, Behavior and Immunity. 2020;87:111-2. Doi: 10.1016/j.bbi.2020.04.074

  19. Sedaghat Z, Kirimi N. Guillain Barre syndrome associated with COVID-19 infection: A case report. Journal of Clinical Neuroscience. 2020;76:233-5. Doi: 10.1016/j.jocn.2020.04.062

  20. Agosti E, Giorgianni A, D’Amore F, Vanacci G, Balbi S, Locatelli D. Is Guillain-Barrè syndrome triggered by SARS-CoV-2? Case report and literature review. Neurolog Scienc. 2020;42(11):1- 6. Doi: 10.1007/s10072-020-04553-9

  21. Arnaud S, Budowski C, Ng Wing Tin S, Degos B. Post SARS-CoV-2 Guillain-Barré syndrome. Clin Neurophysiol. 2020 Jul;131(7):1652-1654. doi: 10.1016/j.clinph.2020.05.003.

  22. Tiet MY, AlShaikh N. Guillain-Barré syndrome associated with COVID-19 infection: a case from the UK. BMJ Case Rep. 2020;13:e236536. Doi: 10.1136/bcr-2020-236536

  23. Sancho-Saldana A, Lambea Gil A, Capablo Liesa JL, Barrera Caballo MR, Haddad Garay M, Rivero Celada D, et al. Guillain–Barré syndrome associated with leptomeningeal enhancement following SARS-CoV-2 infection. Clin Medicine. 2020;20(4):e93-94. Doi: 10.7861/clinmed.2020-0213

  24. Guijarro-Castro C, Rosón-González M, Abreu A, García-Arratibel A, Ochoa-Mulas M. Síndrome de Guillain-Barré tras infección por SARS-CoV-2. Comentarios tras la publicación de 16 nuevos casos. Neurología. 2020;35(6):412-5. Doi: 10.1016/j.nrl.2020.06.002

  25. Zito A, Alfonsi E, Franciotta D, Todisco M, Gastaldi M, Cotta Ramusino M, et al. COVID-19 and Guillain–Barré Syndrome: A Case Report and Review of Literature. Front Neurol. 2020;11:909. Doi: 10.3389/fneur.2020.00909

  26. Korem S, Gandhi H, Dayag DB. Guillain-Barré syndrome associated with COVID-19 disease. BMJ Case Rep. 2020;13:e237215. Doi: 10.1136/bcr-2020-237215

  27. Paybast S, Gorji R, Mavandadi S. Guillain-Barré Syndrome as a Neurological Complication of Novel COVID-19 Infection. A Case Report and Review of the Literature. The Neurologist. 2020;25:101-3.

  28. Khalifa M, Zakaria F, Ragab Y, Saad A, Bamaga A, Emad Y, et al. Guillain-Barré Syndrome Associated With Severe Acute Respiratory Syndrome Coronavirus 2 Detection and Coronavirus Disease 2019 in a Child. J Ped Infect Dis Soc. 2020;9(4):510-3. Doi: 10.1093/jpids/piaa086

  29. Michiles Frank CHM, Rocha Almeida TV, Almeida Marques E, Sousa Monteiro Q, Silveira Feitoza V, Silva Borba MG, et al. Guillain-Barre´ Syndrome Associated with SARS-CoV-2 Infection in a Pediatric Patient. J Trop Pediatr. 2020;fmaa044. Doi: 10.1093/tropej/fmaa044

  30. Hutchins KL, Jansen JH, Comer AD, Scheer RV, Zahn GS, Capps AE, et al. COVID-19-Associated Bifacial Weakness with Paresthesia Subtype of Guillain-Barré Syndrome. Am J Neuroradiol. 2020;41(9):1707-11. Doi: 10.3174/ajnr.A6654

  31. Toscano G, Palmerini F, Ravaglia S, Ruiz L, Invernizzi P, Cuzzoni MG, et al. Guillain-Barré syndrome associated with SARS-CoV-2. N Engl J Med. 2020;382(26):2574-6. Doi: 10.1056/NEJMc2009191.

  32. Frazi MA, Ayromlou H, Jahanbakhsh N, Bavil PH, Janzadeh A, Shayan FK. Guillain-Barré syndrome in a patient infected with SARS-CoV-2, a case report. Journal of Neuroimmunology. 2020;346:577294. Doi. 10.1016/j.jneuroim.2020.577294

  33. Bigaut K, Mallaret M, Baloglu S, Nemoz B, Morand P, Baicry F, et al. Guillain-Barré syndrome related to SARS-CoV-2 infection. Neurol Neuroimmunol Neuroinflamm. 2020;7:e785. Doi: 10.1212/NXI.0000000000000785

  34. Gutierrez-Ortiz C, Mendez A, Rodrigo-Rey S, San Pedro-Murillo E, Bermejo-Guerrero L, Gordo-Manas R, et al. Miller Fisher Syndrome and polyneuritis cranialis in COVID-19. Neurology. 2020;95(5):e601-e605. Doi: 10.1212/WNL.0000000000009619

  35. Velayos Galán A, Del Saz Saucedo P, Peinado Postigo F, Botia Paniagua E. Guillain-Barré syndrome associated with SARS-CoV-2 infection. Neurologia. 2020;35(4):268-9. Doi: 10.1016/j.nrl.2020.04.007

  36. Lantos JE, Strauss SB, Lin E. COVID-19-Associated Miller Fisher Syndrome: MRI Findings. Am J Neuroradiol. 2020;(7):1184-6. Doi: 10.3174/ajnr.A6609

  37. Ameer N, Shekhda KM, Cheesman A. Guillain-Barré syndrome presenting with COVID-19 infection. BMJ Case Rep. 2020;13:e236978. Doi: 10.1136/bcr-2020-236978

  38. Bracaglia M, Naldi I, Govoni A, Brillanti Ventura D, De Massis P. Acute infammatory demyelinating polyneuritis in association with an asymptomatic infection by SARS‑CoV‑2. Journal of Neurology. 2020;267:3166-8. Doi: 10.1007/s00415-020-10014-2

  39. Zhao H, Shen D, Zhou H, Liu J, Sheng S. Guillain-Barre syndrome associated with SARS-CoV-2 infection: causality or coincidence? Lancet Neurol. 2020;19:383-4.

  40. Oguz-Akarsu E, Ozpar R, Mirzayev H, Acet-Ozturk NA, Hekyemez B, Ediger D, et al. Guillain-Barré Syndrome in a Patient with Minimal Symptoms of COVID-19 Infection. 2020. [Epub ahead of print]. Doi: 10.1002/mus.26992

  41. Chan JL, Ebadi H, Sarna JR. Guillain-Barré Syndrome with Facial Diplegia Related to SARS-CoV-2 Infection. Canadian J Neurolog Scienc. 2020;29:1-3. Doi: 10.1017/cjn.2020.106

  42. Ray A. Miller Fisher syndrome and COVID-19: is there a link? BMJ Case Rep. 2020;13:e236419. Doi: 10.1136/bcr-2020-236419

  43. Scheidl E, Diez-Canseco D, Hadji-Naumov A, Bereznai B. Guillain-Barré syndrome during SARS-CoV-2 pandemic: A case report and review of recent literature. J Peripher Nerv Syst. 2020;25(2):204-7. Doi: 10.1111/jns.12382

  44. Kilinc D, van de Pasch S, Doets AY, Jacobs BC, van Vliet J, Garssen MPJ. Guillain-Barré syndrome after SARS-CoV-2 infection. Eur J Neurol. 2020;27(9):1757-8. Doi: 10.1111/ene.14398

  45. Padroni M, Mastrangelo V, Asioli GM, Pavolucci L, Abu-Rumeileh S, Piscaglia MG, et al. Guillain‑Barré syndrome following COVID‑19: new infection, old complication? J Neurol 2020;267(7):1877-9. Doi: 10.1007/s00415-020-09849-6

  46. Riva N, Russo T, Falzone YM, Strollo M, Amadio S, Del Carro U, et al. Post‑infectious Guillain–Barré syndrome related to SARS‑CoV‑2 infection: a case report. J Neurol, 2020;267:2492-4. Doi: 10.1007/s00415-020-09907-z

  47. Helbok R, Beer R, Loscher W, Boesch S, Reindl M, Hornung R, et al. Guillain-Barré syndrome in a patient with antibodies against SARS-COV-2. European journal of neurology. 2020;27(9):1754-6. Doi: https://doi.org/10.1111/ene.14388

  48. Reyes-Bueno JA, Garcia-Trujillo L, Urbaneja P, Ciano-Petersen NL, Postigo-Pozo MJ, Martinez-Tomas C, et al. Miller-Fisher syndrome after SARS-CoV-2 infection. Eur J Neurol. 2020;27:1759-61. Doi: 10.1111/ENE.14383

  49. Fernandez Dominguez J, Ameijide Sanluis E, Garcia Cabo C, Garcia Rodriguez R, Mateos V. Miller–Fisher‑like syndrome related to SARS‑CoV‑2 infection (COVID 19). J Neurology. 2020;267(9):2495-6. Doi: 10.1007/s00415-020-09912-2

  50. Naddaf E, Laughlin RS, Klein CJ, Toledano M, Theel ES, Binnicker MJ, et al. Guillain-Barré Syndrome in a Patient with Evidence of Recent SARS-CoV-2 Infection. Mayo Clin Proc. 2020;95(8):1799-801. Doi: 10.1016/j.mayocp.2020.05.029.

  51. Senel M, Abu-Rumeileh S, Michel D, Garibashvili T, Althaus K, Kassubek J, et al. Miller-Fisher syndrome after COVID-19: neurochemical markers as an early sign of nervous system involvement. Eur J Neurol. 2020 Nov;27(11):2378-80. Doi: 10.1111/ene.14473.

  52. Hirayama T, Hongo Y, Kaida K, Kano O. Guillain-Barré syndrome after COVID-19 in Japan. BMJ Case Rep. 2020 Oct 29;13(10):e239218. doi: 10.1136/bcr-2020-239218.

  53. Marta-Enguita J, Rubio-Baines I, Gastón-Zubimendi I. Fatal Guillain-Barre syndrome after infection with SARS-CoV-2. Neurologia. 2020;35(4):265-7. Doi: 10.1016/j.nrl.2020.04.004

  54. Manganotti P, Pesavento V, Buoite Stella A, Bonzi L, Campagnolo E, Bellavista G, et al. Miller Fisher syndrome diagnosis and treatment in a patient with SARS-CoV-2. J Neurovirol. 2020;26:605-6. Doi: 10.1007/s13365-020-00858-9

  55. Su XW, Palka SV, Rao RR, Chen FS, Brackney CR, Cambi F. SARS-CoV-2–associated Guillain-Barré syndrome with dysautonomia. Muscle & Nerve. 2020;62(2):E48-E49. Doi: 10.1002/mus.26988

  56. Ottaviani D, Boso F, Tranquillini E, Gapeni I, Pedrotti G, Cozzio S, et al. Early Guillain-Barré syndrome in coronavirus disease 2019 (COVID-19): a case report from an Italian COVID-hospital. Neurol Sci. 2020;41(6):1351-4. Doi: 10.1007/s10072-020-04449-8

  57. Wada S, Nagasaki Y, Arimizu Y, Shimo M, Matsukuma Y, Okamoto M, et al. Neurological Disorders Identified during Treatment of a SARS-CoV-2 Infection. Intern Med. 2020;59:2187-9. Doi: 10.2169/internalmedicine.5447-20

  58. Assini A, Benedetti L, Di Maio S, Schirinzi E, Del Sette M. New clinical manifestation of COVID-19 related Guillain-Barrè syndrome highly responsive to intravenous immunoglobulins: two Italian cases. Neurological Science. 2020;41:1657-8. Doi: 10.1007/s10072-020-04484-5

  59. Rana S, Lima AA, Chandra R, Valeriano J, Desai T, Freiberg W, et al. Novel Coronavirus (COVID-19)-Associated Guillain–Barre syndrome: case report. J Clin Neuromusc Dis. 2020;21:240-2.

  60. Lascano AM, Epiney JB, Coen M, Serratrice J, Bernard-Valnet R, Lalive PH, et al. SARS-CoV-2 and Guillain-Barré syndrome: AIDP variant with favorable outcome. Eur J Neurol. 2020;27(9):1751-3. Doi: https://10.1111/ENE.14369

  61. Candessanche JP, Morel J, Pozzetto B, Paul S. COVID-19 may induce Guillain-Barre´ syndrome. Rev Neurolog. 2020;176:516-25. Doi: 10.1016/j.neurol.2020.04.003

  62. Webb S, Wallace VCJ, Martin-Lopez D, Yogarajah M. Guillain-Barré syndrome following COVID-19: a newly emerging post-infectious complication. BMJ Case Rep. 2020;13:e236182. Doi: 10.1136/bcr-2020-236182

  63. Virani A, Rabold E, Hanson T, Haag A, Elrufay R, Cheema T, et al. Guillain-Barré Syndrome associated with SARS-CoV-2 infection. ID Cases. 2020;20:e00771. Doi: https://10.1016/j.idcr.2020.e00771

  64. Diez-Porras L, Verges E, Gil F, Vidal MJ, Massons J, Arboix A. Guillain-Barré-Strohl syndrome and COVID-19: Case report and literature review. Neuromuscular Disorders. 2020;30(10):859-61. Doi: 10.1016/j.nmd.2020.08.354

  65. El Otmani H, El Moutawaki B, Rafai MA, El Benna N, El Kettani C, Soussi M, et al. Covid-19 and Guillain-Barre´ syndrome: More than a coincidence! Rev Neurolog. 2020;176:516-25. Doi: 10.1016/j.neurol.2020.04.007

  66. Ghiasvand F, Ghadimi M, Ghadimi F, Safarpour S, Hosseinzadeh R, Seyed Alinaghi SA. Symmetrical polyneuropathy in coronavirus disease 2019 (COVID-19). IDCases. 2020;20:e00815. Doi: 10.1016/j.idcr.2020.e00815

  67. Alberti P, Beretta S, Piatti M, Karantzoulis A, Piatti ML, Santoro P, et al. Guillain-Barre syndrome related to COVID-19 infection. Neurol Neuroimmunol Neuroinflamm. 2020;7:e741. Doi: 10.1212/NXI.0000000000000741

  68. Berlin DA, Gulick RM, Martinez FJ. Severe Covid-19. N Engl J Med. 2020;383:2451-60. Doi: 10.1056/NEJMcp2009575

  69. Levison LS, Thomsen RW, Christensen DH, Mellmjaer T, Sindrup SH, Andersen H. Guillain-Barré syndrome in Denmark: validation of diagnostic codes and a population-based nationwide study of the incidence in a 30-year period. Clin Epidemiol. 2019;11:275-83.

  70. Zhang Y, Zhao Y, Wang Y. Prognostic factors of Guillain-Barré syndrome: a 111-case retrospective review. Chin Neurosurg J. 2018;4:14. Doi: 10.1186/s41016-018-0122-y.

  71. Mateen FJ, Cornblath DR, Jafari H, Shinohara RT, Khandit D, Ahuja B, et al. Guillain–Barré Syndrome in India: Population-based validation of the Brighton criteria. Vaccine. 2011;29(52):9697-01. Doi: 10.1016/j.vaccine.2011.09.123.

  72. Doets AY, Verboon C, van den Berg B, Harbo T, Cornblath DR, Willison HJ, et al. Regional variation of Guillain-Barré syndrome. Brain. 2018;141(10):2866-77. Doi: 10.1093/brain/awy232.

  73. Gómez Á, Díaz A, Carrión-Penagos J, Reyes J, Reyes S. Clinical and electrophysiological characteristics of Guillain-Barré syndrome in Colombia. J Peripher Nerv Syst. 2019;24(3):268-71. Doi: 10.1111/jns.12340.

  74. Vucic S, Cairns KD, Black KR, Tick Chong PS, Cros D. Neurophysiologic findings in early acute inflammatory demyelinating polyradiculoneuropathy. Clinical Neurophysiology. 2004;115(10):2329-35.

  75. Ma YM, Liu TK, Wong V. Guillain-Barre syndrome in southern Chinese children: 32 year experience in Hong Kong. Pediatr Int. 2010;52(1):13-9.

  76. van den Berg B, Walgaard C, Drenthen J, Fokke C, Jacobs BC, van Doorn PA. Guillain-Barre syndrome: pathogenesis, diagnosis, treatment and prognosis. Nat Rev Neurol. 2014;10(8):469-82.

  77. Yadegari S, Nafissi S, Kazemi N. Comparison of electrophysiological findings in axonal and demyelinating Guillain-Barre syndrome. Iran J Neurol. 2014;13(3):138-43.

  78. Fokke C, van den Berg B, Drenthen J, Walgaard C, van Doorn PA, Jacobs BC. Diagnosis of Guillain-Barré syndrome and validation of Brighton criteria. Brain J Neurol. 2014;137:33-43.

  79. Raphael JC, Chevret S, Hughes RA, Annane D. Plasma exchange for Guillain-Barre syndrome. Cochrane Database Syst Rev. 2012;(7):CD001798. Doi: 10.1002/14651858.CD001798.pub2

  80. Hughes RA, Swan AV, van Doorn PA. Intravenous immunoglobulin for Guillain-Barré syndrome. Cochrane Database Syst Rev. 2014(9):CD002063. Doi: 10.1002/14651858.CD002063.pub6

  81. Hughes RA, Swan AV, Raphaël JC, Annane D, van Koningsveld R, van Doorn PA. Immunotherapy for Guillain-Barré syndrome: a systematic review. Brain. 2007;130:2245-57. doi: 10.1093/brain/awm004.

  82. van den Berg B, Bunschoten C, van Doorn PA, Jacobs BC. Mortality in Guillain-Barre syndrome. Neurology. 2013 Apr 30;80(18):1650-4. doi: 10.1212/WNL.0b013e3182904fcc

  83. Taylor CJ, Hirsch NP, Kullmann DM, Howard RS. Changes in the severity and subtype of Guillain-Barre´ syndrome admitted to a specialist Neuromedical ICU over a 25-year period. J Neurol. 2017;264:564-9. Doi: 10.1007/s00415-016-8380-0

  84. Akbayram S, Dogan M, Akgun C, Peker E, Sayiotan R, Aktar F, et al. Clinical features and prognosis with Guillain-Barre syndrome. Ann Indian Acad Neurol. 2011;14(2):98-102. Doi: 10.4103/0972-2327.82793




2020     |     www.medigraphic.com