1
|
García‐Azorín D, Santana‐López L, Ordax‐Díez A, Lozano‐Alonso JE, Macias Saint‐Gerons D, González‐Osorio Y, Rojo‐Rello S, Eiros JM, Sánchez‐Martínez J, Sierra‐Mencía Á, Recio‐García A, Guerrero‐Peral ÁL, Sanz‐Muñoz I. Incidence and prevalence of headache in influenza: A 2010-2021 surveillance-based study. Eur J Neurol 2024; 31:e16349. [PMID: 38770742 PMCID: PMC11236060 DOI: 10.1111/ene.16349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 03/28/2024] [Accepted: 05/02/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND AND PURPOSE Influenza is a common cause of acute respiratory infection, with headache being one of the symptoms included in the European Commission case definition. The prevalence of headache as a symptom of influenza remains unknown. We aimed to describe the incidence and prevalence of headache in patients with influenza. METHODS All consecutive patients who met the definition criteria of influenza-like illness during the influenza seasons 2010-2011 through 2021-2022 were included. The seasonal cumulative incidence of influenza per 1000 patients at risk and the prevalence of headache as an influenza symptom were calculated, including the 95% confidence intervals (CIs). Subgroup analyses were done based on patients' sex, age group, microbiological confirmation, vaccination status, and influenza type/subtype/lineage. RESULTS During the study period, 8171 patients were eligible. The incidence of headache in the context of influenza varied between 0.24 cases per 1000 patients (season 2020-2021) and 21.69 cases per 1000 patients (season 2017-2018). The prevalence of headache was 66.1% (95% CI = 65.1%-67.1%), varying between 49.6% (season 2021-2022) and 80.1% (season 2010-2011). The prevalence of headache was higher in women (67.9% vs. 65.7%, p = 0.03) and higher in patients between 15 and 65 years old. Headache was more prevalent in patients infected with B subtypes than A subtypes (68.7% vs. 56.9%, p < 0.001). There were no notable differences regarding vaccination status or microbiological confirmation of the infection. CONCLUSIONS Headache is a common symptom in patients with influenza, with a prevalence higher than that observed in other viral infections.
Collapse
Affiliation(s)
- David García‐Azorín
- Department of Medicine, Faculty of MedicineUniversidad de ValladolidValladolidSpain
- Headache Unit, Department of NeurologyHospital Clínico Universitario de ValladolidValladolidSpain
| | - Laura Santana‐López
- Department of Medicine, Faculty of MedicineUniversidad de ValladolidValladolidSpain
| | - Ana Ordax‐Díez
- Dirección General de Salud Pública e InvestigaciónDesarrollo e Innovación, Gerencia Regional de Salud, Junta de Castilla y LeonValladolidSpain
| | - José Eugenio Lozano‐Alonso
- Dirección General de Salud Pública e InvestigaciónDesarrollo e Innovación, Gerencia Regional de Salud, Junta de Castilla y LeonValladolidSpain
| | - Diego Macias Saint‐Gerons
- Department of MedicineUniversity of Valencia, Instituto de Investigación Sanitaria de Valencia (INCLIVA) Health Research Institute and Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)ValenciaSpain
| | - Yésica González‐Osorio
- Headache Unit, Department of NeurologyHospital Clínico Universitario de ValladolidValladolidSpain
| | - Silvia Rojo‐Rello
- Department of MicrobiologyHospital Clínico Universitario de ValladolidValladolidSpain
| | - José M Eiros
- Department of MicrobiologyHospital Clínico Universitario de ValladolidValladolidSpain
- National Influenza CenterValladolidSpain
| | - Javier Sánchez‐Martínez
- National Influenza CenterValladolidSpain
- Fundación Instituto de Estudios de Ciencias de la Salud de Castilla y Leon, Instituto de Ciencias de la Salud de Castilla y Leon (ICSCYL)SoriaSpain
| | - Álvaro Sierra‐Mencía
- Department of Medicine, Faculty of MedicineUniversidad de ValladolidValladolidSpain
| | - Andrea Recio‐García
- Department of Medicine, Faculty of MedicineUniversidad de ValladolidValladolidSpain
| | - Ángel Luis Guerrero‐Peral
- Department of Medicine, Faculty of MedicineUniversidad de ValladolidValladolidSpain
- Headache Unit, Department of NeurologyHospital Clínico Universitario de ValladolidValladolidSpain
| | - Ivan Sanz‐Muñoz
- Department of MicrobiologyHospital Clínico Universitario de ValladolidValladolidSpain
- National Influenza CenterValladolidSpain
| |
Collapse
|
2
|
Beghi E, Ivashynka A, Logroscino G, de Oliveira FF, Fleisher JE, Dumitrascu OM, Patel R, Savica R, Kim YJ. Pitfalls and biases in neuroepidemiological studies of COVID-19 and the nervous system: a critical appraisal of the current evidence and future directions. J Neurol 2023; 270:5162-5170. [PMID: 37682315 DOI: 10.1007/s00415-023-11981-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Neurological manifestations frequently occur in individuals with COVID-19, manifesting during the acute phase, persisting beyond the resolution of acute symptoms, and appearing days or weeks after the initial onset of COVID-19 symptoms. However, predicting the incidence, course, and outcome of these neurological manifestations at the individual patient level remains challenging. Biases in study design and limitations in data collection may contribute to the inconsistency and limited validity of the reported findings. Herein, we focused on critically appraising pitfalls and biases of prior reports and provide guidance for improving the quality and standardization of future research. Patients with COVID-19 exhibit diverse demographic features, sociocultural backgrounds, lifestyle habits, and comorbidities, all of which can influence the severity and progression of the infection and its impact on other organ systems. Overlooked or undocumented comorbidities and related treatments may contribute to neurological sequelae, which may not solely be attributable to COVID-19. It is crucial to consider the potential side effects of vaccines in relation to neurological manifestations. CONCLUSION To investigate neurological manifestations of COVID-19, it is essential to employ valid and reliable diagnostic criteria and standard definitions of the factors of interest. Although population-based studies are lacking, well-defined inception cohorts, including hospitalized individuals, outpatients, and community residents, can serve as valuable compromises. These cohorts should be evaluated for the presence of common comorbidities, alongside documenting the primary non-neurological manifestations of the infectious disease. Lastly, patients with COVID-19 should be followed beyond the acute phase to assess the persistence, duration, and severity of neurological symptoms, signs, or diseases.
Collapse
Affiliation(s)
- Ettore Beghi
- Department of Neuroscience, Istituto di Ricerch Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Andrei Ivashynka
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Gravedona ed Uniti, Italy
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari "Aldo Moro" at "Pia Fondazione Card. G. Panico" Hospital Tricase, Lecce, Italy
| | | | - Jori E Fleisher
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Oana M Dumitrascu
- Departments of Neurology and Ophthalmology, Mayo Clinic, Scottsdale, AZ, USA
| | - Roshni Patel
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
- Neurology Service, Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Rodolfo Savica
- Department of Neurology and Health Science Research, Mayo Clinic, Rochester, MN, USA
| | - Yun Jin Kim
- School of Traditional Chinese Medicine, Xiamen University Malaysia, Jalan Sunsuria, Bandar Sunsuria, 43900, Sepang, Selangor, Malaysia.
| |
Collapse
|
3
|
Kim CY, Sardar Z, Ayele BA, Fleck‐Derderian S, Barrett CE, Sun Y, Clague M, Hurst HA, Boruah A, Zucker J, Maddox R, Sejvar J, Thakur KT. Neurological diagnoses in hospitalized COVID-19 patients during the B.1.1.529 surge. Ann Clin Transl Neurol 2023; 10:1433-1441. [PMID: 37350635 PMCID: PMC10424653 DOI: 10.1002/acn3.51833] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVE Emerging variants and sublineages of SARS-CoV-2 have differing disease severity, transmissibility, and immune evasion. The neurological conditions associated with the original strain of SARS-CoV-2 are well established. Our study assessed the neurological presentations specific to hospitalized patients during the B.1.1.529 (Omicron) variant surge in New York City. METHODS A total of 178 cases with positive RT-PCR result within 6 weeks before admission, and subsequent development of select neurological conditions during the SARS-CoV-2 B.1.1.529 (Omicron) surge between December 1, 2021 and February 28, 2022, were included from 12,800 SARS-CoV-2-positive hospital admissions. Clinical data from acute hospitalizations were compared to findings of inpatient neurological cases with COVID-19 infections from the initial surge in NYC in the same hospital system. RESULTS Compared to SARS-CoV-2 infections of the original strain, COVID-19 cases hospitalized during the Omicron surge (B.1.1.529) were associated with incidental and/or asymptomatic COVID-19 cases (96, 53.9%) and an increased incidence of pre-existing neurological and immunocompromising conditions. Encephalopathy, seizures, and stroke remained the most prevalent neurological conditions identified in hospitalized COVID-19 cases during the study period, reflecting a similar distribution of neurological presentations associated with the original strain. INTERPRETATION In our cohort of 178 admitted SARS-CoV-2-positive patients with select neurological conditions during the Omicron B.1.1.529 surge, 54% of COVID-19 cases were considered incidental and/or asymptomatic, and the identified neurological conditions resembled those associated with the original SARS-CoV-2 strain. Further studies characterizing neurological presentation in Omicron sublineages and other variants are warranted in an ongoing COVID-19 pandemic.
Collapse
Affiliation(s)
- Carla Y. Kim
- Department of NeurologyColumbia University Irving Medical Center/New York Presbyterian HospitalNew YorkNew YorkUSA
| | - Zomer Sardar
- Department of NeurologyColumbia University Irving Medical Center/New York Presbyterian HospitalNew YorkNew YorkUSA
| | - Biniyam A. Ayele
- Department of NeurologyColumbia University Irving Medical Center/New York Presbyterian HospitalNew YorkNew YorkUSA
| | | | | | - Yifei Sun
- Department of BiostatisticsColumbia UniversityNew YorkNew YorkUSA
| | - Madison Clague
- Department of NeurologyColumbia University Irving Medical Center/New York Presbyterian HospitalNew YorkNew YorkUSA
| | - Holly A. Hurst
- Department of NeurologyColumbia University Irving Medical Center/New York Presbyterian HospitalNew YorkNew YorkUSA
| | - Abhilasha Boruah
- Department of NeurologyColumbia University Irving Medical Center/New York Presbyterian HospitalNew YorkNew YorkUSA
- Case Western Reserve University School of MedicineClevelandOhioUSA
| | - Jason Zucker
- Department of Infectious DiseaseColumbia University Irving Medical Center/New York Presbyterian HospitalNew YorkNew YorkUSA
| | - Ryan Maddox
- United States Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - James Sejvar
- United States Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Kiran T. Thakur
- Department of NeurologyColumbia University Irving Medical Center/New York Presbyterian HospitalNew YorkNew YorkUSA
| |
Collapse
|
4
|
Kim CY, McNeill EN, Young C, King F, Clague M, Caldwell M, Boruah A, Zucker J, Thakur KT. Observational Study of Patients Hospitalized With Neurologic Events After SARS-CoV-2 Vaccination, December 2020-June 2021. Neurol Clin Pract 2023; 13:e200166. [PMID: 37251368 PMCID: PMC10212233 DOI: 10.1212/cpj.0000000000200166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/20/2023] [Indexed: 05/31/2023]
Abstract
Background and Objectives The global spread of the COVID-19 pandemic accelerated the vaccine development time line, regulatory approval, and widespread implementation in the population underscoring the importance of postauthorization/postlicensure vaccine safety surveillance. To monitor for vaccine-related adverse events, we prospectively identified patients hospitalized for prespecified neurologic conditions who received mRNA or adenovirus COVID-19 vaccines and assessed cases for potential risk factors and alternative etiologies of the adverse event. Methods We identified prespecified neurologic conditions in hospitalized individuals within 6 weeks of receipt of a dose of any COVID-19 vaccination between December 11, 2020, and June 22, 2021 (Columbia University Irving Medical Center/New York Presbyterian Hospital, New York City, New York). Clinical data from electronic medical records in these vaccinated patients were reviewed for assessment of contributing risk factors and etiologies for these neurologic conditions by use of a published algorithm. Results Among 3,830 individuals screened for COVID-19 vaccination status and neurologic conditions, 138 (3.6%) cases were included in this study (126 after mRNA and 6 after Janssen vaccines). The 4 most prevalent neurologic syndromes included ischemic stroke (52, 37.7%), encephalopathy (45, 32.6%), seizure (22, 15.9%), and intracranial hemorrhage (ICH) (13, 9.4%). All 138 cases (100%) had 1 or more risk factors and/or evidence for established causes. Metabolic derangement was the most common etiology for seizures (24, 53.3%) and encephalopathy (5, 22.7%) while hypertension was the most significant risk factor in ischemic stroke (45, 86.5%) and ICH cases (4, 30.8%). Discussion All cases in this study were determined to have at least 1 risk factor and/or known etiology accounting for their neurologic syndromes. Our comprehensive clinical review of these cases supports the safety of mRNA COVID-19 vaccines.
Collapse
Affiliation(s)
- Carla Y Kim
- Departments of Neurology (CYK, ENM, CY, FK, M. Clague, M. Caldwell, AB, KTT) and Infectious Disease (JZ), Columbia University Irving Medical Center/New York Presbyterian Hospital
| | - Emily N McNeill
- Departments of Neurology (CYK, ENM, CY, FK, M. Clague, M. Caldwell, AB, KTT) and Infectious Disease (JZ), Columbia University Irving Medical Center/New York Presbyterian Hospital
| | - Casey Young
- Departments of Neurology (CYK, ENM, CY, FK, M. Clague, M. Caldwell, AB, KTT) and Infectious Disease (JZ), Columbia University Irving Medical Center/New York Presbyterian Hospital
| | - Fredrick King
- Departments of Neurology (CYK, ENM, CY, FK, M. Clague, M. Caldwell, AB, KTT) and Infectious Disease (JZ), Columbia University Irving Medical Center/New York Presbyterian Hospital
| | - Madison Clague
- Departments of Neurology (CYK, ENM, CY, FK, M. Clague, M. Caldwell, AB, KTT) and Infectious Disease (JZ), Columbia University Irving Medical Center/New York Presbyterian Hospital
| | - Marissa Caldwell
- Departments of Neurology (CYK, ENM, CY, FK, M. Clague, M. Caldwell, AB, KTT) and Infectious Disease (JZ), Columbia University Irving Medical Center/New York Presbyterian Hospital
| | - Abhilasha Boruah
- Departments of Neurology (CYK, ENM, CY, FK, M. Clague, M. Caldwell, AB, KTT) and Infectious Disease (JZ), Columbia University Irving Medical Center/New York Presbyterian Hospital
| | - Jason Zucker
- Departments of Neurology (CYK, ENM, CY, FK, M. Clague, M. Caldwell, AB, KTT) and Infectious Disease (JZ), Columbia University Irving Medical Center/New York Presbyterian Hospital
| | - Kiran T Thakur
- Departments of Neurology (CYK, ENM, CY, FK, M. Clague, M. Caldwell, AB, KTT) and Infectious Disease (JZ), Columbia University Irving Medical Center/New York Presbyterian Hospital
| |
Collapse
|
5
|
Tamborska AA, Wood GK, Westenberg E, Garcia-Azorin D, Webb G, Schiess N, Netravathi M, Baykan B, Dervaj R, Helbok R, Lant S, Özge A, Padovani A, Saylor D, Schmutzhard E, Easton A, Lilleker JB, Jackson T, Beghi E, Ellul MA, Frontera JA, Pollak T, Nicholson TR, Wood N, Thakur KT, Solomon T, Stark RJ, Winkler AS, Michael BD. Global uncertainty in the diagnosis of neurological complications of SARS-CoV-2 infection by both neurologists and non-neurologists: An international inter-observer variability study. J Neurol Sci 2023; 449:120646. [PMID: 37100018 PMCID: PMC10085971 DOI: 10.1016/j.jns.2023.120646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/26/2023] [Accepted: 04/08/2023] [Indexed: 04/28/2023]
Abstract
INTRODUCTION Uniform case definitions are required to ensure harmonised reporting of neurological syndromes associated with SARS-CoV-2. Moreover, it is unclear how clinicians perceive the relative importance of SARS-CoV-2 in neurological syndromes, which risks under- or over-reporting. METHODS We invited clinicians through global networks, including the World Federation of Neurology, to assess ten anonymised vignettes of SARS-CoV-2 neurological syndromes. Using standardised case definitions, clinicians assigned a diagnosis and ranked association with SARS-CoV-2. We compared diagnostic accuracy and assigned association ranks between different settings and specialties and calculated inter-rater agreement for case definitions as "poor" (κ ≤ 0.4), "moderate" or "good" (κ > 0.6). RESULTS 1265 diagnoses were assigned by 146 participants from 45 countries on six continents. The highest correct proportion were cerebral venous sinus thrombosis (CVST, 95.8%), Guillain-Barré syndrome (GBS, 92.4%) and headache (91.6%) and the lowest encephalitis (72.8%), psychosis (53.8%) and encephalopathy (43.2%). Diagnostic accuracy was similar between neurologists and non-neurologists (median score 8 vs. 7/10, p = 0.1). Good inter-rater agreement was observed for five diagnoses: cranial neuropathy, headache, myelitis, CVST, and GBS and poor agreement for encephalopathy. In 13% of vignettes, clinicians incorrectly assigned lowest association ranks, regardless of setting and specialty. CONCLUSION The case definitions can help with reporting of neurological complications of SARS-CoV-2, also in settings with few neurologists. However, encephalopathy, encephalitis, and psychosis were often misdiagnosed, and clinicians underestimated the association with SARS-CoV-2. Future work should refine the case definitions and provide training if global reporting of neurological syndromes associated with SARS-CoV-2 is to be robust.
Collapse
Affiliation(s)
- A A Tamborska
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK
| | - G K Wood
- Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - E Westenberg
- Center for Global Health, Department of Neurology, Faculty of Medicine, Technical University of Munich, Germany
| | - D Garcia-Azorin
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - G Webb
- Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK
| | - N Schiess
- Brain Health Unit, Mental Health and Substance Use Department, World Health Organization, Switzerland
| | - M Netravathi
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - B Baykan
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkiye; EMAR Medical Center, Macka Istanbul, Turkiye
| | - R Dervaj
- Department of Neurology, Apollo Specialty Hospital, Bangalore, Karnataka, India
| | - R Helbok
- Department of Neurology, Division Neuro-Critical Care, Medical University Innsbruck, Austria
| | - S Lant
- Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - A Özge
- Mersin University Medical Faculty, Department of Neurology, Mersin, Turkey
| | - A Padovani
- Clinical and Experimental Sciences Department, Neurology Unit, University and SpedaliCivili, Brescia, Italy
| | - D Saylor
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - E Schmutzhard
- Department of Neurology, Division Neuro-Critical Care, Medical University Innsbruck, Austria
| | - A Easton
- Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Encephalitis Society, UK
| | - J B Lilleker
- Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK; Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - T Jackson
- Institute of Inflammation and Ageing, University of Birmingham, UK; Geriatric Medicine, University Hospitals Birmingham, Birmingham, UK
| | - E Beghi
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - M A Ellul
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK
| | - J A Frontera
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - T Pollak
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - T R Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - N Wood
- Department of Clinical and Movement Neurosciences, University College London, UCL Queen Square Institute of Neurology, London, UK
| | - K T Thakur
- Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY, USA
| | - T Solomon
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK; The Pandemic Institute, Liverpool, UK
| | - R J Stark
- Department of Neurology, Alfred Hospital, Melbourne, Australia; Department of Neuroscience, Monash University, Melbourne, Australia
| | - A S Winkler
- Center for Global Health, Department of Neurology, Faculty of Medicine, Technical University of Munich, Germany; Centre for Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway
| | - B D Michael
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK.
| |
Collapse
|
6
|
Beghi E, Moro E, Davidescu EI, Popescu B, Grosu O, Valzania F, Cotelli MS, Kiteva‐Trenchevska G, Zakharova M, Kovács T, Armon C, Brola W, Yasuda CL, Maia LF, Lovrencic‐Huzjan A, de Seabra MML, Avalos‐Pavon R, Aamodt AH, Meoni S, Gryb V, Ozturk S, Karadas O, Krehan I, Leone MA, Lolich M, Bianchi E, Rass V, Helbok R, Bassetti CLA. Comparative features and outcomes of major neurological complications of COVID-19. Eur J Neurol 2023; 30:413-433. [PMID: 36314485 PMCID: PMC9874573 DOI: 10.1111/ene.15617] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/03/2022] [Accepted: 10/19/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to assess the neurological complications of SARS-CoV-2 infection and compare phenotypes and outcomes in infected patients with and without selected neurological manifestations. METHODS The data source was a registry established by the European Academy of Neurology during the first wave of the COVID-19 pandemic. Neurologists collected data on patients with COVID-19 seen as in- and outpatients and in emergency rooms in 23 European and seven non-European countries. Prospective and retrospective data included patient demographics, lifestyle habits, comorbidities, main COVID-19 complications, hospital and intensive care unit admissions, diagnostic tests, and outcome. Acute/subacute selected neurological manifestations in patients with COVID-19 were analysed, comparing individuals with and without each condition for several risk factors. RESULTS By July 31, 2021, 1523 patients (758 men, 756 women, and nine intersex/unknown, aged 16-101 years) were registered. Neurological manifestations were diagnosed in 1213 infected patients (79.6%). At study entry, 978 patients (64.2%) had one or more chronic general or neurological comorbidities. Predominant acute/subacute neurological manifestations were cognitive dysfunction (N = 449, 29.5%), stroke (N = 392, 25.7%), sleep-wake disturbances (N = 250, 16.4%), dysautonomia (N = 224, 14.7%), peripheral neuropathy (N = 145, 9.5%), movement disorders (N = 142, 9.3%), ataxia (N = 134, 8.8%), and seizures (N = 126, 8.3%). These manifestations tended to differ with regard to age, general and neurological comorbidities, infection severity and non-neurological manifestations, extent of association with other acute/subacute neurological manifestations, and outcome. CONCLUSIONS Patients with COVID-19 and neurological manifestations present with distinct phenotypes. Differences in age, general and neurological comorbidities, and infection severity characterize the various neurological manifestations of COVID-19.
Collapse
Affiliation(s)
- Ettore Beghi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCSMilanItaly
| | - Elena Moro
- Centre Hospitalier Universitaire de Grenoble, Service de Neurologie, Grenoble Institute of NeurosciencesGrenoble Alpes UniversityGrenobleFrance
| | - Eugenia Irene Davidescu
- Neurology Department, Colentina Clinical Hospital, Bucharest, Romania and Department of Clinical Neurosciences“Carol Davila” University of Medicine and PharmacyBucharestRomania
| | - Bogdan Ovidiu Popescu
- Neurology Department, Colentina Clinical Hospital, Bucharest, Romania and Department of Clinical Neurosciences“Carol Davila” University of Medicine and PharmacyBucharestRomania
| | - Oxana Grosu
- Diomid Gherman Institute of Neurology and NeurosurgeryChișinăuMoldova
| | - Franco Valzania
- Neurology Unit, Neuromotor and Rehabilitation DepartmentAzienda USL‐IRCCS di Reggio EmiliaReggio EmiliaItaly
| | | | | | | | | | - Carmel Armon
- Tel Aviv University School of Medicine and Shamir (Assaf Harofeh) Medical CenterTel AvivIsrael
| | - Waldemar Brola
- Department of Neurology, Specialist Hospital Konskie, Collegium MedicumJan Kochanowski UniversityKielcePoland
| | - Clarissa Lin Yasuda
- CEPID BRAINN ‐ Brazilian Institute of Neuroscience and Neurotechnology and University of CampinasCampinasBrazil
| | - Luís F. Maia
- Neurology Department Hospital Santo António – CHUPPortoPortugal
| | | | - Mafalda Maria Laracho de Seabra
- Department of NeurologyCentro Hospitalar Universitário de São João, E.P.EPortoSpain
- Cardiovascular I&D Unit, Portugal Department of Clinical Neurosciences and Mental HealthFaculty of Medicine University of PortoPortoPortugal
| | - Rafael Avalos‐Pavon
- Neurology Service, Facultad de MedicinaUniversidad Autonoma de San Luis Potosi. Hospital CentralSan Luis PotosiMexico
| | | | - Sara Meoni
- Centre Hospitalier Universitaire de Grenoble, Service de Neurologie, Grenoble Institute of NeurosciencesGrenoble Alpes UniversityGrenobleFrance
| | - Victoria Gryb
- Department of Neurology and NeurosurgeryIvano‐Frankivsk National Medical UniversityIvano‐FrankivskUkraine
| | - Serefnur Ozturk
- Selcuk University Faculty of MedicineDepartment of NeurologyKonyaTurkey
| | - Omer Karadas
- University of Health ScienceGulhane School of Medicine, Neurology DepartmentAnkaraTurkey
| | - Ingomar Krehan
- Department of NeurologyKepler University HospitalLinzAustria
| | | | | | - Elisa Bianchi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCSMilanItaly
| | - Verena Rass
- Neurocritical Care Unit, Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Raimund Helbok
- Neurocritical Care Unit, Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | | | | |
Collapse
|
7
|
Padovani A, Pilotto A. Looking for lights in the fog of long-term neurological COVID. Nat Rev Neurol 2023; 19:7-8. [PMID: 36400868 PMCID: PMC9676768 DOI: 10.1038/s41582-022-00750-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Alessandro Padovani
- grid.7637.50000000417571846Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Pilotto
- grid.7637.50000000417571846Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| |
Collapse
|
8
|
Shan D, Li S, Xu R, Nie G, Xie Y, Han J, Gao X, Zheng Y, Xu Z, Dai Z. Post-COVID-19 human memory impairment: A PRISMA-based systematic review of evidence from brain imaging studies. Front Aging Neurosci 2022; 14:1077384. [PMID: 36570532 PMCID: PMC9780393 DOI: 10.3389/fnagi.2022.1077384] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022] Open
Abstract
Many people with coronavirus disease 2019 (COVID-19) report varying degrees of memory impairment. Neuroimaging techniques such as MRI and PET have been utilized to shed light on how COVID-19 affects brain function in humans, including memory dysfunction. In this PRISMA-based systematic review, we compared and summarized the current literature looking at the relationship between COVID-19-induced neuropathological changes by neuroimaging scans and memory symptoms experienced by patients who recovered from COVID-19. Overall, this review suggests a correlational trend between structural abnormalities (e.g., cortical atrophy and white matter hyperintensities) or functional abnormalities (e.g., hypometabolism) in a wide range of brain regions (particularly in the frontal, parietal and temporal regions) and memory impairments in COVID-19 survivors, although a causal relationship between them remains elusive in the absence of sufficient caution. Further longitudinal investigations, particularly controlled studies combined with correlational analyses, are needed to provide additional evidence.
Collapse
Affiliation(s)
- Dan Shan
- Department of Biobehavioral Sciences, Columbia University, New York, NY, United States
| | - Shaoyang Li
- Faculty of Science, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Ruichen Xu
- Department of Integrative Biology, University of Wisconsin-Madison, Madison, WI, United States
| | - Glen Nie
- Department of Biological Science, Northeastern University, Boston, MA, United States
| | - Yangyiran Xie
- School of Medicine, Vanderbilt University, Nashville, TN, United States
| | - Junchu Han
- New York State Psychiatric Institute, Global Psychiatric Epidemiology Group, New York, NY, United States
| | - Xiaoyi Gao
- School of Medicine, Saint Louis University, St. Louis, MO, United States
| | - Yuandian Zheng
- Department of Biobehavioral Sciences, Columbia University, New York, NY, United States
| | - Zhen Xu
- Minhang Crosspoint Academy at Shanghai Wenqi Middle School, Shanghai, China
| | - Zhihao Dai
- School of Medicine, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| |
Collapse
|
9
|
Masaad D, Youssef S, Safadi MF, Shehadeh Agha M. MRI-negative myelitis associated with cerebral venous thrombosis after COVID-19 infection. BMJ Case Rep 2022; 15:15/10/e250535. [PMID: 36307141 PMCID: PMC9621158 DOI: 10.1136/bcr-2022-250535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Transverse myelitis and cerebral venous thrombosis represent some of the described neurological complications of coronavirus disease. A woman in her early 30s presented with headache, left-sided sensory symptoms and voiding difficulty. The patient also reported dry cough, fever, nasal congestion, anosmia and ageusia 2 weeks before presentation. The clinical examination showed sensory disturbances on the left side of the body, starting from the lower abdomen and extending to the left leg, which was consistent with transverse myelitis. The laboratory assessment confirmed a previous infection with coronavirus disease and excluded autoimmune entities. Radiological investigations revealed left transverse sinus thrombosis with no spinal cord abnormalities. The treatment was started with therapeutic anticoagulation and intravenous high-dose steroids. The patient showed significant improvement, and the neurological deficits resolved after 3 months. This is the first documented case of imaging-negative myelitis associated with cerebral venous thrombosis after coronavirus disease.
Collapse
Affiliation(s)
- Dea Masaad
- Department of Neurology, Al-Mouwasat Hospital, Damascus, Syrian Arab Republic
| | | | - Mhd Firas Safadi
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Dresden, Sachsen, Germany
| | | |
Collapse
|
10
|
Stafstrom CE. Neurological effects of COVID-19 in infants and children. Dev Med Child Neurol 2022; 64:818-829. [PMID: 35243616 PMCID: PMC9111795 DOI: 10.1111/dmcn.15185] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 12/13/2022]
Abstract
Neurological manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children are becoming increasingly apparent as the coronavirus disease (COVID-19) pandemic continues. While children manifest relatively milder features of the disease, accumulating evidence warrants concern that COVID-19 exacts both acute- and long-term effects on the developing central and peripheral nervous systems. This review focuses on the relatively underinvestigated topic of the effects of SARS-CoV-2 on the brain in infancy and childhood, concluding that clinicians should be attentive to both the acute effects and long-term consequences of COVID-19 from a neurological perspective.
Collapse
Affiliation(s)
- Carl E. Stafstrom
- Division of Pediatric NeurologyDepartments of Neurology and PediatricsThe Johns Hopkins University School of MedicineBaltimoreMDUSA
| |
Collapse
|
11
|
Lamoureux L, Sajesh B, Slota JA, Medina SJ, Mayor M, Frost KL, Warner B, Manguiat K, Wood H, Kobasa D, Booth SA. Non-Productive Infection of Glial Cells with SARS-CoV-2 in Hamster Organotypic Cerebellar Slice Cultures. Viruses 2022; 14:1218. [PMID: 35746689 PMCID: PMC9227386 DOI: 10.3390/v14061218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022] Open
Abstract
The numerous neurological syndromes associated with COVID-19 implicate an effect of viral pathogenesis on neuronal function, yet reports of direct SARS-CoV-2 infection in the brain are conflicting. We used a well-established organotypic brain slice culture to determine the permissivity of hamster brain tissues to SARS-CoV-2 infection. We found levels of live virus waned after inoculation and observed no evidence of cell-to-cell spread, indicating that SARS-CoV-2 infection was non-productive. Nonetheless, we identified a small number of infected cells with glial phenotypes; however, no evidence of viral infection or replication was observed in neurons. Our data corroborate several clinical studies that have assessed patients with COVID-19 and their association with neurological involvement.
Collapse
Affiliation(s)
- Lise Lamoureux
- One Health Division, Public Health Agency of Canada, National Microbiology Laboratory, 1015 Arlington St., Winnipeg, MB R3E 3R2, Canada; (L.L.); (B.S.); (J.A.S.); (S.J.M.); (M.M.); (K.L.F.); (K.M.); (H.W.)
| | - Babu Sajesh
- One Health Division, Public Health Agency of Canada, National Microbiology Laboratory, 1015 Arlington St., Winnipeg, MB R3E 3R2, Canada; (L.L.); (B.S.); (J.A.S.); (S.J.M.); (M.M.); (K.L.F.); (K.M.); (H.W.)
| | - Jessy A. Slota
- One Health Division, Public Health Agency of Canada, National Microbiology Laboratory, 1015 Arlington St., Winnipeg, MB R3E 3R2, Canada; (L.L.); (B.S.); (J.A.S.); (S.J.M.); (M.M.); (K.L.F.); (K.M.); (H.W.)
- Department of Medical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of Manitoba, 730 William Ave., Winnipeg, MB R3E 0W3, Canada;
| | - Sarah J. Medina
- One Health Division, Public Health Agency of Canada, National Microbiology Laboratory, 1015 Arlington St., Winnipeg, MB R3E 3R2, Canada; (L.L.); (B.S.); (J.A.S.); (S.J.M.); (M.M.); (K.L.F.); (K.M.); (H.W.)
| | - Matthew Mayor
- One Health Division, Public Health Agency of Canada, National Microbiology Laboratory, 1015 Arlington St., Winnipeg, MB R3E 3R2, Canada; (L.L.); (B.S.); (J.A.S.); (S.J.M.); (M.M.); (K.L.F.); (K.M.); (H.W.)
| | - Kathy L. Frost
- One Health Division, Public Health Agency of Canada, National Microbiology Laboratory, 1015 Arlington St., Winnipeg, MB R3E 3R2, Canada; (L.L.); (B.S.); (J.A.S.); (S.J.M.); (M.M.); (K.L.F.); (K.M.); (H.W.)
| | - Bryce Warner
- Special Pathogens, Public Health Agency of Canada, National Microbiology Laboratory, 1015 Arlington St., Winnipeg, MB R3E 3R2, Canada;
| | - Kathy Manguiat
- One Health Division, Public Health Agency of Canada, National Microbiology Laboratory, 1015 Arlington St., Winnipeg, MB R3E 3R2, Canada; (L.L.); (B.S.); (J.A.S.); (S.J.M.); (M.M.); (K.L.F.); (K.M.); (H.W.)
| | - Heidi Wood
- One Health Division, Public Health Agency of Canada, National Microbiology Laboratory, 1015 Arlington St., Winnipeg, MB R3E 3R2, Canada; (L.L.); (B.S.); (J.A.S.); (S.J.M.); (M.M.); (K.L.F.); (K.M.); (H.W.)
| | - Darwyn Kobasa
- Department of Medical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of Manitoba, 730 William Ave., Winnipeg, MB R3E 0W3, Canada;
- Special Pathogens, Public Health Agency of Canada, National Microbiology Laboratory, 1015 Arlington St., Winnipeg, MB R3E 3R2, Canada;
| | - Stephanie A. Booth
- One Health Division, Public Health Agency of Canada, National Microbiology Laboratory, 1015 Arlington St., Winnipeg, MB R3E 3R2, Canada; (L.L.); (B.S.); (J.A.S.); (S.J.M.); (M.M.); (K.L.F.); (K.M.); (H.W.)
- Department of Medical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of Manitoba, 730 William Ave., Winnipeg, MB R3E 0W3, Canada;
| |
Collapse
|
12
|
Beghi E, Helbok R, Oztturk S, Karadas O, Lisnic V, Grosu O, Kovács T, Dobronyi L, Bereczki D, Cotelli MS, Turla M, Davidescu EI, Popescu BO, Valzania F, Cavallieri F, Ulmer H, Maia LF, Amodt AH, Armon C, Brola W, Gryb V, Riahi A, Krehan I, von Oertzen T, Azab MA, Crean M, Lolich M, Lima MJ, Sellner J, Perneczky J, Jenkins T, Meoni S, Bianchi E, Moro E, Bassetti CLA. Short- and long-term outcome and predictors in an international cohort of patients with neuro COVID-19. Eur J Neurol 2022; 29:1663-1684. [PMID: 35194889 PMCID: PMC9111799 DOI: 10.1111/ene.15293] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/31/2022] [Indexed: 11/28/2022]
Abstract
Background and purpose Despite the increasing number of reports on the spectrum of neurological manifestations of COVID‐19 (neuro‐COVID), few studies have assessed short‐ and long‐term outcome of the disease. Methods This is a cohort study enrolling adult patients with neuro‐COVID seen in neurological consultation. Data were collected prospectively or retrospectively in the European Academy of Neurology NEuro‐covid ReGistrY ((ENERGY). The outcome at discharge was measured using the modified Rankin Scale and defined as ‘stable/improved’ if the modified Rankin Scale score was equal to or lower than the pre‐morbid score, ‘worse’ if the score was higher than the pre‐morbid score. Status at 6 months was also recorded. Demographic and clinical variables were assessed as predictors of outcome at discharge and 6 months. Results From July 2020 to March 2021, 971 patients from 19 countries were included. 810 (83.4%) were hospitalized. 432 (53.3%) were discharged with worse functional status. Older age, stupor/coma, stroke and intensive care unit (ICU) admission were predictors of worse outcome at discharge. 132 (16.3%) died in hospital. Older age, cancer, cardiovascular complications, refractory shock, stupor/coma and ICU admission were associated with death. 262 were followed for 6 months. Acute stroke or ataxia, ICU admission and degree of functional impairment at discharge were predictors of worse outcome. 65/221 hospitalized patients (29.4%) and 10/32 non‐hospitalized patients (24.4%) experienced persisting neurological symptoms/signs. 10/262 patients (3.8%) developed new neurological complaints during the 6 months of follow‐up. Conclusions Neuro‐COVID is a severe disease associated with worse functional status at discharge, particularly in older subjects and those with comorbidities and acute complications of infection.
Collapse
Affiliation(s)
- Ettore Beghi
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Neuroscience
| | - Raimund Helbok
- Medical University of Innsbruck, Department of Neurology, Neurological Intensive Care Unit
| | | | - Omer Karadas
- University of Health Science, Gulhane School of Medicine, Neurology Department, Ankara, Turkey
| | - Vitalie Lisnic
- Nicolae Testemiceanu State Medical and Pharmaceutical University, Neurology
| | - Oxana Grosu
- Academy of Sciences of Moldova, Neurology, Nicolae Testemiceanu State Medical and Pharmaceutical University, Neurology
| | | | | | | | | | | | | | | | - Franco Valzania
- Azienda USL-IRCCS di Reggio Emilia, Neurology Unit, Neuromotor & Rehabilitation Department
| | | | - Hanno Ulmer
- Innsbruck Medical University, Department of Medical Statistics, Informatics and Health Economics
| | - Luis F Maia
- Centro Hospitalar Universitario do Porto EPE, Neurology
| | | | - Carmel Armon
- Tel Aviv University School of Medicine, Department of Neurology
| | - Waldemer Brola
- Specialist Hospital Konskie, Collegium Medicum, Jan Kochanowski University, Department of Neurology, Kielce
| | - Victoria Gryb
- Ivano-Frankivsk Medical University, Vascular Neurology
| | - Anis Riahi
- Military hospital of Tunis, Tunis El Manar University, Department of Neurology
| | | | - Tim von Oertzen
- Kepler Universitatsklinikum GmbH, Dpet of Neurology 1, Johannes Kepler Universitat Linz, Medical Faculty
| | - Mohammed A Azab
- Idaho State University Boise, Department of Biochemistry and Molecular Biology
| | - Michael Crean
- European Academy of Neurology, department of neurology
| | | | | | - Johann Sellner
- Landesklinikum Mistelbach-Gänserndorf Abteilung für Urologie, Department of Neurology
| | | | - Tom Jenkins
- The University of Sheffield Institute for Translational Neuroscience, Department of neurology
| | - Sara Meoni
- Pole de Psychiatrie et Neurologie, CHUGA, Pole de Psychiatrie et Neurologie
| | | | - Elena Moro
- Division of Neurology, Centre Hospitalier Universitaire of Grenoble, Grenoble Alpes University, Neurology, CHUGA, Neuroscience
| | | | | |
Collapse
|
13
|
Piontkivska H, Wales-McGrath B, Miyamoto M, Wayne ML. ADAR Editing in Viruses: An Evolutionary Force to Reckon with. Genome Biol Evol 2021; 13:evab240. [PMID: 34694399 PMCID: PMC8586724 DOI: 10.1093/gbe/evab240] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 02/06/2023] Open
Abstract
Adenosine Deaminases that Act on RNA (ADARs) are RNA editing enzymes that play a dynamic and nuanced role in regulating transcriptome and proteome diversity. This editing can be highly selective, affecting a specific site within a transcript, or nonselective, resulting in hyperediting. ADAR editing is important for regulating neural functions and autoimmunity, and has a key role in the innate immune response to viral infections, where editing can have a range of pro- or antiviral effects and can contribute to viral evolution. Here we examine the role of ADAR editing across a broad range of viral groups. We propose that the effect of ADAR editing on viral replication, whether pro- or antiviral, is better viewed as an axis rather than a binary, and that the specific position of a given virus on this axis is highly dependent on virus- and host-specific factors, and can change over the course of infection. However, more research needs to be devoted to understanding these dynamic factors and how they affect virus-ADAR interactions and viral evolution. Another area that warrants significant attention is the effect of virus-ADAR interactions on host-ADAR interactions, particularly in light of the crucial role of ADAR in regulating neural functions. Answering these questions will be essential to developing our understanding of the relationship between ADAR editing and viral infection. In turn, this will further our understanding of the effects of viruses such as SARS-CoV-2, as well as many others, and thereby influence our approach to treating these deadly diseases.
Collapse
Affiliation(s)
- Helen Piontkivska
- Department of Biological Sciences, Kent State University, Ohio, USA
- School of Biomedical Sciences, Kent State University, Ohio, USA
- Brain Health Research Institute, Kent State University, Ohio, USA
| | | | - Michael Miyamoto
- Department of Biology, University of Florida, Gainesville, Florida, USA
| | - Marta L Wayne
- Department of Biology, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
14
|
Baumann M. COVID-19 and mental health in children and adolescents: a diagnostic panel to map psycho-social consequences in the pandemic context. DISCOVER MENTAL HEALTH 2021; 1:2. [PMID: 35174361 PMCID: PMC8544185 DOI: 10.1007/s44192-021-00002-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/30/2021] [Indexed: 11/25/2022]
Abstract
Since the beginning of the COVID-19 pandemic, much research has been done on the psycho-social consequences, especially for children, adolescents and families. In the long run, there is a large set of quantitative data available. However, these still seem to be not well understood. Theoretical classifications of the evidence also diagnostic tools still seem to be open. This paper elaborates a possible systematisation based on theoretical models of systemic self-organisation theories. This leads to a model for a comprehensive psycho-social child-in-environment diagnostic to map potential problem areas. Such a theoretical framing should enable both: a deeper understanding of the impact of pandemics on young people and hypotheses for intervention strategies in the context of pandemic management as well as in the context of diagnostic-systemic interventions in psycho-social working settings. In the coming months and years, it will be essential to be able to understand and describe psychosocial disabilities that have developed in the context of the pandemic in a differentiated way in order to establish targeted interventions.
Collapse
Affiliation(s)
- Menno Baumann
- Fliedner-Fachhochschule Düsseldorf, Düsseldorf, Nordrhein-Westfalen Germany
| |
Collapse
|
15
|
Beghi E, Giussani G, Westenberg E, Allegri R, Garcia-Azorin D, Guekht A, Frontera J, Kivipelto M, Mangialasche F, Mukaetova-Ladinska EB, Prasad K, Chowdhary N, Winkler AS. Acute and post-acute neurological manifestations of COVID-19: present findings, critical appraisal, and future directions. J Neurol 2021; 269:2265-2274. [PMID: 34674005 PMCID: PMC8528941 DOI: 10.1007/s00415-021-10848-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/13/2021] [Accepted: 10/13/2021] [Indexed: 12/22/2022]
Abstract
Acute and post-acute neurological symptoms, signs and diagnoses have been documented in an increasing number of patients infected by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which causes Coronavirus Disease 2019 (COVID-19). In this review, we aimed to summarize the current literature addressing neurological events following SARS-CoV-2 infection, discuss limitations in the existing literature and suggest future directions that would strengthen our understanding of the neurological sequelae of COVID-19. The presence of neurological manifestations (symptoms, signs or diagnoses) both at the onset or during SARS-CoV-2 infection is associated with a more severe disease, as demonstrated by a longer hospital stay, higher in-hospital death rate or the continued presence of sequelae at discharge. Although biological mechanisms have been postulated for these findings, evidence-based data are still lacking to clearly define the incidence, range of characteristics and outcomes of these manifestations, particularly in non-hospitalized patients. In addition, data from low- and middle-income countries are scarce, leading to uncertainties in the measure of neurological findings of COVID-19, with reference to geography, ethnicity, socio-cultural settings, and health care arrangements. As a consequence, at present a specific phenotype that would specify a post-COVID (or long-COVID) neurological syndrome has not yet been identified.
Collapse
Affiliation(s)
- Ettore Beghi
- Laboratory of Neurological Disorders, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156, Milan, Italy.
| | - Giorgia Giussani
- Laboratory of Neurological Disorders, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156, Milan, Italy
| | - Erica Westenberg
- Department of Neurology, Centre for Global Health, Technical University of Munich, Munich, Germany
| | - Ricardo Allegri
- Department of Cognitive Neurology, Instituto de Investigaciones Neurológicas Fleni, Buenos Aires, Argentina
| | - David Garcia-Azorin
- Department of Neurology, Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry & Russian National Research Medical University, Moscow, Russia
| | | | - Miia Kivipelto
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.,The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
| | - Francesca Mangialasche
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
| | | | - Kameshwar Prasad
- Deapartment of Neurology, and Chief Executive Office, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, 834009, India
| | - Neerja Chowdhary
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Andrea Sylvia Winkler
- Department of Neurology, Centre for Global Health, Technical University of Munich, Munich, Germany.,Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| |
Collapse
|
16
|
Zentralnervöse Befunde bei COVID-19. ROFO-FORTSCHR RONTG 2021. [DOI: 10.1055/a-1395-2177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
17
|
Moro E, Taba P. COVID-19: An unforgettable challenge for the neurology community. Eur J Neurol 2021; 28:3221-3222. [PMID: 34033184 PMCID: PMC8239591 DOI: 10.1111/ene.14937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Elena Moro
- Division of Neurology, INSERM 1214, CHU Grenoble, Grenoble Institute of Neuroscience, Grenoble Alpes University, Grenoble, France
| | - Pille Taba
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| |
Collapse
|