19 and GBS Onset SARS-Cov- 2 Testing Clinical Features (MRC Score)

Home , Hypoesthesia, Sensory ataxia

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Author Patient Interval SARS-CoV- Clinical features Electro- CSF Ab to MRI Treatment/ No: COVID- 2 testing (MRC score) diagnosis gangliosides Response to treatment Age/ 19 and Sex GBS onset

Zhao et al. 1,61/ F GBS as NPS + Paraparesis progressing in 3 days to AIDP ACD ND ND IVIG. Recovery in 30 days 4/1/2020 presenting tetraparesis (ULs 4/5, LLs 3/5), feature areflexia LLs, distal hypoesthesia

Camdessanche 2,64/M 11 days NPS + Distal paresthesia progressing to AIDP ACD Negative ND IVIG. NR et al. tetraparesis (LLs 2/5, Uls 2-4/5) 4/15/2020 areflexia, dysphagia, and respiratory failure Sedaghat and 3,65/M 14 days NPS + Ascending tetraplegia (ULs 2-3/5, AMSAN ND ND Head and IVIG. NR Karimi LLs 1-2/5) bilateral facial palsy, cervical spine: 4/15/2020 areflexia, distal hypoesthesia non contributory

Toscano et al. 4,77/F 7 days NPS + Distal paresthesia progressing to AMSAN ACD Negative Enhancement of 2 IVIG courses. Minimal 4/17/2020 tetraplegia, bulbar palsy, areflexia PCR- caudal roots improvement and repiratory failure 5,23/M 10 days NPS + Facial diplegia, LLs paresthesia, AMSAN ACD ND Enhancement of IVIG. Mild improvement of sensory ataxia, areflexia PCR- facial nerves facial weakness and disappearance of paresthesia 6,55/M 10 days NPS + Distal paresthesia, LLs weakness AMAN ACD Negative Enhancement of 2 IVIG courses. At 1 month progressing to tetraparesis, bilateral PCR- caudal roots still ventilated facial palsy, areflexia, respiratory failure 7,76/M 5 days NPS + LLs weakness progressing to AIDP Normal ND Head and spine: IVIG. Motor improvement tetraparesis PCR- normal but still unable to stand 8,61/M 7 days 2NPS – LLs paresthesia, tetraplegia, AIDP Normal Negative Spine normal IVIG, PE. At 1 month still Chest CT+ areflexia, facial weakness, dysphagia, PCR- tetraplegic and ventilated Serology + respiratory failure (IgG)

Uncini A, et al. J Neurol Neurosurg Psychiatry 2020; 91:1105–1110. doi: 10.1136/jnnp-2020-324491 BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) J Neurol Neurosurg Psychiatry

Gutierrez- 9,50/ 5 days NPS + Ophthalmoparesis, perioral ND ACD GD1b (IgG) ND IVIG. Recovery in 2 weeks Ortiz et al. paresthesia, areflexia, gait ataxia PCR- 4/17/2020 10,39/ 3 days NPS+ Bilateral CN VI palsy,,areflexia ND ACD ND ND ND. Spontaneous recovery M PCR- in 2 weeks

Virani et al. 11,54/ NR NPS+ Tetraparesis (ULs 3/5, LLs 2/5) ND ND ND Thoracic and IVIG. Recovery of 4/18/2020 M areflexia, urinary retention, lumbar spine: respiratory and Uls respiratory failure normal weakness in 10 days

Galan et al. 12,43/ 10 NPS+ Tetraparesis (3-4/5), distal AIDP ND ND ND IVIG, favorable outcome 4/23/2020 M hypoesthesia, facial diplegia, dysphagia areflexia El Otmani et 13,70/F 3 days NPS+ Distal paresthesia progressing rapidly AMSAN ACD ND ND IVIG. No improvement after al. to tetraplegia. Areflexia PCR- 1 week 4/24/ 2020

Padroni et al.. 14,70/F 28 NPS+ Distal paresthesia and gait difficulties AIDP ACD ND ND IVIG. NR 4/24/2020 progressing to tetraparesis (distal Uls and LLs 4/5), areflexia, respiratory failure Coen et al. 32,70’/ 10 NPS+ Paraparesis, distal allodynia, AIDP ACD Negative Spine: normal IVIG. Rapid improvement 4/28/2020 M difficulty in voiding, constipation areflexia Alberti et al. 15,71/ NC NPS+ Distal paresthesia progressing to AIDP ACD ND ND IVIG. Death the day after 4/29/2020 M tetraplegia (Uls 3/5, LLs, 2/5), PCR- the admission. hypoesthesia at 4 limbs, areflexia, drug resistant hypertension, respiratory failure Arnaud et al. 16,64/ 16 days NPS+ Rapidly progressive paraparesis, AIDP ACD ND ND IVIG. Not better specified 5/11/2020 M distal proprioceptive loss at 4 limbs, PCR- “success” areflexia Ottaviani et al. 17,66/F 10 days 2nd NPS+ Paraplegia and mild Uls weakness AIDP ACD Negative ND IVIG. NR 5/12/2020 (4/5), areflexia. Progression with PCR- facial palsy, confusion and agitation, respiratory failure Caamaño and 18,61/ 10 days NPS+ Bilateral facial palsy ND ACD ND Head normal Low dose oral prednisone. Beato M PCR- Barely notable improvement 5/14/2020 after 2 weeks

Gigli et al. 19,53/ NR 2 NPS- Paresthesiia, atxia AIDP ACD Negative N D NR 5/19/2020 M Chest CT+ PCR- Serology+ (IgM and IgG) Riva et al. 20,60’/ 20 days 2 NPS- Proximal LLs weakness (3-4/5) with AIDP Normal Negative Cervical spine: IVIG. Slow improvement 5/26/2020 M Chest CT+ severe position and proprioception PCR- normal Serology+ deficit, areflexia. Progression with (IgG) Uls involvement, facial diplegia and bulbar palsy

Scheidl et al. 21,54/F 14 days NPS+ Paraparesis (3-4/5), distal paresthesia AIDP ACD ND Cervical spine: IVIG. Almost complete 5/26/2020 and sensory loss, areflexia, dysphagia normal recovery

Fernandez- 22,74/F 12 NPS+ Gait ataxia and LLs areflexia Equivocal ACD Negative Head normal IVIG. Improvement of gait Dominguez et PCR- ataxia and reappearance of al. reflexes. 5/26/2020 Bigaut et al. 23,43/ 21 days NPS+ Distal LLs weakness, paresthesia, AIDP ACD Negative Cranial (III, IVIG, progressive 5/27/2020 M and hypoesthesia ascending to distal PCR- VI,VII, VIII) improvement Uls, hypoesthesia LLs, ataxia, neuritis, areflexia, facial palsy radiculitis and brachial and lumbar plexitis 24,70/F 10 days NPS+ Proximal tetraparesis, Uls and AIDP ACD ND ND IVIG. Slow progressive perioral paresthesia, areflexia, PCR- improvement respiratory failure Assini et al. 25,55/ 20 days NPS+ Bilateral CN III,V,IX,X,XII AIDP Normal Negative Head: normal IVIG. Rapid improvement 5/28/2020 M involvement. Hyporeflexia, PCR- and recovery respiratory failure 26,60/ 23 days NPS+ Weakness LLs, right foot drop, AMSAN Normal Negative ND IVIG. Rapid improvement M areflexia, gastroplegia, paralytic PCR- of dysautonomia ileus, loss of blood pressure control, respiratory failure. Lantos et al. 27,36/ 4 days NPS+ Partial lt CN III cranial nerve palsy, ND ND equivocal Enlargement IVIG.Improvement 5/28/2020 M paresthesia and hypostesia LLs, result to and ataxia.followed by bilateral CN VI Asialo-GM1 ehhancement palsy, hyporeflexia CN III

Chan et al. 28,58/ GBS as NPS+ Facial diplegia, dysarthria, and distal AIDP ACD ND Bilateral CN VII IVIG. Minimal 5/29/2020 M presenting LLs paresthesia, areflexia enhancement improvement of facial feature diplegia at discharge Lascano et al. 29,52/F 15 4th NFS+ Back pain, limb weakness, distal AIDP ACD Negative Spine: no roots IVIG. At 5 weeks bedbound 6/1/2020 Serology + paresthesia, ataxia progressing to PCR- enhancement but able to stand up with (IgM,IgG) tetraplegia with areflexia, respiratory assistance. failure, dysautonomia 30,63/F 7 2nd NPS+ LLs pain, mild weakness evolving to AIDP Normal ND ND IVIG. Full motor recovery at tetraparesis, distal paresthesias and dismissal areflexia 31,61/F 22 NPS+ LL weakness distal paresthesia, AIDP ACD ND Head: normal IVIG. Improvement with bilateral facial palsy, dizziness, PCR- Lumbosacral regained ability to walk with dysphagia, dysautonomia, areflexia. roots assistance enhancement Oguz-Akarsu 33,53/F NC NPS+ LLs, weakness (4/5) and AIDP Normal ND Thickening and PE. Improvement in 2 et al. 6/4/2020 hypoesthesia, slight distal weakness PCR- hyperintensity weeks, able to walk without ULs, dysarthria of cervical and assistance lumbar roots Sancho- 34,56/F 15 days NPS+ Gait unsteadiness and hand AIDP ACD Negative Brainstem and IVIG. Significant Saldaña et al. paresthesia evolving to proximal PCR- cervical improvement in 2 weeks 6/9/2020 tetraparesis, head dtrop, bilateral leptomeningeal facial palsy, bulbar weakness, enhancement. areflexia Manganotti et 35,50/F 16 days NPS+ Ophtalmoplegia, ataxia, areflexia, ND ACD Negative Head: normal IVIG. Recovery in 7 days al. 6/11/2020 mild hypoesthesia CN V2-V3

Helbok et al. 36,68/ 14 days NPS- LLs distal paresthesia, dysesthesia AIDP ACD Negative Spine MRI: non IVIG (30 g) and PE. In 2 6/12/2020 M Chest CT+ and hyposthesia, ataxic stance and contributory months regained motility Serology+ inability to walk progressing to without significant tetraparesis (proximal 2/5, distal 4/5) assistance and respiratory failure Kilinc et al. 37,50/ 28 days Fecal PCR+ Facia diplegia, mild proximal AIDP Normal Negative ND IVIG. Facial diplegia and 6/13/2020 M Serology + weakness, impaired proprioception PCR- mild proximal weakness (IgM and LLs , areflexia, gait ataxia persisted after 2 weeks IgG) Webb et al. 38,57/ 7 days NPS+ Distal LLs paresthesia, difficulties in AIDP ACD Negative ND IVIG. Weaned off 6/14/2020 M standing progressing to tetraparesis PCR- ventilation (ULs 4/5, LLs 1-3/5) dysphagia and respiratory failure

Rana et al. 39,54/ 14 days NPS+ Distal paresthesia progressing to AIDP ND ND Spine: negative IVIG. Improvement of 6/2020 M tetraparesis (LLs 0-1/5, ULs 3-4/5) respiratory status with areflexia, urinary retention and extubation followed by respiratory failure followed by facial worsening of weakness diplegia and ophthalmoparesis Farzi et al. 40,41/ 10 days NPS+ Distal LLs paresthesia, tetraparesis AIDP ND ND ND IVIG. In 3 days able to stand 6/20/2020 M (ULs 4/5, LLs/3/5), distal and walk for a short distance hypoesthesia, hypo-areflexia, unable without assistance to stand and walk without assistance Reyes Bueno 41,51/F 15 days NPS- Limb and spine pain followed by AIDP ACD Negative Negative IVIG. Progressive and Serrano- Serology+ paraparesis (2-3/5) with inability to improvement Castro (IgG) walk, lt CN VI paresis, bilateral 6/20/2020 facial paresis, dry mouth, diarrhea and unstable blood pressure Hutchins et al. 42/21/ 16 days NPS+ Facial diplegia followed after 19 days AIDP ACD Negative Bilateral CNVI PE. Slight improvement of 6/25/2020 M by proximal ULs and LLs weakness and CNVII facial palsy and paresthesia (4/5), Uls parestesia and areflexia enhancement Spine normal

Supplementary table 1. Features of reported Guillain-Barré syndrome patients with SARS-CoV-2 infection listed according to the date of publication online.

ACD, albumin-cytological dissociation; CN, cranial nerve; CSF, cerebrospinal fluid; CT, computerized tomography; IVIG, intravenous immunoglobulin; LL, lower limb; MRC, Medical research council scale; NC, not calculable; ND, not done; NPS, nasopharyngeal swab, NR, Not reported; PCR, reverse transcriptase polymerase chain-reaction for SARS-CoV-2; PE, plasma exchange; UL, upper limb; +, positive; -, negative.

Uncini A, et al. J Neurol Neurosurg Psychiatry 2020; 91:1105–1110. doi: 10.1136/jnnp-2020-324491