Autonomic and neuropathic complaints of long-COVID objectified: an investigation from electrophysiological perspective

Abstract

Purpose Here , we aimed to assess the frequency and phenomenology of autonomic and neuropathic complaints of long-COVID and to evaluate them by means of electrophysiology. Methods Step 1. Patients with prior COVID-19 infection were screened by COMPASS-31 and mTORONTO to create the target population for further evaluation. Step 2. Patients with high scores were invited for a detailed history of their complaints and electrophysiological analysis, which included nerve conduction studies, cutaneous silent period (CSP), and sympathetic skin response (SSR). We also constituted a control group composed of healthy subjects of similar age and sex for electrophysiological analysis. Results There were 106 patients, who matched the study criteria. Among them, thirty-eight patients (%35.8) had neuropathic or autonomic complaints or both. Fatigue and headache were significantly more frequent in patients with autonomic and neuropathic complaints. Detailed examination and electrophysiological evaluation were performed in 14 of 38 patients. Neuropathic complaints were patchy and proximally located in the majority. The entire CSP suppression index was higher in the patients ( p = 0.002). There was no difference in palmar and plantar SSR between patients and healthy subjects. mTORONTO scores were negatively correlated with palmar and plantar SSR amplitudes, and the correlation was moderate. Conclusion Neuropathic or autonomic complaints were seen in more than one-third of patients with long-COVID. Neuropathic complaints were generally patchy, proximally predominant, asymmetric, or diffuse. The CSP suppression index was abnormal whereas SSRs were normal.

Electrophysiological assessment in patients with COVID-19-related peripheral neuropathies and myopathies: a systematic review

“…All studies included in this review reported that NCS, specifically sensory NCV, was not significantly affected when comparing healthy control to patients with COVID-19, which agrees with other studies that showed no or mild abnormalities in NCS ( 32 , 33 ). Also, patients initially referred for electrophysiological assessments due to sensory symptoms had abnormal MNCV, while the SNCV was generally normal ( 21 ).…”

Role of Electrodiagnostic Studies in COVID-19–Related Neuromuscular Disease: A Literature Review

“…All of the studies included in this review reported that NCS findings, including sensory nerve conduction velocity (NCV), were not significantly altered in patients with COVID-19 relative to healthy controls. This aligns with previous research that revealed either no or very slight NCS abnormalities [7]. Studies of COVID-19 severity, considering factors such as intubation, weaning from mechanical ventilation, and pneumonia, have identified substantial variation in EMG/ NCS between more and less severe cases [8].…”

Study of sympathetic skin response in patients with COVID-19 infection

“…We conducted a study with larger sample size as well. Another study by Ser et al revealed neuropathic and autonomic complaints in more than one-third of patients with long COVID-19 and abnormal cutaneous silent period suppression index but normal SSR parameters [ 29 ]. One of the reasons for the difference between the results of this study and our research could be that the SSR evaluation in the mentioned study was performed on a limited number of patients who had neuropathic or autonomic symptoms after COVID-19 infection (14 out of 38 cases).…”