Bilateral facial palsy with paresthesias, variant of Guillain-Barré syndrome following COVID-19 vaccine: A case series of 9 patients

• Published in: Neuromuscular disorders : NMD 2022-07, Vol.32 (7), p.572-574
• Main Authors: Castiglione, J.I., Crespo, J.M., Lecchini, L., Silveira, F.O., Luis, M.B., Cotti, N., Simison, C.J., Aguirre, F., Piedrabuena, M.A., Alonso, R.N., Azcona, C.L., Sosa, P.S., Maldonado, E., Barroso, F.
• Format: Article
• Language: English
• Subjects: Bilateral Facial Palsy (BFP); COVID-19 - prevention & control; COVID-19 vaccine; COVID-19 Vaccines - adverse effects; Facial diplegia; Facial Paralysis - diagnosis; Facial Paralysis - epidemiology; Guillain-Barre Syndrome - epidemiology; Guillain-Barré Syndrome (GBS); Humans; Paresthesia - diagnosis; Paresthesia - epidemiology
• ISSN: 0960-8966; 1873-2364
• DOI: 10.1016/j.nmd.2022.05.003

•Several cases of Guillain-Barré syndrome associated with COVID-19 vaccine have been reported, including rare variants such as bilateral facial palsy with paraesthesias.•We report 9 cases of bilateral facial palsy with a history of COVID-19 vaccination within the previous month.•Nerve conduction studies revealed demyelinating polyneuropathy in 4 patients, and 5 presented bilateral focal facial nerve involvement, exclusively.•Ganglioside antibody panel was positive in 4 patients (anti-GM1=2, anti-GD1a=1 and anti-sulfatide=1).•Epidemiological studies are essential to determine whether any causal relationship may exist with this rare GBS variant and COVID-19 vaccine administration. Several cases of Guillain-Barré Syndrome (GBS) associated with COVID-19 vaccination have been reported, including the rare subtype known as Bilateral Facial Palsy with paresthesias (BFP). To date, it is not known whether a causal relationship may exist between the two. We report 9 cases of BFP in patients vaccinated against COVID-19 in the previous month. Nerve conduction studies revealed demyelinating polyneuropathy in 4 patients, and 5 presented bilateral, focal facial nerve involvement, exclusively. Ganglioside antibody panel was positive in 4 patients (anti-GM1=2, anti-GD1a=1 and anti-sulfatide=1). Seven patients received intravenous immunoglobulin treatment, one plasma exchange, and one patient died from sudden cardiac arrest following arrhythmia before treatment could be administered. Rates of BFP following COVID-19 vaccination, did not differ from those reported in previous series. Epidemiological studies are essential to determine whether a causal relationship may exist between this rare form of GBS and COVID-19 vaccination.