Applications of Non-invasive Neuromodulation for the Management of Disorders Related to COVID-19

Abstract

Background: Novel coronavirus disease (COVID-19) morbidity is not restricted to the respiratory system, but also affects the nervous system. Non-invasive neuromodulation may be useful in the treatment of the disorders associated with COVID-19.Objective: To describe the rationale and empirical basis of the use of non-invasive neuromodulation in the management of patients with COVID-10 and related disorders.Methods: We summarize COVID-19 pathophysiology with emphasis of direct neuroinvasiveness, neuroimmune response and inflammation, autonomic balance and neurological, musculoskeletal and neuropsychiatric sequela. This supports the development of a framework for advancing applications of non-invasive neuromodulation in the management COVID-19 and related disorders.Results: Non-invasive neuromodulation may manage disorders associated with COVID-19 through four pathways: (1) Direct infection mitigation through the stimulation of regions involved in the regulation of systemic anti-inflammatory responses and/or autonomic responses and prevention of neuroinflammation and recovery of respiration; (2) Amelioration of COVID-19 symptoms of musculoskeletal pain and systemic fatigue; (3) Augmenting cognitive and physical rehabilitation following critical illness; and (4) Treating outbreak-related mental distress including neurological and psychiatric disorders exacerbated by surrounding psychosocial stressors related to COVID-19. The selection of the appropriate techniques will depend on the identified target treatment pathway.Conclusion: COVID-19 infection results in a myriad of acute and chronic symptoms, both directly associated with respiratory distress (e.g., rehabilitation) or of yet-to-be-determined etiology (e.g., fatigue). Non-invasive neuromodulation is a toolbox of techniques that based on targeted pathways and empirical evidence (largely in non-COVID-19 patients) can be investigated in the management of patients with COVID-19.

Is the heart rate variability monitoring using the analgesia nociception index a predictor of illness severity and mortality in critically ill patients with COVID-19? A pilot study

“…Therefore, activation of the NTS and the cholinergic anti-inflammatory pathway, both pharmacologically, by activating the alpha 7 nicotinic receptors, and electrically, through noninvasive brain neuromodulation and vagus nerve stimulation (VNS), as also suggested by Baptista et al [39], appear to be promising therapeutic strategies to balance the ANS and produce a balanced autonomic response [40][41][42]. Besides, Leitzke et al [43] have recently reported that these therapeutic approaches for sympathovagal balance in severe courses of COVID-19 can be achieved diagnostically by measuring HRV.…”

Prevalence and characteristics of new‐onset pain in COVID‐19 survivours, a controlled study

“…It has been hypothesized that SARS‐CoV‐2 could invade the CNS through the circulation, cerebral spinal fluid or via cranial nerves/olfactory bulb, by synapse‐connection or by direct endocytic paths (similar to ZIKA virus) (Baptista et al., 2020; Channappanavar & Perlman, 2017). Indeed, COVID‐19 is capable to invade astrocytes, neuroblasts, and neurons via the direct binding to the ACE2 receptor (Baptista et al., 2020). This would lead to the dysfunction of ACE2‐mediated cascades with potential implications in neuroinflammation, neurodegeneration, and neurotoxicity processes.…”

Presentation and management of anxiety in individuals with acute symptomatic or asymptomatic COVID-19 infection, and in the post-COVID-19 recovery phase

“…3. Non-invasive brain stimulation (NIBS), including transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) (Baptista et al 2020;Shinjo et al 2020). tDCS is an experimental NIBS technique, which involves placing two electrodes over the head and running a low intensity current between them to either stimulate (anodal) or inhibit (cathodal) neuronal activity.…”