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Dai L, Lyu L, Zhou P, Jiang S. Causal associations of COVID-19 on neurosurgical diseases risk: a Mendelian randomization study. Hum Genomics 2024; 18:13. [PMID: 38311757 PMCID: PMC10840232 DOI: 10.1186/s40246-024-00575-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: 12/20/2023] [Accepted: 01/22/2024] [Indexed: 02/06/2024] Open
Abstract
Many researchers have explored the potential association between one neurosurgical disease and coronavirus disease 2019 (COVID-19), but few systematically analyzed the association and causality between COVID-19 and various neurosurgical diseases. A Mendelian randomization analysis was conducted to evaluate the causal association between COVID-19 (including critically ill COVID-19, hospitalized COVID-19, and respiratory syndrome coronavirus 2 (SARS-CoV-2) infection) and 30 neurosurgical diseases within European populations. The consequences of inverse variance weighted models suggest that genetic susceptibility of critically ill COVID-19 may increase the risk of cerebral infarction (odds ratio [OR] = 1.02; p-value = 0.006), genetic susceptibility of SARS-CoV-2 infection may increase the risk of stroke (OR = 1.02; p-value = 0.047), and conversely, genetic susceptibility of hospitalized COVID-19 may reduce the risk of pituitary adenoma and craniopharyngioma (OR = 0.90; p-value = 0.032). In addition, evidences revealed potential associations between genetic susceptibility of COVID-19 and spinal stenosis (OR = 1.03; p-value = 0.028), diffuse brain injury (OR = 1.21; p-value = 0.040) and focal brain injury (OR = 1.12; p-value = 0.040). By testing for heterogeneity and pleiotropy, the above causal conclusions are robust. In summary, our analysis shows that COVID-19 has an independent and powerful causal influence on multiple neurosurgical disorders.
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Affiliation(s)
- Lirui Dai
- Department of Neurosurgery, Pituitary Adenoma Multidisciplinary Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Liang Lyu
- Department of Neurosurgery, Pituitary Adenoma Multidisciplinary Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Peizhi Zhou
- Department of Neurosurgery, Pituitary Adenoma Multidisciplinary Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
| | - Shu Jiang
- Department of Neurosurgery, Pituitary Adenoma Multidisciplinary Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
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2
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Shamim D, Ganatra F, Khan M, Gronseth G. New Onset Seizures in Hospitalized COVID-19 Patients; A Systematic Review and Meta-Analysis. Neurohospitalist 2024; 14:34-43. [PMID: 38235025 PMCID: PMC10790614 DOI: 10.1177/19418744231202317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Objective Seizures in COVID-19 patients continue to be a common reason for consulting the neurology service in the inpatient setting. This paper assesses the frequency of new onset seizures in adult hospitalized COVID-19 patients. Method PubMed and EMBASE were searched, with fifteen cohort studies identified to calculate the primary outcome, which was the frequency of new onset seizures in hospitalized COVID-19 patients. An inverse variance meta-analysis of single proportions with a random effects model was applied to these cohort studies to calculate the primary outcome. Risk of bias in individual studies was assessed using the 10-item risk of bias tool for prevalence studies. Results The meta-analysis revealed a frequency of .71% (95% confidential interval: .32-1.25, I2 = 89%, 147/28242 patients) for acute symptomatic seizures in patients with COVID-19. For secondary outcomes, the risk of seizures in patients who had EEG completed was 8.49% (95% confidential interval: .62-24.07, I2 = 14%, 44/535 patients). Slightly less than half of patients with COVID-19 and seizures were reported to have acute imaging abnormalities (45.7%) with acute vascular insults being commonly reported. Only a small percentage of COVID-19 patients with seizures (2.8%) met the criteria for COVID-19 encephalitis as determined by the international encephalitis consortium. Conclusion The frequency of seizures in COVID-19 was .71% (95% confidential interval: .32-1.25). Slightly less than half of COVID-19 patients had head imaging abnormalities as a complication of COVID-19 infection. Only a small percentage of patients with seizures and COVID-19 met the criteria for COVID-19 encephalitis.
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Affiliation(s)
- Daniah Shamim
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Fatima Ganatra
- Department of Medicine, DOW University of Health Sciences, Karachi, Pakistan
| | - Murtaza Khan
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Gary Gronseth
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
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3
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Emmert BE, Gandelman S, Do D, Donovan K, Kolson DL, Schindler MK. A Characterization of Neurology Consults for Inpatients with SARS-CoV-2 Infection Compared to Other Respiratory Viruses. Neurol Int 2023; 15:1393-1402. [PMID: 38132968 PMCID: PMC10745801 DOI: 10.3390/neurolint15040089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 11/16/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023] Open
Abstract
Introduction: Neurological consultation for patients infected with SARS-CoV-2 is common; it is currently unknown whether the neurologist's approach to inpatient consultation of patients with SARS-CoV-2 should differ from the paradigm used to evaluate hospitalized patients with similar respiratory viruses. The goal of the present study is to determine if the preponderance of new neurologic diagnoses differs between inpatients with SARS-CoV-2 and similar non-SARS-CoV-2 respiratory viruses for whom neurology is consulted. Methods: We performed a retrospective chart analysis of inpatient neurologic consultations at three major Philadelphia-based hospitals. We compared the final neurologic diagnosis of 152 patients infected with SARS-CoV-2 to 54 patients with a similar ubiquitous non-SARS-CoV-2 respiratory virus (influenza A, influenza B, respiratory syncytial virus, rhinovirus, or adenovirus, the most commonly tested respiratory viruses at our institution). Secondary metrics included age, sex, level of care, prior neurologic diagnoses, and mortality. A multinomial logistic regression model was utilized to evaluate the relative difference between diagnostic category groups on all metrics. Results: The proportion of patients with seizure who were infected with SARS-CoV-2 admitted to an intensive care unit (ICU) was significantly higher than those who were admitted to a medical-surgical floor. SARS-CoV-2 was also associated with increased risk for ICU admission compared to other common respiratory viruses. SARS-CoV-2 inpatients requiring neurologic consultation were also more likely to be older and female as compared to the non-SARS-CoV-2 cohort. In other domains, the proportion of neurologic diagnoses between SAR-CoV-2 and non-SARS-CoV-2 respiratory viruses showed no significant difference. Conclusion: Patients requiring inpatient neurologic consultation with a diagnosis of SARS-CoV-2 infection or another respiratory virus were found to be remarkably similar in terms of their ultimate neurologic diagnosis, with the exception of a larger preponderance of seizure in critical-care-level patients with SARS-CoV-2 infection. Our study suggests that the neurological approach to patients hospitalized with SARS-CoV-2 should be similar to that for patients with similar common respiratory infections, noting that seizure was seen more frequently in critically ill patients infected with SARS-CoV-2.
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Affiliation(s)
- Brian E. Emmert
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Stephanie Gandelman
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David Do
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kevin Donovan
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Dennis L. Kolson
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Matthew K. Schindler
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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4
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Selitskiy GV, Sorokina ND, Pertsov SS, Zherdeva AS, Tsagashek AV. [Clinical and neurophysiological parameters in patients with epilepsy in the long-term period after COVID-19]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:60-65. [PMID: 36843460 DOI: 10.17116/jnevro202312302160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
OBJECTIVE Clinical and psychophysiological assessment of the dynamics of the condition of patients with epilepsy in 4-6 months after the coronavirus infection. MATERIAL AND METHODS An open controlled prospective comparative outpatient clinical and physiological study of patients diagnosed with epilepsy after suffering from COVID-19 (after 4-6 months) of moderate severity (n=16), patients diagnosed with epilepsy who did not suffer from COVID-19 (n=7), a control group (n=11) after confirmed COVID-19 (after 4-6 months). All groups were in the age range 23 to 50 years. Clinical/neurological and somatic research included: anamnesis, neurological examination, questioning, ECG, EEG, clinical and psychometric tests. RESULTS There was an increase in the representation of epileptiform activity in the background EEG and more pronounced activity in provoking samples compared with background recording in 26.5% of patients who had suffered COVID-19 compared with the group of patients with epilepsy who had not suffered COVID-19. The detection of rare epileptic seizures in 18.8% of cases in the group of epilepsy patients, who underwent COVID-19, indicates an increase in epileptogenesis and a decrease in therapeutic control over seizures. At the same time, 87.5% of patients in this group showed a statistically significant increase in the influence of the sympathetic nervous system on the regulation of heart rhythm and an increase in anxiety and depression. CONCLUSION The results can complement the understanding of the neuropsychiatric status of patients with epilepsy after COVID-19, which provides prerequisites for the development of optimal recovery directions in the rehabilitation period to maintain drug remission of epilepsy and reduce the possible progression of the disease.
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Affiliation(s)
- G V Selitskiy
- Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - N D Sorokina
- Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - S S Pertsov
- Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.,Anokhin Research Institute of Normal Physiology, Moscow, Russia
| | - A S Zherdeva
- Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A V Tsagashek
- Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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5
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Muacevic A, Adler JR, Anderson C, Sheraton M. Seizures, Vitamin D Deficiency, and Severe Hypophosphatemia: The Unique Presentation of a SARS-CoV-2 Case. Cureus 2023; 15:e33303. [PMID: 36606109 PMCID: PMC9809502 DOI: 10.7759/cureus.33303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2023] [Indexed: 01/04/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a virus that belongs to the species severe acute respiratory syndrome-related coronavirus (SARSr-CoV), which is related to the SARS-CoV-1 virus that caused the 2002-2004 SARS outbreak. SARS-CoV-2 causes coronavirus disease 2019 (COVID-19). It has been associated with electrolyte abnormalities. In this report, we discuss the case of a SARS-CoV-2-infected person presenting with recurrent seizure episodes resulting from hypophosphatemia. A 52-year-old male patient with questionable prior seizure history presented to the emergency department (ED) twice within eight days with recurring seizure episodes. While the physical examination at the first presentation was significant for a head laceration with post-ictal confusion, that at the second presentation was only significant for post-ictal confusion. Laboratory examination at the first visit revealed SARS-CoV-2 positivity, hypokalemia, hypophosphatemia, and low vitamin D levels. On the second visit, the patient was again found to have hypophosphatemia. CT of the head and the cervical spine, as well as radiographs of the chest done on the first visit, were all normal. On his first visit, the patient's electrolyte abnormalities were corrected, and he was discharged with antiepileptic medications after 24 hours of observation and consultation with neurology. However, his vitamin D levels, the results of which came back only after his first discharge, were corrected only during his second visit. This time, he was discharged from the ED and had an effective resolution of symptoms. SARS-CoV-2 infections can result in vitamin D deficiency and hypophosphatemia, resulting in seizures, and hence should be treated with both replacement therapies and antiepileptic medications. This case also highlights the importance of obtaining phosphorus and vitamin D levels in SARS-CoV-2-infected patients with seizures.
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6
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Sorokina ND, Pertsov SS, Selitsky GV, Zherdeva AS, Tsagashek AV. [Impact of COVID-19 on some neurological and psychological features in epilepsy]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:7-11. [PMID: 36946390 DOI: 10.17116/jnevro20231230317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
The new coronavirus infection spread around the world in a very short time and turned into a pandemic with a wave-like flow for more than two years. COVID-19infection affects selectively various organs and systems, including the nervous system; neurological manifestations have been reported, including anosmia, encephalopathy, stroke, epileptogenic disorders, which necessitates studies of the course of brain diseases, among which epilepsy occupies a significant place.
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Affiliation(s)
- N D Sorokina
- Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - S S Pertsov
- Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- Anokhin Research Institute of Normal Physiology, Moscow, Russia
| | - G V Selitsky
- Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A S Zherdeva
- Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A V Tsagashek
- Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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7
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Stancampiano F, Jhawar N, Alsafi W, Valery J, Harris D, Kempaiah P, Shah S, Heckman M, Siddiqui H, Libertin C. Use of remdesivir for COVID-19 pneumonia in patients with advanced kidney disease: A retrospective multicenter study. CLINICAL INFECTION IN PRACTICE 2022; 16:100207. [PMID: 36268055 PMCID: PMC9557110 DOI: 10.1016/j.clinpr.2022.100207] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/25/2022] [Accepted: 09/26/2022] [Indexed: 11/29/2022] Open
Abstract
Background and objectives Remdesivir, an antiviral drug routinely used in the treatment of COVID-19 has not yet received FDA approval for use in patients with advanced kidney disease defined as GFR < 30 mL/min/1.73 m2. There is concern that an excipient in Veklury (Gilead's proprietary name for remdesivir) called sulfobutylether-beta-cyclodextrin (SBECD), which is renally cleared, may accumulate and reach toxic levels in patients with advanced kidney disease. The aim of this study was to summarize characteristics and incidence of adverse events of chronic kidney disease (CKD) patients who received remdesivir during hospitalization.Design, setting, participants, and measurements.We retrospectively studied patients admitted to one of several hospitals of the Mayo Clinic Foundation with the diagnosis of COVID-19 pneumonia and CKD. Laboratory values were also measured when remdesivir was first administered and stopped. All analyses were performed in the overall patient group and three separate subgroups of patients with a GFR ≥ 15, a GFR < 15 and dialysis, and a GFR < 15 and no dialysis. Results A total of 444 CKD patients who were admitted to the hospital with COVID-19 pneumonia between May 2020 and September 2021 were included. Information was collected on patient characteristics, hospitalization, and adverse events. In the overall cohort, median age was 72 years (Range: 21-100 years), 55.2 % of patients were male, and most (86.5 %) were Caucasian. CKD stage was 3 for 114 patients (25.7 %), 4 for 229 patients (51.6 %), and 5 for 101 patients (22.7 %). A total of 146 patients (32.9 %) were admitted to the ICU, 103 (23.2 %) died in the hospital, and 120 (27.0 %) were on dialysis. The proportion of patients with an adverse event did not differ dramatically between the GFR ≥ 15 (20.9 %), GFR < 15 and dialysis (30.2 %), and GFR < 15 and no dialysis (32.3 %) groups (P = 0.12). Conclusion Our results suggest that the use of remdesivir in patients with very severe CKD is safe, even in those who are not on renal replacement therapy.
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Affiliation(s)
- F. Stancampiano
- Department of Medicine, Mayo Clinic Florida, 4500 San Pablo Rd, 3-W Cannaday, Jacksonville, FL 32224, United States,Corresponding author
| | - N. Jhawar
- Department of Medicine, Mayo Clinic Florida, 4500 San Pablo Rd, 3-W Cannaday, Jacksonville, FL 32224, United States
| | - W. Alsafi
- Clinical Research Unit, Mayo Clinic Florida, 4500 San Pablo Rd, 3-W Cannaday, Jacksonville, FL 32224, United States
| | - J. Valery
- Department of Medicine, Mayo Clinic Florida, 4500 San Pablo Rd, 3-W Cannaday, Jacksonville, FL 32224, United States
| | - D.M. Harris
- Department of Medicine, Mayo Clinic Florida, 4500 San Pablo Rd, 3-W Cannaday, Jacksonville, FL 32224, United States
| | - P. Kempaiah
- Division of Infectious Disease, Mayo Clinic Florida, 4500 San Pablo Rd, Griffin 142, Jacksonville, FL 32224, United States
| | - S. Shah
- Division of Transplant Medicine and Critical Care, Mayo Clinic Florida, 4500 San Pablo Rd, Mayo 03, Jacksonville, FL 32224, United States
| | - M.G. Heckman
- Division of Clinical Trials and Biostatistics, Mayo Clinic Florida, 4500 San Pablo Rd, Stabile 750 N, Jacksonville, FL 32224, United States
| | - H. Siddiqui
- Division of Clinical Trials and Biostatistics, Mayo Clinic Florida, 4500 San Pablo Rd, Stabile 750 N, Jacksonville, FL 32224, United States
| | - C.R. Libertin
- Division of Infectious Disease, Mayo Clinic Florida, 4500 San Pablo Rd, Davis 408N, Jacksonville, FL 32224, United States
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8
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Hussaini H, Rogers S, Kataria S, Uddin K, Mohamed KH, Mohamed AS, Tariq F, Ahmad S, Awais A, Ahmed Z, Chukwurah A, Khan A. COVID-19-Induced Seizures: A Meta-Analysis of Case Series and Retrospective Cohorts. Cureus 2022; 14:e28633. [PMID: 36196331 PMCID: PMC9524720 DOI: 10.7759/cureus.28633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 11/30/2022] Open
Abstract
The adverse events and complications of coronavirus disease 2019 (COVID-19) continue to challenge the medical profession despite the worldwide vaccination against the severe acute respiratory coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19. Other than typical respiratory manifestations, COVID-19 also presents a wide range of neurological manifestations. This article underlines the pooled incidence of COVID-19-induced seizures in patients with epilepsy and without epilepsy. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocols, we conducted a bibliographical search, and an initial search revealed 1,375 articles. In total, 21 articles were included in the final analysis by following the inclusion criteria. A total of 11,526 patients from 21 published articles that met the predetermined search criteria were included. The median age of the patients was 61.9 years, of whom 51.5% were males. A total of 255 patients presented with seizures as the first manifestation of COVID-19 with a prevalence of 2.2% (95% confidence interval = 0.05-0.24, p < 0.01) (I2 = 97%), of which 71 patients had previously been diagnosed with epilepsy. Among patients with epilepsy, 49 patients had seizures as an initial presentation of SARA-CoV-2 with an incidence of 72% (0.54-0.85, p = 0.1) (I2 = 34). Although the incidence of COVID-19-induced seizures is not high compared to other neurological manifestations, seizure incidence in epileptic patients with COVID-19 is remarkably high. New-onset seizures in any patient should be considered a presentation of COVID-19 in the absence of other causative factors.
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9
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Baksh A, Hadid A, Jaiganesh T. COVID-19 Encephalopathy Presenting As New-Onset Seizure: A Case Report. Cureus 2022; 14:e28204. [PMID: 36158377 PMCID: PMC9484586 DOI: 10.7759/cureus.28204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2022] [Indexed: 01/08/2023] Open
Abstract
Since its outbreak, it's been well-documented that coronavirus disease 2019 (COVID-19) can present with wide variety of neurological manifestations in absence of the usual respiratory symptoms. We report one such severe neurological manifestation of SARS-CoV-2 infection. To our knowledge, this is the first reported case of COVID-19 encephalopathy with CSF and MRI findings in the United Arab Emirates. We present a case of a 52-year-old female who presented with complaints of altered mentation, anosmia, headache, dizziness, weakness, lethargy, and vomiting. While in the emergency department she developed two generalized tonic-clonic seizure episodes, a more pronounced delirium, and tachypnea which required intubation. She was then admitted to the intensive care unit (ICU). She was COVID-19 positive and subsequent MRI revealed encephalopathy. She was discharged from ICU and was under long-term care at the time of case documentation.
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10
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Adesse D, Gladulich L, Alvarez-Rosa L, Siqueira M, Marcos AC, Heider M, Motta CS, Torices S, Toborek M, Stipursky J. Role of aging in Blood-Brain Barrier dysfunction and susceptibility to SARS-CoV-2 infection: impacts on neurological symptoms of COVID-19. Fluids Barriers CNS 2022; 19:63. [PMID: 35982454 PMCID: PMC9386676 DOI: 10.1186/s12987-022-00357-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 07/18/2022] [Indexed: 12/21/2022] Open
Abstract
COVID-19, which is caused by Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2), has resulted in devastating morbidity and mortality worldwide due to lethal pneumonia and respiratory distress. In addition, the central nervous system (CNS) is well documented to be a target of SARS-CoV-2, and studies detected SARS-CoV-2 in the brain and the cerebrospinal fluid of COVID-19 patients. The blood-brain barrier (BBB) was suggested to be the major route of SARS-CoV-2 infection of the brain. Functionally, the BBB is created by an interactome between endothelial cells, pericytes, astrocytes, microglia, and neurons, which form the neurovascular units (NVU). However, at present, the interactions of SARS-CoV-2 with the NVU and the outcomes of this process are largely unknown. Moreover, age was described as one of the most prominent risk factors for hospitalization and deaths, along with other comorbidities such as diabetes and co-infections. This review will discuss the impact of SARS-CoV-2 on the NVU, the expression profile of SARS-CoV-2 receptors in the different cell types of the CNS and the possible role of aging in the neurological outcomes of COVID-19. A special emphasis will be placed on mitochondrial functions because dysfunctional mitochondria are also a strong inducer of inflammatory reactions and the "cytokine storm" associated with SARS-CoV-2 infection. Finally, we will discuss possible drug therapies to treat neural endothelial function in aged patients, and, thus, alleviate the neurological symptoms associated with COVID-19.
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Affiliation(s)
- Daniel Adesse
- Laboratório de Biologia Estrutural, Instituto Oswaldo Cruz, Fiocruz, Avenida Brasil, 4365, Pavilhão Carlos Chagas, sala 307b, Rio de Janeiro, RJ, 21040-360, Brazil.
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA.
| | - Luis Gladulich
- Laboratório de Biologia Estrutural, Instituto Oswaldo Cruz, Fiocruz, Avenida Brasil, 4365, Pavilhão Carlos Chagas, sala 307b, Rio de Janeiro, RJ, 21040-360, Brazil
| | - Liandra Alvarez-Rosa
- Laboratório de Biologia Estrutural, Instituto Oswaldo Cruz, Fiocruz, Avenida Brasil, 4365, Pavilhão Carlos Chagas, sala 307b, Rio de Janeiro, RJ, 21040-360, Brazil
- Laboratório Compartilhado, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Michele Siqueira
- Laboratório Compartilhado, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Anne Caroline Marcos
- Laboratório de Biologia Estrutural, Instituto Oswaldo Cruz, Fiocruz, Avenida Brasil, 4365, Pavilhão Carlos Chagas, sala 307b, Rio de Janeiro, RJ, 21040-360, Brazil
| | - Marialice Heider
- Laboratório de Biologia Estrutural, Instituto Oswaldo Cruz, Fiocruz, Avenida Brasil, 4365, Pavilhão Carlos Chagas, sala 307b, Rio de Janeiro, RJ, 21040-360, Brazil
| | - Caroline Soares Motta
- Laboratório de Biologia Estrutural, Instituto Oswaldo Cruz, Fiocruz, Avenida Brasil, 4365, Pavilhão Carlos Chagas, sala 307b, Rio de Janeiro, RJ, 21040-360, Brazil
| | - Silvia Torices
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Michal Toborek
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
- Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Joice Stipursky
- Laboratório Compartilhado, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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11
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Kallel N, Saidani A, Kotti A, Moussa N, Maddeh S, Gargouri R, Msaad S, Feki W. Coronavirus disease 19 (
COVID
‐19) and Cerebral venous sinus thrombosis (
CVST
): A case series and review of the literature. Clin Case Rep 2022; 10:e6143. [PMID: 35957796 PMCID: PMC9359113 DOI: 10.1002/ccr3.6143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/07/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Nesrine Kallel
- Department of Pneumology, Hedi Chaker University Hospital Sfax Tunisia
| | - Amal Saidani
- Department of Pneumology, Hedi Chaker University Hospital Sfax Tunisia
| | - Amina Kotti
- Department of Pneumology, Hedi Chaker University Hospital Sfax Tunisia
| | - Nedia Moussa
- Department of Pneumology, Hedi Chaker University Hospital Sfax Tunisia
| | - Sabrine Maddeh
- Department of Pneumology, Hedi Chaker University Hospital Sfax Tunisia
| | - Rahma Gargouri
- Department of Pneumology, Hedi Chaker University Hospital Sfax Tunisia
| | - Sameh Msaad
- Department of Pneumology, Hedi Chaker University Hospital Sfax Tunisia
| | - Walid Feki
- Department of Pneumology, Hedi Chaker University Hospital Sfax Tunisia
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12
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Zalpoor H, Akbari A, Nabi-Afjadi M, Forghaniesfidvajani R, Tavakol C, Barzegar Z, Iravanpour F, Hosseini M, Mousavi SR, Farrokhi MR. Hypoxia-inducible factor 1 alpha (HIF-1α) stimulated and P2X7 receptor activated by COVID-19, as a potential therapeutic target and risk factor for epilepsy. Hum Cell 2022; 35:1338-1345. [PMID: 35831562 PMCID: PMC9281298 DOI: 10.1007/s13577-022-00747-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/03/2022] [Indexed: 12/25/2022]
Abstract
Based on available evidence, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a neuroinvasive virus. According to the centers for disease control and prevention (CDC), coronavirus disease 2019 (COVID-19) may cause epilepsy. In this line, COVID-19 can stimulate hypoxia-inducible factor-1 alpha (HIF-1α) and activate P2X7 receptor. Both HIF-1α and P2X7 receptors are linked to epileptogenesis and seizures. Therefore, in the current study, we suggested that COVID-19 may have a role in epileptogenesis and seizure through HIF-1α stimulation and P2X7 receptor activation. Consequently, pharmacological targeting of these factors could be a promising therapeutic approach for such patients.
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Affiliation(s)
- Hamidreza Zalpoor
- Department of Neurosurgery, Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. .,Network of Immunity in Infection, Malignancy & Autoimmunity (NIIMA), Universal Scientific Education & Research Network (USERN), Tehran, Iran.
| | - Abdullatif Akbari
- Department of Neurosurgery, Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Network of Immunity in Infection, Malignancy & Autoimmunity (NIIMA), Universal Scientific Education & Research Network (USERN), Tehran, Iran
| | - Mohsen Nabi-Afjadi
- Department of Biochemistry, Faculty of Biological Science, Tarbiat Modares University, Tehran, Iran
| | - Razieh Forghaniesfidvajani
- Network of Immunity in Infection, Malignancy & Autoimmunity (NIIMA), Universal Scientific Education & Research Network (USERN), Tehran, Iran
| | - Chanour Tavakol
- Medical School, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohreh Barzegar
- Department of Neurosurgery, Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farideh Iravanpour
- Department of Neurosurgery, Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahshid Hosseini
- Department of Neurosurgery, Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Reza Mousavi
- Department of Neurosurgery, Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Majid Reza Farrokhi
- Department of Neurosurgery, Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. .,Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
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13
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Westman G, Zelano J. Epilepsy diagnosis after Covid-19: A population-wide study. Seizure 2022; 101:11-14. [PMID: 35842976 PMCID: PMC9270960 DOI: 10.1016/j.seizure.2022.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/07/2022] [Accepted: 07/09/2022] [Indexed: 12/16/2022] Open
Abstract
Background We aimed to investigate whether SARS-CoV-2 infection was associated with an increased risk of incident epilepsy. Methods National register-based matched study. Verified cases of SARS-CoV-2 infection were acquired from the system for communicable disease surveillance in Sweden (SmiNet) and linked to data from the National Patient Register (NPR) and Cause of Death register in Sweden. Cases and non-infected controls were compared using a Cox proportional hazards model. Results A total of 1,221,801 SARS-CoV-2 infected patients and 1,223,312 controls were included. Infection was not associated with an increased risk of epilepsy on a whole population level (HR 1.01, 95% CI 0.92–1.12). Statistically significant effects were observed in patients between 61 and 80 years (HR 1.66, 95% CI 1.37–2.02), also when adjusting for stroke, traumatic brain injury, tumours (same age group HR 1.50, 95% CI 1.24–1.82) and mechanical ventilation (HR 1.28, 95% CI 1.05–1.57). In patients 81–100 years, a similar significant difference was observed (HR 1.77, 95% CI 1.30–2.42), which remained after adjustment for stroke, traumatic brain injury and tumours (HR 1.51, 95% CI 1.10–2.05) but not when mechanical ventilation was included as a covariate (HR 1.34, 95% CI 0.97–1.84). Conclusions On a whole population level, SARS-CoV-2 infections is not associated with an increased risk of epilepsy. In patients above 60 years, a moderately increased risk of epilepsy was observed. However, considering potential non-controllable bias and that Covid-19 patients in intensive care present with a lower risk than the general ICU population, the virus-induced epileptogenic effect is likely very small.
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Affiliation(s)
- Gabriel Westman
- Department of Medical Sciences, Infectious Diseases, Uppsala University, Uppsala 75185, Sweden.
| | - Johan Zelano
- Department of clinical neuroscience, Institute of neuroscience and physiology, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, Blå stråket 7, Gothenburg 41345, Sweden; Wallenberg Center for Molecular and Translational Medicine, University of Gothenburg, Sweden.
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Ganesh A, Reis IR, Varma M, Patry DG, Cooke LJ. Neurological and Head/Eyes/Ears/Nose/Throat Manifestations of COVID-19: A Systematic Review and Meta-Analysis. Can J Neurol Sci 2022; 49:514-531. [PMID: 34287109 PMCID: PMC8460425 DOI: 10.1017/cjn.2021.180] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/10/2021] [Accepted: 07/15/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND/OBJECTIVE Coronavirus disease 2019 (COVID-19) has been associated with various neurological and atypical head/eyes/ears/nose/throat (HEENT) manifestations. We sought to review the evidence for these manifestations. METHODS In this systematic review and meta-analysis, we compiled studies published until March 31, 2021 that examined non-respiratory HEENT, central, and peripheral nervous system presentations in COVID-19 patients. We included 477 studies for qualitative synthesis and 59 studies for meta-analyses. RESULTS Anosmia, ageusia, and conjunctivitis may precede typical upper/lower respiratory symptoms. Central nervous system (CNS) manifestations include stroke and encephalopathy, potentially with brainstem or cranial nerve involvement. MRI studies support CNS para-/postinfectious etiologies, but direct neuroinvasion seems very rare, with few cases detecting Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in the CNS. Peripheral nervous system (PNS) manifestations include muscle damage, Guillain-Barre syndrome (GBS), and its variants. There was moderate-to-high study heterogeneity and risk of bias. In random-effects meta-analyses, anosmia/ageusia was estimated to occur in 56% of COVID-19 patients (95% CI: 0.41-0.71, I2:99.9%), more commonly than in patients without COVID-19 (OR: 14.28, 95% CI: 8.39-24.29, I2: 49.0%). Neurological symptoms were estimated to occur in 36% of hospitalized patients (95% CI: 0.31-0.42, I2: 99.8%); ischemic stroke in 3% (95% CI: 0.03-0.04, I2: 99.2%), and GBS in 0.04% (0.033%-0.047%), more commonly than in patients without COVID-19 (OR[stroke]: 2.53, 95% CI: 1.16-5.50, I2: 76.4%; OR[GBS]: 3.43,1.15-10.25, I2: 89.1%). CONCLUSIONS Current evidence is mostly from retrospective cohorts or series, largely in hospitalized or critically ill patients, not representative of typical community-dwelling patients. There remains a paucity of systematically gathered prospective data on neurological manifestations. Nevertheless, these findings support a high index of suspicion to identify HEENT/neurological presentations in patients with known COVID-19, and to test for COVID-19 in patients with such presentations at risk of infection.
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Affiliation(s)
- Aravind Ganesh
- Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Isabella R. Reis
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Malavika Varma
- Department of Emergency Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - David G. Patry
- Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Lara J. Cooke
- Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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15
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Milan A, Salles P, Pelayo C, Uribe-San-Martin R. Acute to Chronic Electro-Clinical Manifestations of Neuro-COVID and the Long-Haul Consequences in People With Epilepsy: A Review. Cureus 2022; 14:e26020. [PMID: 35865450 PMCID: PMC9293262 DOI: 10.7759/cureus.26020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2022] [Indexed: 11/12/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection can involve the central nervous system (CNS). Acute symptomatic seizures or epileptiform discharges have not been commonly reported in patients with altered mental status related to coronavirus disease 2019 (COVID-19) infection. However, long-term neurological symptoms have been reported after COVID-19 infection (i.e., brain fog, cognitive complaints, and confusion), suggesting chronic encephalopathy. People with epilepsy (PWE) have been specifically affected by the COVID-19 pandemic, with changes in their seizure frequency, quality of life, health care accessibility, and medication interactions. This narrative review highlights possible pathophysiological mechanisms of COVID-19 on the brain, related to short- and long-term epileptiform activity and the impact of this infection on PWE.
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16
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Al Jandale O, Almoshantaf MB, Qaddah A, Bakkour A, Mohammed Sharif Ahmed E. Tonic non-colonic convulsions-status epilepticus- as the presenting complaint of COVID-19. Ann Med Surg (Lond) 2022; 78:103744. [PMID: 35573473 PMCID: PMC9088155 DOI: 10.1016/j.amsu.2022.103744] [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] [Received: 02/28/2022] [Revised: 05/02/2022] [Accepted: 05/08/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction COVID19 might present as neurological symptoms including headaches, dizziness, anosmia, stroke, and loss of consciousness. Cases with severe COVID-19 are more likely to be complicated by neurological symptoms, but tonic non-colonic convulsion is still a rare presentation of COVID19 as an initial symptom. Case presentation A 23-years old male presented to the ambulance with a complaint of loss of consciousness for more than 1 h and tonic convulsions without clonic movements. The investigations including computed tomography for the brain and chest and lumbar puncture were within normal range and the diagnostic workup concluded that COVID-19 is the cause of the status epilepticus. Discussion Our case demonstrates a tonic non-clonic convulsion as a possible complication for COVID-19 infection as some respiratory viruses can cause neurological symptoms. After excluding the co-incidence of other pathological etiologies, we highly suspect that the seizures in our case are generated by COVID-19 infection. Conclusion This case represents a rare case in the literature review which can increase the awareness of tonic non-clonic seizures and other neurological manifestations as the presenting symptom of the COVID19. COVID-19 can manifest with neurological symptoms. Severe cases of COVID-19 are more likely to be complicated be rarer symptoms. Tonic non-Clonic seizures are rare in COVID-19 and have never been reported before.
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Affiliation(s)
- Omar Al Jandale
- Department of Cardiology, Damascus University, Damascus, Syria
| | | | - Aya Qaddah
- Department of Neurology, Damascus University, Damascus, Syria
| | - Agyad Bakkour
- Faculty of Medicine, Albaath University, Homs, Syria
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17
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Seizures and COVID-19: results from the Spanish Society of Neurology’s COVID-19 Registry. J Clin Neurosci 2022; 101:112-117. [PMID: 35594831 PMCID: PMC9108087 DOI: 10.1016/j.jocn.2022.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 11/20/2022]
Abstract
We describe a series of patients with COVID-19 who presented with seizures, reported in the Spanish Society of Neurology’s COVID-19 Registry. This observational, descriptive, multicentre, registry-based study includes patients with confirmed COVID-19 who experienced seizures during active infection. We describe the clinical presentation of COVID-19, seizures, and results of complementary tests. We also describe the suspected aetiology of the seizures. Of 232 reported cases, 26 (11.2%) presented with seizures; 7 of these patients (26.9%) had prior history of epilepsy, whereas the remaining 19 (73.1%) had no history of seizures. In most cases, seizures presented on days 0 and 7 after onset of COVID-19. By seizure type, 8 patients (30.7%) presented generalised tonic-clonic seizures, 7 (26.9%) status epilepticus, 8 (30.7%) focal impaired-awareness seizures, and 4 (11.7%) secondary generalised seizures. Six patients (23.1%) also presented other neurological symptoms, including altered mental status and decreased level of consciousness. Predisposing factors for seizures (eg, dementia, tumour, cerebrovascular disease) were observed in 10 of the 19 patients with no prior history of epilepsy (52.6%). Patients with COVID-19 may present with seizures over the course of the disease, either alone or in the context of encephalopathy. Seizures may present in patients with no prior history of epilepsy; however, most of these patients present predisposing factors.
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18
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Hingorani KS, Bhadola S, Cervantes-Arslanian AM. COVID-19 and the Brain. Trends Cardiovasc Med 2022; 32:323-330. [PMID: 35461991 PMCID: PMC9022395 DOI: 10.1016/j.tcm.2022.04.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 12/11/2022]
Abstract
Entering the third year into the pandemic, overwhelming evidence demonstrates that Coronavirus disease 2019 (COVID-19) infection is a systemic illness, often with involvement of the central nervous system. Multiple mechanisms may underlie the development of neurologic manifestations of illness, including hypoxia, systemic illness, hypercoagulability, endothelial dysfunction, general critical illness, inflammatory response, and neurotropism of the severe acute respiratory syndrome coronavirus 2 (SARS-Co-V2) virus. COVID-19 infection is associated with neurologic involvement in all stages; acute infection, subacute/post-infection, and growing evidence also suggests during a chronic phase, the post-acute sequalae of COVID-19 (PASC). With over 20,000 published articles on COVID and the brain at the time of writing, it is virtually impossible to present an unbiased comprehensive review of how SARS-Co-V2 impacts the nervous system. In this review, we will present an overview of common neurologic manifestations, in particular focusing on the cerebrovascular complications, and proposed pathophysiology.
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19
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Post COVID – 19 neurological disorders; a single center experience; a case series. Ann Med Surg (Lond) 2022; 76:103508. [PMID: 35371472 PMCID: PMC8957714 DOI: 10.1016/j.amsu.2022.103508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Coronavirus disease 2019 (COVID-19) pandemic, is a newly conducted respiratory disease caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). The current study aims to estimate the neurological diseases which develop after COVID-19 infection. Method This is a single center retrospective case series conducted in seven months. the patients were collected in an out-patient clinic. Diagnosis of COVID-19 and the way of diagnosis is confirmed through either polymerase chain reaction (PCR) test for COVID-19 and/or typical findings on chest computed tomography scan (CT scan). Patients developed neurological symptoms after being infected with COVID-19. Symptoms have to be developed within less than 6 months of recovery, or developed during illness and persisted after recovery. Result A total number of 59 patients infected with SARS-CoV2 were included. The majority of the patients had mild symptoms 32 (54%), 12 (20%) patients developed severe symptoms. Headache was the most common presenting symptom 27(46%) followed by fatigue in 8 (13.5%). The majority of the patients 55 (91.6%) presented with no focal signs. MRI was done for 27 (46%) patients without abnormal finding in 22 cases. Nearly 22 (37.3%) cases were diagnosed as recurrent episodes of migraine or new onset of migraine. All patients were managed according to the underlying pathology, only (28, 47.5%) patients were known to be completely recovered. Conclusion SARS-CoV2 can invade and cause inflammation in the central and peripheral nervous systems. It is responsible for many neurological problems. More studies are necessary to analyze the long term effect of the virus on the nervous system. COVID-19 survivors might be at risk of developing neurological disorders. The exact prevalence and risk groups are yet to be established. This study aims to estimate the post-COVID-19 neurological sequelae.
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20
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Cho YJ, Kim HK. New-Onset Seizures in Patients With COVID-19: A Case Series From a Single Public Hospital in Korea. J Korean Med Sci 2022; 37:e97. [PMID: 35347905 PMCID: PMC8960940 DOI: 10.3346/jkms.2022.37.e97] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/07/2022] [Indexed: 11/27/2022] Open
Abstract
Seizure is an uncommon complication of coronavirus disease 2019 (COVID-19). The frequency and characteristics of new-onset seizures in hospitalized patients with COVID-19 were investigated. Of a total of 1,487 patients with confirmed COVID-19, six (0.4%) developed new-onset seizures. All six had severe or critical COVID-19 requiring intensive care and mechanical ventilation or high-flow oxygen therapy. Among COVID-19 patients admitted to the intensive care unit (n = 169), the incidence of new-onset seizures was 3.6%. Underlying structural lesions (acute infarction and remote hemorrhage), hypoxia, sepsis, and metabolic derangements were associated with the development of seizures. Of the six patients, three patients died, and, at the time of discharge, one patient had a severe disability, while the remaining two were well recovered.
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Affiliation(s)
- Yeo Jeong Cho
- Department of Neurology, National Medical Center, Seoul, Korea
| | - Hyun Kyung Kim
- Department of Neurology, National Medical Center, Seoul, Korea.
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21
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Vengalil S, Mahale R, Chakradhar N, Alluri S, Sagar Navanith PR, Ganaraja VH, Haripriya KR, Vikram HV, Asranna A, Mailankody P, Seshagiri DV, Cheerla HM, Maturu VN, Vaddepally CR, Kenchaiah R, Srijithesh PR, Chaudhuri JR, Netravathi M, Alladi S. The Spectrum of Neuro-COVID: A Study of a Comprehensively Investigated Large Cohort from India. Ann Indian Acad Neurol 2022; 25:194-202. [PMID: 35693675 PMCID: PMC9175391 DOI: 10.4103/aian.aian_310_21] [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] [Received: 04/09/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Though reports of neurological manifestations of COVID-19 have emerged from various parts of the world, the cohorts reported are from the West and mostly derived from electronic databases. Much remains unknown regarding neuro-COVID in developing countries. India is the second-worst affected country, and this study reports the neurological manifestations of COVID-19 in a comprehensively evaluated cohort. Objective: The aim of this study was to describe the range of neurological manifestations of COVID-19 in India with an emphasis on the risk factors, laboratory and imaging findings and short-term outcome. Methods: Retrospective review of hospital records of all confirmed COVID-19 patients with neurological manifestations, receiving inpatient care in two neurology referral hospitals were done. All demographic, clinical details, investigations, and treatment were analysed. Results: A total of 120 confirmed COVID-19 cases presenting with neurological symptoms were included. The mean age of illness and duration of illness was 48.03 ± 17.3 years and 10.9 ± 17.3 days respectively. New onset of neurological symptoms occurred in 100 cases while 20 patients had worsening of pre-existing neurological illness. Stroke was the commonest neurological disorder (43%), followed by encephalopathy (23%) and Guillain-Barre syndrome (10%). Other unusual neurological manifestations included new-onset headache (7%), seizures including denovo status epilepticus (5%) and meningo-encephalitis (5%). Nearly half of the patients had preceding COVID-19 symptoms. Poor outcome at discharge was seen in 40% and mortality occurred in 15%. Conclusion: Stroke and encephalopathy constitute the most common neurological manifestations. The absence of preceding COVID-19 symptoms in nearly half the cases is striking. Poor outcome was seen in nearly 50% despite early recognition and management.
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Affiliation(s)
- Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Rohan Mahale
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - N Chakradhar
- Department of Neurology, Yashoda Super Speciality Hospitals, Somajiguda, Hyderabad, Telangana, India
| | - Swathi Alluri
- Department of Neurology, Yashoda Super Speciality Hospitals, Somajiguda, Hyderabad, Telangana, India
| | - P R Sagar Navanith
- Department of Pulmonary Medicine, Yashoda Super Speciality Hospitals, Somajiguda, Hyderabad, Telangana, India
| | - V H Ganaraja
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - K R Haripriya
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Holla Venkappayya Vikram
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Ajay Asranna
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Pooja Mailankody
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Doniparthi V Seshagiri
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - H Manoj Cheerla
- Department of Pulmonary Medicine, Yashoda Super Speciality Hospitals, Somajiguda, Hyderabad, Telangana, India
| | - V N Maturu
- Department of Pulmonary Medicine, Yashoda Super Speciality Hospitals, Somajiguda, Hyderabad, Telangana, India
| | - C R Vaddepally
- Department of Pulmonary Medicine, Yashoda Super Speciality Hospitals, Somajiguda, Hyderabad, Telangana, India
| | - Raghavendra Kenchaiah
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - P R Srijithesh
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Jaydip Ray Chaudhuri
- Department of Neurology, Yashoda Super Speciality Hospitals, Somajiguda, Hyderabad, Telangana, India
| | - M Netravathi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Post COVID-19 Infection Neuromyelitis Optica Spectrum Disorder (NMOSD): A Case Report-Based Systematic Review. Mult Scler Relat Disord 2022; 60:103697. [DOI: 10.1016/j.msard.2022.103697] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/04/2022] [Accepted: 02/18/2022] [Indexed: 12/17/2022]
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Moorthamers S, Preseau T, Sanoussi S, Gazagnes MD. COVID-19 masquerading as a non-convulsive status epilepticus. Int J Emerg Med 2022; 15:3. [PMID: 35079294 PMCID: PMC8778487 DOI: 10.1186/s12245-022-00412-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/06/2022] [Indexed: 11/10/2022] Open
Abstract
Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), more and more atypical presentations of COVID-19 are being reported. Here, we present and discuss non-convulsive status epilepticus (NCSE) as presenting symptom of SARS-CoV-2 infection at the Emergency Department.
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Balcom EF, Nath A, Power C. Acute and chronic neurological disorders in COVID-19: potential mechanisms of disease. Brain 2021; 144:3576-3588. [PMID: 34398188 PMCID: PMC8719840 DOI: 10.1093/brain/awab302] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a global pandemic caused by SARS-CoV-2 infection and is associated with both acute and chronic disorders affecting the nervous system. Acute neurological disorders affecting patients with COVID-19 range widely from anosmia, stroke, encephalopathy/encephalitis, and seizures to Guillain-Barré syndrome. Chronic neurological sequelae are less well defined although exercise intolerance, dysautonomia, pain, as well as neurocognitive and psychiatric dysfunctions are commonly reported. Molecular analyses of CSF and neuropathological studies highlight both vascular and immunologic perturbations. Low levels of viral RNA have been detected in the brains of few acutely ill individuals. Potential pathogenic mechanisms in the acute phase include coagulopathies with associated cerebral hypoxic-ischaemic injury, blood-brain barrier abnormalities with endotheliopathy and possibly viral neuroinvasion accompanied by neuro-immune responses. Established diagnostic tools are limited by a lack of clearly defined COVID-19 specific neurological syndromes. Future interventions will require delineation of specific neurological syndromes, diagnostic algorithm development and uncovering the underlying disease mechanisms that will guide effective therapies.
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Affiliation(s)
- Erin F Balcom
- Division of Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Avindra Nath
- Section of Infections of the Nervous System, NINDS-NIH, Bethesda, MD, USA
| | - Christopher Power
- Division of Neurology, University of Alberta, Edmonton, Alberta, Canada
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Siahaan YMT, Ketaren RJ, Hartoyo V, Hariyanto TI. Epilepsy and the risk of severe coronavirus disease 2019 outcomes: A systematic review, meta-analysis, and meta-regression. Epilepsy Behav 2021; 125:108437. [PMID: 34839246 PMCID: PMC8590948 DOI: 10.1016/j.yebeh.2021.108437] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/19/2021] [Accepted: 11/08/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with epilepsy experience seizures, which have been reported to increase and worsen during the coronavirus disease (COVID-19) pandemic. However, the association between epilepsy and COVID-19 outcomes remains unclear. The aim of this study was to analyze whether patients with epilepsy have an increased risk of having poor COVID-19 outcomes. METHODS We comprehensively evaluated potential articles extracted from the medRxiv, Europe PMC, and PubMed databases until June 30, 2021, using selected keywords. All published studies on epilepsy and COVID-19 were selected. We used the Review Manager 5.4 and Comprehensive Meta-Analysis 3 software for statistical analysis. RESULTS Thirteen studies with 67,131 patients with COVID-19 were included in the analysis. Evaluation of the collated data revealed an association between epilepsy and increased severity of COVID-19 (OR, 1.69; 95%CI: 1.11-2.59; p = 0.010; I2 = 29%; random-effect modeling) and mortality from COVID-19 (OR, 1.71; 95%CI: 1.14-2.56; p = 0.010; I2 = 53%; random-effect modeling). The results also showed that the association between epilepsy and increased risk of developing severe COVID-19 is influenced by sex and neurodegenerative disease. CONCLUSIONS The findings of this study suggest that patients with epilepsy are at risk of having poor COVID-19 outcomes. Patients with epilepsy need special attention and should be prioritized for administration of the COVID-19 vaccine. Registration details: PROSPERO (CRD42021264979).
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Affiliation(s)
- Yusak Mangara Tua Siahaan
- Department of Neurology, Faculty of Medicine, Pelita Harapan University, Karawaci, Tangerang 15811, Indonesia
| | - Retno Jayantri Ketaren
- Department of Neurology, Faculty of Medicine, Pelita Harapan University, Karawaci, Tangerang 15811, Indonesia
| | - Vinson Hartoyo
- Department of Neurology, Faculty of Medicine, Pelita Harapan University, Karawaci, Tangerang 15811, Indonesia
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Du Y, Zhao W, Du L, Liu J. Neuropsychiatric symptoms associated with the COVID-19 and its potential nervous system infection mechanism: the role of imaging in the study. PSYCHORADIOLOGY 2021; 1:199-211. [PMID: 38666221 PMCID: PMC10917188 DOI: 10.1093/psyrad/kkab019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/07/2021] [Accepted: 12/01/2021] [Indexed: 04/28/2024]
Abstract
The epidemic of coronavirus disease 2019 (COVID-19) has broken the normal spread mode of respiratory viruses, namely, mainly spread in winter, resulting in over 230 million confirmed cases of COVID-19. Many studies have shown that severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) can affect the nervous system by varying degrees. In this review, we look at the acute neuropsychiatric impacts of COVID-19 patients, including acute ischemic stroke, encephalitis, acute necrotizing encephalopathy, dysosmia, and epilepsy, as well as the long-term neuropsychiatric sequelae of COVID-19 survivors: mental disorder and neurodegenerative diseases. In particular, this review discusses long-term changes in brain structure and function associated with COVID-19 infection. We believe that the traditional imaging sequences are important in the acute phase, while the nontraditional imaging sequences are more meaningful for the detection of long-term neuropsychiatric sequelae. These long-term follow-up changes in structure and function may also help us understand the causes of neuropsychiatric symptoms in COVID-19 survivors. Finally, we review previous studies and discuss some potential mechanisms of SARS-CoV-2 infection in the nervous system. Continuous focus on neuropsychiatric sequelae and a comprehensive understanding of the long-term impacts of the virus to the nervous system is significant for formulating effective sequelae prevention and management strategies, and may provide important clues for nervous system damage in future public health crises.
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Affiliation(s)
- Yanyao Du
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
| | - Wei Zhao
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
- Clinical Research Center for Medical Imaging in Hunan Province, Changsha 410011, Hunan, China
| | - Lei Du
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati 45255, OH, USA
| | - Jun Liu
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
- Clinical Research Center for Medical Imaging in Hunan Province, Changsha 410011, Hunan, China
- Department of Radiology Quality Control Center, Hunan Province, Changsha 410011, Hunan, China
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Ishiyama H, Ishii J, Yoshimura H, Tsunogae M, Fujiwara S, Hiya S, Inui R, Shiomi Y, Nakazawa S, Kimura M, Kuroda T, Murakami Y, Maekawa K, Ohara N, Kohara N, Kawamoto M. Neurological Manifestations and Long-term Sequelae in Hospitalized Patients with COVID-19. Intern Med 2021; 60:3559-3567. [PMID: 34511566 PMCID: PMC8666216 DOI: 10.2169/internalmedicine.7802-21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022] Open
Abstract
Objective Various neurological manifestations have been increasingly reported in coronavirus disease 2019 (COVID-19). We determined the neurological features and long-term sequelae in hospitalized COVID-19 patients. Methods We retrospectively studied 95 consecutive hospitalized patients with COVID-19 between March 1 and May 13, 2020. Acute neurological presentations (within two weeks of the symptom onset of COVID-19) were compared between 60 non-severe and 35 severely infected patients who required high-flow oxygen. In the 12 ventilated patients (the most severe group), we evaluated neurological complications during admission, subacute neurological presentations, and neurological sequelae (51 and 137 days from the onset [median], respectively). Results Of the 95 patients (mean age 53 years old; 40% women), 63% had acute neurological presentations, with an increased prevalence in cases of severe infections (83% vs. 52%, p<0.001). Impaired consciousness and limb weakness were more frequent in severe patients than in non-severe ones (0% vs. 49%; p<0.001, and 0% vs. 54%; p<0.001, respectively). In the most severe group (mean age 72 years old; 42% women), 83% of patients had neurological complications [cerebrovascular disease (17%), encephalopathy (82%), and neuropathy (55%)], and 92% had subacute neurological presentations [impaired consciousness (17%), higher brain dysfunction (82%), limb weakness (75%), and tremor (58%)]. Neurological sequelae were found in 83% of cases, including higher brain dysfunction (73%), limb weakness (50%), and tremor (58%). Conclusions Neurological manifestations are common in COVID-19, with the possibility of long-lasting sequelae.
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Affiliation(s)
- Hiroyuki Ishiyama
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Junko Ishii
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Hajime Yoshimura
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Marie Tsunogae
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Satoru Fujiwara
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Satomi Hiya
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Ryoma Inui
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Yuma Shiomi
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Shinsaku Nakazawa
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Masamune Kimura
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Takehito Kuroda
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Yasutaka Murakami
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Kota Maekawa
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Nobuyuki Ohara
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Nobuo Kohara
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Michi Kawamoto
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
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Mauritz M, Trinka E. Akut symptomatische epileptische Anfälle in Assoziation mit COVID-19. ZEITSCHRIFT FÜR EPILEPTOLOGIE 2021. [PMCID: PMC8482359 DOI: 10.1007/s10309-021-00443-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Akut symptomatische epileptische Anfälle treten in einem engen zeitlichen Zusammenhang zu einer akuten strukturellen oder funktionellen Schädigung des Gehirns auf, die viele verschiedene Ursachen haben kann. Neurologische Symptome wie Enzephalopathie, Geruchsstörung und Kopfschmerzen finden sich häufig bei COVID-19. Epileptische Anfälle ereignen sich nur in 1–2 % aller mit COVID-19 hospitalisierten Patient*innen. Eine mögliche direkte Invasion des ZNS durch SARS-CoV‑2 sowie indirekte Effekte durch Hypoxie, Inflammation und metabolische Entgleisungen werden als Ursache für die neurologischen Manifestationen bei COVID-19 angenommen.
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Affiliation(s)
- Matthias Mauritz
- Universitätsklinik für Neurologie, Christian Doppler Klinik, Paracelsus Medizinische Universität und Centre for Cognitive Neuroscience, Ignaz-Harrer-Str. 79, 5020 Salzburg, Österreich
- Neuroscience Institute, Christian Doppler Klinik, Paracelsus Medizinische Universität und Centre for Cognitive Neuroscience, Salzburg, Österreich
| | - Eugen Trinka
- Universitätsklinik für Neurologie, Christian Doppler Klinik, Paracelsus Medizinische Universität und Centre for Cognitive Neuroscience, Ignaz-Harrer-Str. 79, 5020 Salzburg, Österreich
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Österreich
- Neuroscience Institute, Christian Doppler Klinik, Paracelsus Medizinische Universität und Centre for Cognitive Neuroscience, Salzburg, Österreich
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29
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Gogia B, Thottempudi N, Ajam Y, Singh A, Ghanayem T, Dabi A, Fang X, Masel T, Rai P. EEG Characteristics in COVID-19 Survivors and Non-survivors With Seizures and Encephalopathy. Cureus 2021; 13:e18476. [PMID: 34659916 PMCID: PMC8502751 DOI: 10.7759/cureus.18476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 12/31/2022] Open
Abstract
The objective of this study is to report EEG findings in both COVID-19 survivors and non-survivors who underwent EEG either due to seizure or encephalopathy. Out of total 1468 COVID-19-positive patients, 19 patients underwent EEG. Eight out of 19 patients had a history of seizure disorder and in the remaining 11 with no prior history of seizures, four had a clinical seizure during their hospital stay. Only one had new-onset complex focal status epilepticus on EEG. Amongst the survivors (13/19), the most common EEG findings were normal followed by mild diffuse slowing. Amongst the non-survivors (6/19), the most common EEG finding was moderate to severe slowing in 50% of the patients. It can be deduced that COVID-19 infection does not increase the propensity of epileptiform discharges on EEG. There is perhaps a trend towards increased risk of new-onset status epilepticus in patients with encephalopathy and focal lesions.
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Affiliation(s)
- Bhanu Gogia
- Vascular Neurology/Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | | | - Yousaf Ajam
- Neurology, Weill Cornell Medical Center, New York, USA
| | | | - Tamer Ghanayem
- Neurology, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Alok Dabi
- Neurology, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Xiang Fang
- Neurology, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Todd Masel
- Neurology, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Prashant Rai
- Neurology, University of Texas Medical Branch at Galveston, Galveston, USA
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30
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Chattopadhyay S, Basu S, Majumdar K. Seizure after recovery from Covid-19. J Family Med Prim Care 2021; 10:2713-2715. [PMID: 34568161 PMCID: PMC8415682 DOI: 10.4103/jfmpc.jfmpc_2478_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/21/2021] [Accepted: 04/09/2021] [Indexed: 01/15/2023] Open
Abstract
There are various neurological presentations of covid-19 but here we report a 27-year-old female developed first episode of seizure, 14 days after documented SARS-CoV-2 infection. She had generalized tonic-clonic seizure with multiple injuries. She had no previous or family history of seizure but she had generalized anxiety disorder and was doing well on selective serotonin reuptake inhibitor (SSRI). Electroencephalogram (EEG) showed theta waves background (likely post-ictal discharges). Magnetic resonance Imagining (MRI) Brain showed features of focal cerebritis on both the frontal lobes. She was started with anti-epileptic drug. After 6 weeks, repeat MRI Brain and EEG were completely normal.
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Affiliation(s)
| | - Sagar Basu
- Department of Neuro-Medicine, KPC Medical College and Hospital, Kolkata, West Bengal, India
| | - Kamalesh Majumdar
- Department of Radiology, KPC Medical College and Hospital, Kolkata, West Bengal, India
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31
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Jumkhawala SA, Bente JA. New-onset seizures after bamlanivimab infusion. Br J Clin Pharmacol 2021; 88:1395-1397. [PMID: 34532885 DOI: 10.1111/bcp.15066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/29/2021] [Accepted: 08/08/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Saahil A Jumkhawala
- Saint Barnabas Medical Center, Livingston, New Jersey, USA.,Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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32
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Hensley MK, Markantone D, Prescott HC. Neurologic Manifestations and Complications of COVID-19. Annu Rev Med 2021; 73:113-127. [PMID: 34416121 DOI: 10.1146/annurev-med-042320-010427] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has created a global pandemic. Beyond the well-described respiratory manifestations, SARS-CoV-2 may cause a variety of neurologic complications, including headaches, alteration in taste and smell, encephalopathy, cerebrovascular disease, myopathy, psychiatric diseases, and ocular disorders. Herein we describe SARS-CoV-2's mechanism of neuroinvasion and the epidemiology, outcomes, and treatments for neurologic manifestations of COVID-19. Expected final online publication date for the Annual Review of Medicine, Volume 73 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Matthew K Hensley
- Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15232, USA;
| | - Desiree Markantone
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA;
| | - Hallie C Prescott
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA; .,VA Center for Clinical Management Research, HSR&D Center of Innovation, Ann Arbor, Michigan 48109, USA
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33
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Day C, Studders C, Arklie K, Kaur A, Teetzen K, Kirsch R, Abelseth L, Fraser I, Abelseth E, Willerth SM. The effect of SARS-CoV-2 on the nervous system: a review of neurological impacts caused by human coronaviruses. Rev Neurosci 2021; 33:257-268. [PMID: 34388333 DOI: 10.1515/revneuro-2021-0041] [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: 03/15/2021] [Accepted: 07/02/2021] [Indexed: 11/15/2022]
Abstract
The COVID-19 pandemic has affected millions of people worldwide. While coronaviruses typically have low rates of neurotropic effects, the massive transmission of SARS-CoV-2 suggests that a substantial population will suffer from potential SARS-CoV-2-related neurological disorders. The rapid and recent emergence of SARS-CoV-2 means little research exists on its potential neurological effects. Here we analyze the effects of similar viruses to provide insight into the potential effects of SARS-CoV-2 on the nervous system and beyond. Seven coronavirus strains (HCoV-OC43, HCoV-HKU1, HCoV-229E, HCoV-NL63, SARS-CoV, MERS-CoV, SARS-CoV-2) can infect humans. Many of these strains cause neurological effects, such as headaches, dizziness, strokes, seizures, and critical illness polyneuropathy/myopathy. Certain studies have also linked coronaviruses with multiple sclerosis and extensive central nervous system injuries. Reviewing these studies provides insight into the anticipated effects for patients with SARS-CoV-2. This review will first describe the effects of other coronaviruses that have caused severe disease (SARS-CoV, MERS-CoV) on the nervous system, as well as their proposed origins, non-neurological effects, and neurological infection mechanisms. It will then discuss what is known about SARS-CoV-2 in these areas with reference to the aforementioned viruses, with the goal of providing a holistic picture of SARS-CoV-2.
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Affiliation(s)
- Colin Day
- Biomedical Engineering Program, University of Victoria, Victoria, BC, Canada V8W 2Y2
- Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada V8W 2Y2
| | - Carson Studders
- Department of Mechanical Engineering, University of Victoria, Victoria, BC, Canada V8W 2Y2
- Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada V8W 2Y2
| | - Kim Arklie
- Department of Mechanical Engineering, University of Victoria, Victoria, BC, Canada V8W 2Y2
- Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada V8W 2Y2
| | - Asees Kaur
- Department of Mechanical Engineering, University of Victoria, Victoria, BC, Canada V8W 2Y2
- Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada V8W 2Y2
| | - Kyra Teetzen
- Biomedical Engineering Program, University of Victoria, Victoria, BC, Canada V8W 2Y2
- Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada V8W 2Y2
| | - Rebecca Kirsch
- Department of Chemistry, University of Victoria, Victoria, BC, Canada V8W 2Y2
| | - Laila Abelseth
- Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada V8W 2Y2
| | - Ian Fraser
- Department of Mechanical Engineering, University of Victoria, Victoria, BC, Canada V8W 2Y2
| | - Emily Abelseth
- Biomedical Engineering Program, University of Victoria, Victoria, BC, Canada V8W 2Y2
| | - Stephanie M Willerth
- Department of Mechanical Engineering, University of Victoria, Victoria, BC, Canada V8W 2Y2
- Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada V8W 2Y2
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada V8W 2Y2
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Norouzi M, Miar P, Norouzi S, Nikpour P. Nervous System Involvement in COVID-19: a Review of the Current Knowledge. Mol Neurobiol 2021; 58:3561-3574. [PMID: 33765290 DOI: 10.1007/s12035-021-02347-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 03/03/2021] [Indexed: 01/08/2023]
Abstract
The current pandemic of the new human coronavirus (CoV), i.e., severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has created an urgent global condition. The disease, termed coronavirus disease 2019 (COVID-19), is primarily known as a respiratory tract infection. Although SARS-CoV-2 directly invades the lungs, COVID-19 is a complex multi-system disease with varying degrees of severity and affects several human systems including the cardiovascular, respiratory, gastrointestinal, neurological, hematopoietic, and immune systems. From the existing data, most COVID-19 cases develop a mild disease typically presented with fever and respiratory illness. However, in some patients, clinical evidence suggests that COVID-19 might progress to acute respiratory distress syndrome (ARDS), multi-organ dysfunction, and septic shock resulting in a critical condition. Likewise, specific organ dysfunction seems to be related to the disease complication, worsens the condition, and increases the lethality of COVID-19. The neurological manifestations in association with disease severity and mortality have been reported in COVID-19 patients. Despite the continuously increasing reports of the neurological symptoms of SARS-CoV-2, our knowledge about the possible routes of nervous system involvement associated with COVID-19 is limited. Herein, we will primarily describe the critical aspects and clinical features of SARS-CoV-2 related to nervous system impairment and then discuss possible routes of SARS-CoV-2 nervous system involvement based on the current evidence.
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Affiliation(s)
- Mahnaz Norouzi
- Department of Genetics, Faculty of Sciences, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Paniz Miar
- Department of Genetics and Molecular Biology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shaghayegh Norouzi
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, 3083, Australia
| | - Parvaneh Nikpour
- Department of Genetics and Molecular Biology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
- Pediatric Inherited Diseases Research Center, Research Institute for Primordial Prevention of Noncommunicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
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Lewis A, Jain R, Frontera J, Placantonakis DG, Galetta S, Balcer L, Melmed KR. COVID-19 associated brain/spinal cord lesions and leptomeningeal enhancement: A meta-analysis of the relationship to CSF SARS-CoV-2. J Neuroimaging 2021; 31:826-848. [PMID: 34105198 PMCID: PMC8242764 DOI: 10.1111/jon.12880] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/03/2021] [Accepted: 05/07/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND AND PURPOSE We reviewed the literature to evaluate cerebrospinal fluid (CSF) results from patients with coronavirus disease 2019 (COVID-19) who had neurological symptoms and had an MRI that showed (1) central nervous system (CNS) hyperintense lesions not attributed to ischemia and/or (2) leptomeningeal enhancement. We sought to determine if these findings were associated with a positive CSF severe acute respiratory syndrome associated coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR). METHODS We performed a systematic review of Medline and Embase from December 1, 2019 to November 18, 2020. CSF results were evaluated based on the presence/absence of (1) ≥ 1 CNS hyperintense lesion and (2) leptomeningeal enhancement. RESULTS In 117 publications, we identified 193 patients with COVID-19 who had an MRI of the CNS and CSF testing. There were 125 (65%) patients with CNS hyperintense lesions. Patients with CNS hyperintense lesions were significantly more likely to have a positive CSF SARS-CoV-2 PCR (10% [9/87] vs. 0% [0/43], p = 0.029). Of 75 patients who had a contrast MRI, there were 20 (27%) patients who had leptomeningeal enhancement. Patients with leptomeningeal enhancement were significantly more likely to have a positive CSF SARS-CoV-2 PCR (25% [4/16] vs. 5% [2/42], p = 0.024). CONCLUSION The presence of CNS hyperintense lesions or leptomeningeal enhancement on neuroimaging from patients with COVID-19 is associated with increased likelihood of a positive CSF SARS-CoV-2 PCR. However, a positive CSF SARS-CoV-2 PCR is uncommon in patients with these neuroimaging findings, suggesting they are often related to other etiologies, such as inflammation, hypoxia, or ischemia.
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Affiliation(s)
- Ariane Lewis
- Department of NeurologyNYU Langone Medical CenterNew YorkNew YorkUSA
- Department of NeurosurgeryNYU Langone Medical CenterNew YorkNew YorkUSA
| | - Rajan Jain
- Department of NeurosurgeryNYU Langone Medical CenterNew YorkNew YorkUSA
- Department of RadiologyNYU Langone Medical CenterNew YorkNew YorkUSA
| | - Jennifer Frontera
- Department of NeurologyNYU Langone Medical CenterNew YorkNew YorkUSA
- Department of NeurosurgeryNYU Langone Medical CenterNew YorkNew YorkUSA
| | | | - Steven Galetta
- Department of NeurologyNYU Langone Medical CenterNew YorkNew YorkUSA
- Department of OphthalmologyNYU Langone Medical CenterNew YorkNew YorkUSA
| | - Laura Balcer
- Department of NeurologyNYU Langone Medical CenterNew YorkNew YorkUSA
- Department of OphthalmologyNYU Langone Medical CenterNew YorkNew YorkUSA
- Department of Population HealthNYU Langone Medical CenterNew YorkNew YorkUSA
| | - Kara R. Melmed
- Department of NeurologyNYU Langone Medical CenterNew YorkNew YorkUSA
- Department of NeurosurgeryNYU Langone Medical CenterNew YorkNew YorkUSA
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36
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Manca R, De Marco M, Ince PG, Venneri A. Heterogeneity in Regional Damage Detected by Neuroimaging and Neuropathological Studies in Older Adults With COVID-19: A Cognitive-Neuroscience Systematic Review to Inform the Long-Term Impact of the Virus on Neurocognitive Trajectories. Front Aging Neurosci 2021; 13:646908. [PMID: 34149394 PMCID: PMC8209297 DOI: 10.3389/fnagi.2021.646908] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/28/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Other than its direct impact on cardiopulmonary health, Coronavirus Disease 2019 (COVID-19) infection affects additional body systems, especially in older adults. Several studies have reported acute neurological symptoms that present at onset or develop during hospitalisation, with associated neural injuries. Whilst the acute neurological phase is widely documented, the long-term consequences of COVID-19 infection on neurocognitive functioning remain unknown. Although an evidence-based framework describing the disease chronic phase is premature, it is important to lay the foundations for future data-driven models. This systematic review aimed at summarising the literature on neuroimaging and neuropathological findings in older over-60 patients with COVID-19 following a cognitive neuroscientific perspective, to clarify the most vulnerable brain areas and speculate on the possible cognitive consequences. Methods: PubMed and Web of Science databases were searched to identify relevant manuscripts published between 1st March 2020 and 31th December 2020. Outputs were screened and selected by two assessors. Relevant studies not detected by literature search were added manually. Results: Ninety studies, mainly single cases and case series, were included. Several neuroimaging and neuropathological findings in older patients with COVID-19 emerged from these studies, with cerebrovascular damage having a prominent role. Abnormalities (hyperintensities, hypoperfusion, inflammation, and cellular damage) were reported in most brain areas. The most consistent cross-aetiology findings were in white matter, brainstem and fronto-temporal areas. Viral DNA was detected mainly in olfactory, orbitofrontal and brainstem areas. Conclusion: Studies on COVID-19 related neural damage are rich and diverse, but limited to description of hospitalised patients with fatal outcome (i.e., in neuropathological studies) or severe symptoms (i.e., in neuroimaging studies). The damage seen in this population indicates acute and largely irreversible dysfunction to neural regions involved in major functional networks that support normal cognitive and behavioural functioning. It is still unknown whether the long-term impact of the virus will be limited to chronic evolution of acute events, whether sub-clinical pathological processes will be exacerbated or whether novel mechanisms will emerge. Based on current literature, future theoretical frameworks describing the long-term impact of COVID-19 infection on mental abilities will have to factor in major trends of aetiological and topographic heterogeneity.
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Affiliation(s)
- Riccardo Manca
- Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Matteo De Marco
- Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Paul G Ince
- Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Annalena Venneri
- Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
- Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom
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Carroll E, Melmed KR, Frontera J, Placantonakis DG, Galetta S, Balcer L, Lewis A. Cerebrospinal fluid findings in patients with seizure in the setting of COVID-19: A review of the literature. Seizure 2021; 89:99-106. [PMID: 34044299 PMCID: PMC8127527 DOI: 10.1016/j.seizure.2021.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 11/30/2022] Open
Abstract
We reviewed the literature on cerebrospinal fluid (CSF) studies in patients who had a seizure in the setting of COVID-19 infection to evaluate for evidence of viral neuroinvasion. We performed a systematic review of Medline and Embase to identify publications that reported one or more patients with COVID-19 who had a seizure and had CSF testing preformed. The search ranged from December 1st 2019 to November 18th 2020. We identified 56 publications which described 69 unique patients who met our inclusion criteria. Of the 54 patients whose past medical history was provided, 2 (4%) had epilepsy and 1 (2%) had a prior seizure in the setting of hyperglycemia, but the remaining 51 (94%) had no history of seizures. Seizure was the initial symptom of COVID-19 for 15 (22%) patients. There were 26 (40%) patients who developed status epilepticus. SARS-CoV-2 PCR testing was performed in the CSF for 45 patients; 6 (13%) had a positive CSF SARS-CoV-2 PCR, only 1 (17%) of whom had status epilepticus. The cycle thresholds were not reported. Evaluation for CSF SARS-CoV-2 antibodies (directly or indirectly, via testing for CSF oligoclonal bands or immunoglobulins) was performed in 26 patients, only 2 (8%) of whom had evidence of intrathecal antibody synthesis. Of the 11 patients who had CSF autoimmune antibody panels tested, 1 had NMDA antibodies and 1 had Caspr-2 antibodies. Detection of SARS-CoV-2 in the CSF of patients with seizures who have COVID-19 is uncommon. Our review suggests that seizures in this patient population are not likely due to direct viral invasion of the brain.
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Affiliation(s)
- Elizabeth Carroll
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA.
| | - Kara R Melmed
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA; Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA
| | - Jennifer Frontera
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA; Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA
| | | | - Steven Galetta
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA; Department of Ophthalmology, NYU Langone Medical Center, New York, NY, USA
| | - Laura Balcer
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA; Department of Ophthalmology, NYU Langone Medical Center, New York, NY, USA; Department of Population Health, NYU Langone Medical Center, New York, NY, USA
| | - Ariane Lewis
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA; Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA
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Miscommunication in the age of communication: A crowdsourcing framework for symptom surveillance at the time of pandemics. Int J Med Inform 2021; 151:104486. [PMID: 33991885 PMCID: PMC8111883 DOI: 10.1016/j.ijmedinf.2021.104486] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/22/2021] [Accepted: 05/07/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE There was a significant delay in compiling a complete list of the symptoms of COVID-19 during the 2020 outbreak of the disease. When there is little information about the symptoms of a novel disease, interventions to contain the spread of the disease would be suboptimal because people experiencing symptoms that are not yet known to be related to the disease may not limit their social activities. Our goal was to understand whether users' social media postings about the symptoms of novel diseases could be used to develop a complete list of the disease symptoms in a shorter time. MATERIALS AND METHODS We used the Twitter API to download tweets that contained 'coronavirus', 'COVID-19', and 'symptom'. After data cleaning, the resulting dataset consisted of over 95,000 unique, English tweets posted between January 17, 2020 and March 15, 2020 that contained references to the symptoms of COVID-19. We analyzed this data using network and time series methods. RESULTS We found that a complete list of the symptoms of COVID-19 could have been compiled by mid-March 2020, before most states in the U.S. announced a lockdown and about 75 days earlier than the list was completed on CDC's website. DISCUSSION & CONCLUSION We conclude that national and international health agencies should use the crowd-sourced intelligence obtained from social media to develop effective symptom surveillance systems in the early stages of pandemics. We propose a high-level framework that facilitates the collection, analysis, and dissemination of information that are posted in various languages and on different social media platforms about the symptoms of novel diseases.
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Duan K, Premi E, Pilotto A, Cristillo V, Benussi A, Libri I, Giunta M, Bockholt HJ, Liu J, Campora R, Pezzini A, Gasparotti R, Magoni M, Padovani A, Calhoun VD. Alterations of frontal-temporal gray matter volume associate with clinical measures of older adults with COVID-19. Neurobiol Stress 2021; 14:100326. [PMID: 33869679 PMCID: PMC8041745 DOI: 10.1016/j.ynstr.2021.100326] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/03/2021] [Accepted: 04/05/2021] [Indexed: 12/19/2022] Open
Abstract
COVID-19, the infectious disease caused by the most recently discovered severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has become a global pandemic. It dramatically affects people's health and daily life. Neurological complications are increasingly documented for patients with COVID-19. However, the effect of COVID-19 on the brain is less studied, and existing quantitative neuroimaging analyses of COVID-19 were mainly based on the univariate voxel-based morphometry analysis (VBM) that requires corrections for a large number of tests for statistical significance, multivariate approaches that can reduce the number of tests to be corrected have not been applied to study COVID-19 effect on the brain yet. In this study, we leveraged source-based morphometry (SBM) analysis, a multivariate extension of VBM, to identify changes derived from computed tomography scans in covarying gray matter volume patterns underlying COVID-19 in 120 neurological patients (including 58 cases with COVID-19 and 62 patients without COVID-19 matched for age, gender and diseases). SBM identified that lower gray matter volume (GMV) in superior/medial/middle frontal gyri was significantly associated with a higher level of disability (modified Rankin Scale) at both discharge and six months follow-up phases even when controlling for cerebrovascular diseases. GMV in superior/medial/middle frontal gyri was also significantly reduced in patients receiving oxygen therapy compared to patients not receiving oxygen therapy. Patients with fever presented significant GMV reduction in inferior/middle temporal gyri and fusiform gyrus compared to patients without fever. Patients with agitation showed GMV reduction in superior/medial/middle frontal gyri compared to patients without agitation. Patients with COVID-19 showed no significant GMV differences from patients without COVID-19 in any brain region. Results suggest that COVID-19 may affect the frontal-temporal network in a secondary manner through fever or lack of oxygen.
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Affiliation(s)
- Kuaikuai Duan
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, USA
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia Institute of Technology, Georgia State University, Emory University, Atlanta, USA
| | - Enrico Premi
- Stroke Unit, Azienda Socio Sanitaria Territoriale Spedali Civili, Spedali Civili Hospital, Brescia, Italy
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Viviana Cristillo
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Alberto Benussi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Ilenia Libri
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Marcello Giunta
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - H. Jeremy Bockholt
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia Institute of Technology, Georgia State University, Emory University, Atlanta, USA
| | - Jingyu Liu
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia Institute of Technology, Georgia State University, Emory University, Atlanta, USA
- Department of Computer Science, Georgia State University, Atlanta, USA
| | - Riccardo Campora
- Neuroradiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Alessandro Pezzini
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Roberto Gasparotti
- Neuroradiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Mauro Magoni
- Stroke Unit, Azienda Socio Sanitaria Territoriale Spedali Civili, Spedali Civili Hospital, Brescia, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Vince D. Calhoun
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, USA
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia Institute of Technology, Georgia State University, Emory University, Atlanta, USA
- Department of Computer Science, Georgia State University, Atlanta, USA
- Department of Psychology, Computer Science, Neurosciences, Mathematics & Statistics, Georgia State University, Atlanta, USA
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40
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Clark JR, Liotta EM, Reish NJ, Shlobin NA, Hoffman SC, Orban ZS, Lim PH, Koralnik IJ, Batra A. Abnormal movements in hospitalized COVID-19 patients: A case series. J Neurol Sci 2021; 423:117377. [PMID: 33676146 PMCID: PMC7908881 DOI: 10.1016/j.jns.2021.117377] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/20/2021] [Accepted: 02/22/2021] [Indexed: 12/04/2022]
Abstract
BACKGROUND Abnormal movements in Covid-19 patients have been reported with varying degree of frequency, prompting neurologic consultation and additional diagnostic evaluation. We sought to evaluate the frequency and etiology of abnormal movements among hospitalized Covid-19 patients undergoing neurologic consultation. METHODS We retrospectively analyzed the first 50 consecutive patients with confirmed Covid-19 hospitalized at our tertiary medical care center who underwent acute inpatient neurology consultation from March 2020 through May 2020. Indication for neurologic consultation and diagnostic studies performed were identified by electronic medical record review. RESULTS Of the 50 initial consultation requests, 11 (22.0%) patients were evaluated for abnormal movements (nine male and two female). Myoclonus was diagnosed in 6/11 (54.5%) patients. Additionally, two patients were diagnosed with seizures (confirmed on EEG in one), while two additional patients were diagnosed with tremor (physiologic and probable functional). A single case of serotonin syndrome was also identified. CONCLUSION Abnormal movements observed in hospitalized Covid-19 patients can have a wide range of etiologies and were a frequent initial indication for neurologic consultation. Myoclonus was the most frequent type of abnormal movement observed. Early clinical recognition and directed diagnostic work-up is essential for accurate diagnoses in these patients.
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Affiliation(s)
- Jeffrey R Clark
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Eric M Liotta
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Nicholas J Reish
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Nathan A Shlobin
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Steven C Hoffman
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Zachary S Orban
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Patrick H Lim
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Igor J Koralnik
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Ayush Batra
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
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41
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A presumed case of new-onset focal seizures as a delayed complication of COVID-19 infection. Epilepsy Behav Rep 2021; 16:100447. [PMID: 33817617 PMCID: PMC8011035 DOI: 10.1016/j.ebr.2021.100447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 01/16/2023] Open
Abstract
Previously seizures have been reported as presenting neurological manifestation with COVID-19 infection. There is a growing literature on the delayed neurologic effects of COVID-19 infection. Here, we report a case with insidious onset of focal impaired awareness seizures associated with left temporal epileptiform interictal and ictal discharges consistent with focal epilepsy; occurring within a short time frame of the diagnosis of COVID-19 infection. This may be possibly a post COVID-19 inflammatory syndrome manifesting as new onset focal epilepsy with focal non-motor seizures with impaired awareness. As implicated by presentation with seizure as in our case, longterm follow-up studies are warranted to further investigate if the patients who acquire COVID-19 infection are at increased risk of developing epilepsy as a delayed manifestation.
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Balestrini S, Wilson G, Eldred C, Evans H, Sisodiya SM. The impact of COVID-19 in Dravet syndrome: A UK survey. Acta Neurol Scand 2021; 143:389-395. [PMID: 33570168 PMCID: PMC8013591 DOI: 10.1111/ane.13405] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 12/18/2022]
Abstract
Objectives To understand the risks, impact and outcome of COVID‐19 in people affected by Dravet Syndrome (DS). Materials and Methods An anonymous cross‐sectional online survey was conducted between June 17 and July 13, 2020, addressed to families of people with DS. Results A total of 116 responses were collected, from families of children (n = 86; 74%) and adults (30; 26%) with DS. The majority (106; 91%) were shielded at the family home during lockdown. Symptoms compatible with COVID‐19 were reported in 22 (19%) individuals. Only four individuals with symptoms had a PCR swab test, none of which was positive. Only one symptomatic person had antibody testing (but not swab testing), which was positive. One person had repeatedly positive swab tests whilst in hospital for renal failure, but had no typical symptoms of COVID‐19. In 50% of people with DS who developed possible or probable COVID‐19 symptoms, seizure worsening was reported, in terms of increased seizure frequency or duration or both. Medical attention was required in 9/22 (41%), all of whom were children. Conclusions In this cohort of people with DS, we observed an infection rate, determined by compatible symptoms, of 19%, with no deaths and benign outcome in most cases despite the underlying complex epilepsy although children often required medical attention. Early adoption of preventative measures, including testing of symptomatic individuals, regular surveillance for people living in residential care facilities, and shielding of individuals with comorbidities increasing the risk of severe outcome, may limit the impact of COVID‐19.
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Affiliation(s)
- Simona Balestrini
- Department of Clinical and Experimental Epilepsy UCL Queen Square Institute of Neurology London UK
- Chalfont Centre for Epilepsy Chalfont St. Peter UK
| | - Galia Wilson
- Dravet Syndrome UK (DSUK)Registered Charity Number 1128289, Member of Dravet Syndrome European Federation (DSEF) London UK
| | - Claire Eldred
- Dravet Syndrome UK (DSUK)Registered Charity Number 1128289, Member of Dravet Syndrome European Federation (DSEF) London UK
| | - Helen Evans
- Dravet Syndrome UK (DSUK)Registered Charity Number 1128289, Member of Dravet Syndrome European Federation (DSEF) London UK
| | - Sanjay M. Sisodiya
- Department of Clinical and Experimental Epilepsy UCL Queen Square Institute of Neurology London UK
- Chalfont Centre for Epilepsy Chalfont St. Peter UK
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Abstract
Neuroinfectious diseases can affect immunocompetent and immunosuppressed individuals and cause a variety of emergencies including meningitis, encephalitis, and abscess. Neurologic infections are frequently complicated by secondary injuries that also present emergently such as cerebrovascular disease, acute obstructive hydrocephalus, and seizure. In most cases, timely recognition and early treatment of infection can improve the morbidity and mortality of infectious neurologic emergencies.
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Shulman JG, Ford T, Cervantes-Arslanian AM. Neurologic Emergencies during the Coronavirus Disease 2019 Pandemic. Neurol Clin 2021; 39:671-687. [PMID: 33896538 PMCID: PMC7995638 DOI: 10.1016/j.ncl.2021.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Julie G Shulman
- Department of Neurology, Boston University School of Medicine, 72 East Concord Street, Suite C3, Boston, MA 02118, USA.
| | - Thomas Ford
- Department of Neurology, Boston University School of Medicine, 72 East Concord Street, Suite C3, Boston, MA 02118, USA
| | - Anna M Cervantes-Arslanian
- Department of Neurology, Boston University School of Medicine, 72 East Concord Street, Suite C3, Boston, MA 02118, USA; Department of Neurosurgery, Boston University School of Medicine, 725 Albany St, Suite 7C, Boston, MA 02118, USA; Department of Medicine (Infectious Diseases), Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown, 2nd floor, Boston MA 02118, USA
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Bhagat R, Kwiecinska B, Smith N, Peters M, Shafer C, Palade A, Sagi V. New-Onset Seizure With Possible Limbic Encephalitis in a Patient With COVID-19 Infection: A Case Report and Review. J Investig Med High Impact Case Rep 2021; 9:2324709620986302. [PMID: 33648382 PMCID: PMC7930644 DOI: 10.1177/2324709620986302] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
With the outbreak of COVID-19 (coronavirus disease 2019) as a global pandemic, various of its neurological manifestations have been reported. We report a case of a 54-year-old male with new-onset seizure who tested positive for severe acute respiratory syndrome coronavirus 2 from a nasopharyngeal swab sample. Investigative findings, which included contrast-enhancing right posterior temporal lobe T2-hyperintensity on brain magnetic resonance imaging, right-sided lateralized periodic discharges on the electroencephalogram, and elevated protein level on cerebrospinal fluid analysis, supported the diagnosis of possible encephalitis from COVID-19 infection. The findings in this case are placed in the context of the existing literature.
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Affiliation(s)
| | | | - Nolan Smith
- University of Louisville, Louisville, KY, USA
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Epilepsy and COVID-19: Updated evidence and narrative review. Epilepsy Behav 2021; 116:107785. [PMID: 33515934 PMCID: PMC7805398 DOI: 10.1016/j.yebeh.2021.107785] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/31/2020] [Accepted: 12/31/2020] [Indexed: 01/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) outbreak started in Wuhan, China, in late 2019 and rapidly spread globally. Vaccines have recently been developed and are being administered in some countries, but their widespread use is not yet sufficient; the battle against COVID-19 is protracted and people need to adapt to living under the influence of this disease. Epilepsy is a common chronic neurological condition characterized by spontaneous recurrence of unprovoked seizures. Various effects of COVID-19 on epilepsy have been studied in recent months. As clinicians, we need to keep up with daily updates in the evidence regarding interactions between COVID-19 and epilepsy. This review article summarizes the current evidence. Prospective studies on epilepsy and COVID-19 remain lacking. Most articles have comprised case reports, case series, retrospective studies, and recommendations/opinions that do not include data. However, summarizing these articles can identify the demands for research into COVID-19 and epilepsy by clarifying what is known and what remains unclear from current research.
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Vellieux G, Sonneville R, Vledouts S, Jaquet P, Rouvel-Tallec A, d’Ortho MP. COVID-19-Associated Neurological Manifestations: An Emerging Electroencephalographic Literature. Front Physiol 2021; 11:622466. [PMID: 33679425 PMCID: PMC7933549 DOI: 10.3389/fphys.2020.622466] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/29/2020] [Indexed: 02/02/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide since the end of year 2019 and is currently responsive for coronavirus infectious disease 2019 (COVID-19). The first reports considered COVID-19 as a respiratory tract disease responsible for pneumonia, but numerous studies rapidly emerged to warn the medical community of COVID-19-associated neurological manifestations, including encephalopathy at the acute phase and other postinfectious manifestations. Using standard visual analysis or spectral analysis, recent studies reported electroencephalographic (EEG) findings of COVID-19 patients with various neurological symptoms. Most EEG recordings were normal or revealed non-specific abnormalities, such as focal or generalized slowing, interictal epileptic figures, seizures, or status epilepticus. Interestingly, novel EEG abnormalities over frontal areas were also described at the acute phase. Underlying mechanisms leading to brain injury in COVID-19 are still unknown and matters of debate. These frontal EEG abnormalities could emphasize the hypothesis whereby SARS-CoV-2 enters the central nervous system (CNS) through olfactory structures and then spreads in CNS via frontal lobes. This hypothesis is reinforced by the presence of anosmia in a significant proportion of COVID-19 patients and by neuroimaging studies confirming orbitofrontal abnormalities. COVID-19 represents a new viral disease characterized by not only respiratory symptoms but also a systemic invasion associated with extra-respiratory signs. Neurological symptoms must be the focus of our attention, and functional brain evaluation with EEG is crucial, in combination with anatomical and functional brain imaging, to better understand its pathophysiology. Evolution of symptoms together with EEG patterns at the distance of the acute episode should also be scrutinized.
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Affiliation(s)
- Geoffroy Vellieux
- Université de Paris, NeuroDiderot, Inserm, Paris, France
- Neurophysiologie clinique, Service de Physiologie – Explorations Fonctionnelles, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Romain Sonneville
- Médecine Intensive-Réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
- Université de Paris, UMR 1148, LVTS, Paris, France
| | - Sérafima Vledouts
- Université de Paris, NeuroDiderot, Inserm, Paris, France
- Neurophysiologie clinique, Service de Physiologie – Explorations Fonctionnelles, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Pierre Jaquet
- Médecine Intensive-Réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
- Université de Paris, UMR 1148, LVTS, Paris, France
| | - Anny Rouvel-Tallec
- Université de Paris, NeuroDiderot, Inserm, Paris, France
- Neurophysiologie clinique, Service de Physiologie – Explorations Fonctionnelles, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Marie-Pia d’Ortho
- Université de Paris, NeuroDiderot, Inserm, Paris, France
- Neurophysiologie clinique, Service de Physiologie – Explorations Fonctionnelles, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
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Borah P, Deb PK, Chandrasekaran B, Goyal M, Bansal M, Hussain S, Shinu P, Venugopala KN, Al-Shar'i NA, Deka S, Singh V. Neurological Consequences of SARS-CoV-2 Infection and Concurrence of Treatment-Induced Neuropsychiatric Adverse Events in COVID-19 Patients: Navigating the Uncharted. Front Mol Biosci 2021; 8:627723. [PMID: 33681293 PMCID: PMC7930836 DOI: 10.3389/fmolb.2021.627723] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/12/2021] [Indexed: 01/08/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) binds to the angiotensin-converting enzyme 2 (ACE2) receptor and invade the human cells to cause COVID-19-related pneumonia. Despite an emphasis on respiratory complications, the evidence of neurological manifestations of SARS-CoV-2 infection is rapidly growing, which is substantially contributing to morbidity and mortality. The neurological disorders associated with COVID-19 may have several pathophysiological underpinnings, which are yet to be explored. Hypothetically, SARS-CoV-2 may affect the central nervous system (CNS) either by direct mechanisms like neuronal retrograde dissemination and hematogenous dissemination, or via indirect pathways. CNS complications associated with COVID-19 include encephalitis, acute necrotizing encephalopathy, diffuse leukoencephalopathy, stroke (both ischemic and hemorrhagic), venous sinus thrombosis, meningitis, and neuroleptic malignant syndrome. These may result from different mechanisms, including direct virus infection of the CNS, virus-induced hyper-inflammatory states, and post-infection immune responses. On the other hand, the Guillain-Barre syndrome, hyposmia, hypogeusia, and myopathy are the outcomes of peripheral nervous system injury. Although the therapeutic potential of certain repurposed drugs has led to their off-label use against COVID-19, such as anti-retroviral drugs (remdesivir, favipiravir, and lopinavir-ritonavir combination), biologics (tocilizumab), antibiotics (azithromycin), antiparasitics (chloroquine and hydroxychloroquine), and corticosteroids (dexamethasone), unfortunately, the associated clinical neuropsychiatric adverse events remains a critical issue. Therefore, COVID-19 represents a major threat to the field of neuropsychiatry, as both the virus and the potential therapies may induce neurologic as well as psychiatric disorders. Notably, potential COVID-19 medications may also interact with the medications of pre-existing neuropsychiatric diseases, thereby further complicating the condition. From this perspective, this review will discuss the possible neurological manifestations and sequelae of SARS-CoV-2 infection with emphasis on the probable underlying neurotropic mechanisms. Additionally, we will highlight the concurrence of COVID-19 treatment-associated neuropsychiatric events and possible clinically relevant drug interactions, to provide a useful framework and help researchers, especially the neurologists in understanding the neurologic facets of the ongoing pandemic to control the morbidity and mortality.
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Affiliation(s)
- Pobitra Borah
- School of Pharmacy, Graphic Era Hill University, Dehradun, India
| | - Pran Kishore Deb
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Philadelphia University, Amman, Jordan
| | - Balakumar Chandrasekaran
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Philadelphia University, Amman, Jordan
| | - Manoj Goyal
- Department of Anesthesia Technology, College of Applied Medical Sciences in Jubail, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Monika Bansal
- Department of Neuroscience Technology College of Applied Medical Sciences in Jubail, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Snawar Hussain
- Department of Biomedical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Pottathil Shinu
- Department of Biomedical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Katharigatta N Venugopala
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Kingdom of Saudi Arabia.,Department of Biotechnology and Food Technology, Durban University of Technology, Durban, South Africa
| | - Nizar A Al-Shar'i
- Department of Medicinal Chemistry and Pharmacognosy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Satyendra Deka
- Pratiksha Institute of Pharmaceutical Sciences, Chandrapur Road, Panikhaiti, Guwahati, India
| | - Vinayak Singh
- Drug Discovery and Development Centre (H3D), University of Cape Town, Rondebosch, South Africa.,South African Medical Research Council Drug Discovery and Development Research Unit, Department of Chemistry and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Rondebosch, South Africa
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49
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Lewis A, Frontera J, Placantonakis DG, Lighter J, Galetta S, Balcer L, Melmed KR. Cerebrospinal fluid in COVID-19: A systematic review of the literature. J Neurol Sci 2021; 421:117316. [PMID: 33561753 PMCID: PMC7833669 DOI: 10.1016/j.jns.2021.117316] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/16/2020] [Accepted: 01/07/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We sought to review the literature on cerebrospinal fluid (CSF) testing in patients with COVID-19 for evidence of viral neuroinvasion by SARS-CoV-2. METHODS We performed a systematic review of Medline and Embase between December 1, 2019 and November 18, 2020 to identify case reports or series of patients who had COVID-19 diagnosed based on positive SARS-CoV-2 polymerase chain reaction (PCR) or serologic testing and had CSF testing due to a neurologic symptom. RESULTS We identified 242 relevant documents which included 430 patients with COVID-19 who had acute neurological symptoms prompting CSF testing. Of those, 321 (75%) patients had symptoms that localized to the central nervous system (CNS). Of 304 patients whose CSF was tested for SARS-CoV-2 PCR, there were 17 (6%) whose test was positive, all of whom had symptoms that localized to the central nervous system (CNS). The majority (13/17, 76%) of these patients were admitted to the hospital because of neurological symptoms. Of 58 patients whose CSF was tested for SARS-CoV-2 antibody, 7 (12%) had positive antibodies with evidence of intrathecal synthesis, all of whom had symptoms that localized to the CNS. Of 132 patients who had oligoclonal bands evaluated, 3 (2%) had evidence of intrathecal antibody synthesis. Of 77 patients tested for autoimmune antibodies in the CSF, 4 (5%) had positive findings. CONCLUSION Detection of SARS-CoV-2 in CSF via PCR or evaluation for intrathecal antibody synthesis appears to be rare. Most neurological complications associated with SARS- CoV-2 are unlikely to be related to direct viral neuroinvasion.
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Affiliation(s)
- Ariane Lewis
- Department of Neurology, NYU Langone Medical Center, New York, NY 10016, USA; Department of Neurosurgery, NYU Langone Medical Center, New York, NY 10016, USA.
| | - Jennifer Frontera
- Department of Neurology, NYU Langone Medical Center, New York, NY 10016, USA; Department of Neurosurgery, NYU Langone Medical Center, New York, NY 10016, USA
| | | | - Jennifer Lighter
- Department of Pediatrics, NYU Langone Medical Center, New York, NY 10016, USA
| | - Steven Galetta
- Department of Neurology, NYU Langone Medical Center, New York, NY 10016, USA; Department of Ophthalmology, NYU Langone Medical Center, New York, NY 10016, USA
| | - Laura Balcer
- Department of Neurology, NYU Langone Medical Center, New York, NY 10016, USA; Department of Ophthalmology, NYU Langone Medical Center, New York, NY 10016, USA; Department of Population Health, NYU Langone Medical Center, New York, NY 10016, USA
| | - Kara R Melmed
- Department of Neurology, NYU Langone Medical Center, New York, NY 10016, USA; Department of Neurosurgery, NYU Langone Medical Center, New York, NY 10016, USA
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50
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Zareh-Shahamati S, Noorbakhsh M, Digaleh H, Safarpour-Lima B. Severe acute respiratory syndrome coronavirus 2 and seizure: An insight into the pathophysiologic mechanisms. CURRENT JOURNAL OF NEUROLOGY 2021; 20:43-48. [PMID: 38011476 PMCID: PMC8511601 DOI: 10.18502/cjn.v20i1.6379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/05/2020] [Indexed: 12/03/2022]
Abstract
Based on previous studies, seizure has been reported to accompany coronavirus disease 2019 (COVID-19). Underlying mechanisms are those leading to the direct central nervous system (CNS) invasion through hematogenous spread or trans-synaptic retrograde invasion, causing meningoencephalitis. On the other hand, there are pathophysiologic mechanisms that seizure would be one of their early consequences, such as cytokine storm, hypoxemia, metabolic derangement, and structural brain lesions. Herein, we focused on available evidence to provide an insight into the pathophysiologic mechanisms that link seizure and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, as a better understanding of pathophysiology would lead to better diagnosis and treatment.
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Affiliation(s)
- Shima Zareh-Shahamati
- Department of Neurology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahyar Noorbakhsh
- Autoimmune Disease Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Hadi Digaleh
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnam Safarpour-Lima
- Department of Neurology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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