Within weeks of vaccination against COVID-19, neuromuscular diseases such as Guillain-Barré syndrome (GBS) and peripheral neuropathies can develop due to a close temporal relationship. However, a casual relationship has yet to be proven. These are the results of 8 case studies described in Acta Neurologica Belgica.
Neuromuscular complications have been reported in close temporal association with COVID-19, particularly GBS. Viral myositis, mononeuritis multiplex and critical illness myopathy are among the other neuromuscular diseases. Post administration of COVID-19 vaccines including BNT162b2 (Pfzer-BioNTech), ChAdOx1 nCoV-19 (AstraZeneca) and Ad26. COV2.S (Janssen) several case reports of GBS have been published. Of particular interest was that 2 case series reported onset of GBS with bifacial weakness with limb paresthesia after COVID-19 vaccination.
The aim of the current study was to evaluate 8 patients who developed an emerging neuromuscular disorder after COVID-19 vaccination.
Clinical researchers working at 2 different treatment centers in Belgium observed a pattern of emerging neuromuscular disorders developing in 8 patients within 1 to 4 weeks after either the first or second dose of COVID-19 vaccination.
Four COVID-19 vaccines – Pfizer-BioNTech, Moderna, Janssen and AstraZeneca – were being offered to people in Belgium when this study was conducted. Six of the patients received the Pfizer mRNA vaccine while the remaining two received the AstraZeneca vaccine.
Clinicians performed thorough clinical assessments on each patient, including sensory, reflex, and muscle strength tests. After the clinical examination, the clinicians referred each of the patients for further specific diagnostic tests, including nerve conduction studies (NCS), magnetic resonance imaging (MRI), spinal taps to assess cerebrospinal fluid (CSF) for albuminocytological dissociation, blood tests determination of serum ganglioside antibodies and screening of infectious diseases.
Definitive diagnoses of neuromuscular disorder included 2 cases of chronic inflammatory demyelinating polyneuropathy (CIDP) with subacute onset, 3 cases of acute inflammatory demyelinating polyneuropathy (AIDP) with an indication of GBS, 2 cases of arm plexopathy, 1 case of subacute axonal sensorimotor polyneuropathy, and 1 case that was variant GBS with bifacial weakness.
Patients received treatments based on tolerability, including intravenous immunoglobulins (IVIG), oral methylprednisolone, and azathioprine. One patient received no treatment due to mild discomfort and natural symptom stabilization.
Most patients recovered at the time of the last clinical follow-up with only mild residual sensory discomfort or motor weakness. One patient made a full recovery, while another patient received ongoing IVIG treatment due to variable improvements and deteriorations in condition.
“These different presentations strengthen the association between COVID-19 vaccination and specific GBS phenotypes,” the researchers noted. They added: “While a causal relationship between these diseases and the vaccine cannot be demonstrated at this time, the temporal relationship is striking.”
Leemans W, Antonis S, De Vooght W, Lemmens R, Van Damme P. Neuromuscular complications after COVID-19 vaccination: a series. Acta Neurol Belg. Published online May 2, 2022. doi:10.1007/s13760-022-01941-0