Written by: Sean Brady
Edited by: Esther Melamed
Who is commonly impacted and what are the common symptoms?
It has been reported that between 36.4 – 82.3% of hospitalized Covid-19 patients present with neurological manifestations [1] (e.g., headache, brain fog, loss of smell, etc.).
As the pandemic continues into 2021, It is becoming increasingly clear that many patients go on to have long-term neurological symptoms post initial COVID infection. This long-lasting condition has been called by many names, including “post-COVID syndrome”, “Long-COVID”, and most recently Post-Acute Sequelae of SARS-CoV-2 Infection (PASC). It is also notable that many patients with PASC may not have required hospitalization at the initial stage of infection. A new study (https://doi.org/10.1002/acn3.51350) [1] of 100 non-hospitalized patients (50 SARS-CoV-2 positive and 50 SARS-CoV-2 negative), who presented to a neuro-post-COVID clinic at Northwestern University, were evaluated at around 4.72 months post symptom onset in the SARS-CoV-2 positive group, or at 5.82 months in the SARS-CoV-2 negative group[1]. The patients were noted to have different neurological symptoms, including: ‘brain fog’ (81%), headache (68%), numbness/tingling (60%), dysgeusia (distortion of the sense of taste) (59%), anosmia (loss or impairment of the sense of smell) (55%), myalgias (muscle pains) (55%) and fatigue (85%) [1]. Overall, the study found that ~85% of patients were suffering from multiple neurologic symptoms [1]. The average age for the cohort was 43.2±11.3 years and 70% of patients were female [1]. To the latter point, this is similar to other autoimmune diseases (e.g.., multiple sclerosis, rheumatoid arthritis, and systemic lupus erythematosus) where women are affected more commonly than men [1].
Do we know the etiology of these sequelae in relation to infection with SARS-CoV-2?
There are multiple theories as to how these neurological symptoms could be arising in connection to infection with SARS-CoV-2, that include both direct viral invasion into the central (CNS – e.g.., brain and spinal cord)[2] and peripheral nervous system (PNS – e.g., peripheral nerves)[3] as well as indirect damage to the CNS and PNS[4]. Notably, indirect damage to the CNS and PNS may be due to proinflammatory immunological dysregulation and the rise of autoimmunity[5][6][7]. Research is urgently needed to determine the mechanism of viral damage to the nervous system[7]. The hope is that more clarity on the mechanism of damage will help create better and more targeted treatments.
What is being done to help improve our understanding of the PASC neurological manifestations?
The NIH has launched a database, called NeuroCOVID [8], to monitor neurological COVID-19 symptoms [8]. This de-identified database will serve as a hub for connecting scientists and clinicians who are researching the “[prevention, management, and treatment of] neurological complications associated with COVID-19” [8]. The NIH has also recently announced a 1.15-billion-dollar research initiative to track and study PASC[9].
The goal and hope is that with ongoing research, we will learn how to better care for patients experiencing PASC neurological manifestations and ultimately develop more precise treatments to help patients improve their quality of life.
If you or someone you know is experiencing Long-COVID symptoms you can go to this website (https://www.survivorcorps.com) to find a wealth of information including locations of post-covid clinics.
References
Graham, E. L., Clark, J. R., Orban, Z. S., Lim, P. H., Szymanski, A. L., Taylor, C., DiBiase, R. M., Jia, D. T., Balabanov, R., Ho, S. U., Batra, A., Liotta, E. M., & Koralnik, I. J. (2021). Persistent neurologic symptoms and cognitive dysfunction in non‐hospitalized Covid‐19 “long haulers.” Annals of Clinical and Translational Neurology.
DosSantos, M. F., Devalle, S., Aran, V., Capra, D., Roque, N. R., Coelho-Aguiar, J. de M., Spohr, T. C. L. de S. e, Subilhaga, J. G., Pereira, C. M., Meira, I. D., Filho, P. N. S., & Moura-Neto, V. (2020). Neuromechanisms of SARS-CoV-2: A Review. Frontiers in Neuroanatomy, 14, 37.
Mahalakshmi, A. M., Ray, B., Tuladhar, S., Bhat, A., Paneyala, S., Patteswari, D., Sakharkar, M. K., Hamdan, H., Ojcius, D. M., Bolla, S. R., Essa, M. M., Chidambaram, S. B., & Qoronfleh, M. W. (2021). Does COVID‐19 contribute to development of neurological disease? Immunity, Inflammation and Disease, 9(1), 48–58.
Fotuhi, M., Mian, A., Meysami, S., & Raji, C. A. (2020). Neurobiology of COVID-19. Journal of Alzheimer’s Disease, 76(1), 3–19.
Bodnar, B., Patel, K., Ho, W., Luo, J. J., & Hu, W. (2021). Cellular mechanisms underlying neurological/neuropsychiatric manifestations of COVID‐19. Journal of Medical Virology, 93(4), 1983–1998.
Franke, C., Ferse, C., Kreye, J., Reincke, S. M., Sanchez-Sendin, E., Rocco, A., Steinbrenner, M., Angermair, S., Treskatsch, S., Zickler, D., Eckardt, K.-U., Dersch, R., Hosp, J., Audebert, H. J., Endres, M., Ploner, J. C., & Prüss, H. (2020). High frequency of cerebrospinal fluid autoantibodies in COVID-19 patients with neurological symptoms. Brain, Behavior, and Immunity, 93, 415–419.
Andalib, S., Biller, J., Napoli, M. D., Moghimi, N., McCullough, L. D., Rubinos, C. A., Nobleza, C. O., Azarpazhooh, M. R., Catanese, L., Elicer, I., Jafari, M., Liberati, F., Camejo, C., Torbey, M., & Divani, A. A. (2021). Peripheral Nervous System Manifestations Associated with COVID-19. Current Neurology and Neuroscience Reports, 21(3), 9.
NIH launches database to track neurological symptoms associated with COVID-19. (2021, January 26). National Institutes of Health. https://www.nih.gov/news-events/news-releases/nih-launches-database-track-neurological-symptoms-associated-covid-19
Collins, F. S. (2021, February 23). NIH launches new initiative to study “Long COVID.” National Institutes of Health. https://www.nih.gov/about-nih/who-we-are/nih-director/statements/nih-launches-new-initiative-study-long-covid.
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