COVID-19 and neuromuscular disorders

Guidon, Amanda C.; Amato, Anthony A.

doi:10.1212/wnl.0000000000009566

Cited by 275 publications

(348 citation statements)

References 58 publications

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“…Considering the high percentage of CB (86.8%) found on ultrastructural exam makes us think that EM is more sensitive for the diagnosis of CQ or HCQ induced myopathy than OM. Also, two previous reports [ 17 , 21 ] observed the presence of coiled- and vermicular-shaped material very similar to CB on EM. So, considering both cases, the percentage of CB would increase to 92% of cases.…”

Section: Discussionsupporting

confidence: 67%

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Side Effects of Chloroquine and Hydroxychloroquine on Skeletal Muscle: a Narrative Review

Carvalho

2020

Curr Pharmacol Rep

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Purpose of Review Concerning adverse neuromuscular effects, there are quite a few reports about the incidence and prevalence of chloroquine (CQ) and hydroxychloroquine (HCQ) myopathy. Given the above, I decided to explore the relationships of these drugs with skeletal muscle in an attempt to clarify how they affect the muscle now and in the future, as millions of people are using CQ and HCQ. Recent Findings The literature review identified 28 publications about CQ/HCQ myopathy, totaling 56 patients, from 1963 to 2020. A compilation of all patients was carried out by computing demographic features, clinical aspects, laboratory exams, and clinical evolution. All articles but two represented a large series about incidence and prevalence of the myopathy. Fifty-nine percent used QC, mean daily dose was 393 mg per day, and mean duration of treatment was 37 months. The predominant underlying diseases were rheumatoid arthritis (42.8%) and lupus erythematosus (26.8%). Respiratory distress was present in 12.5% in patients with proximal muscle weakness (87.2%). Dysphagia and cervical and axial weakness were observed in a smaller percentage. Creatine kinase was elevated in 60.7%, and EMG showed a myopathic pattern in 54%. Muscle biopsy showed a vacuolar pattern in 53.7%, and curvilinear bodies (CB) were the predominant ultrastructural finding (86.8%). After drug withdrawal, 85.4% of patients improved, and 12.7% died from other causes than myopathy. Summary CQ and HCQ myopathy has been known for a long time, but the incidence is low, being described only with long-term use. The use of these drugs for a short period has not been reported, although a prolonged elimination half-life of these drugs actually exists.

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Section: Discussionsupporting

confidence: 67%

“…Additionally, a third of patients infected with other coronavirus infections manifested with myalgias and elevated CKs [ 15 ] and rhabdomyolysis [ 16 ]. So, it is possible that coronavirus infections may cause a viral myositis [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Side Effects of Chloroquine and Hydroxychloroquine on Skeletal Muscle: a Narrative Review

Carvalho

2020

Curr Pharmacol Rep

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“…So far, several cases of Guillain-Barr e syndrome have been reported suggesting that the virus may have a role [15,16]. Muscle could be one target of the virus too [17]: muscular symptoms were more common amongst SARS-CoV-2-positive patients and creatine kinase level was higher compared with controls. Unfortunately, to avoid contamination, muscle magnetic resonance imaging and electromyography have not been performed in these cases, so there are not enough data to speculate about the pathogenesis of muscular involvement.…”

Section: Discussionmentioning

confidence: 99%

Assessment of neurological manifestations in hospitalized patients with COVID‐19

Luigetti

Bentivoglio

Riso

et al. 2020

Euro J of Neurology

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Background and purpose: The objective of this study was to assess the neurological manifestations in a series of consecutive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients, comparing their frequency with a population hospitalized in the same period for flu/respiratory symptoms, finally not related to SARS-CoV-2. Methods: Patients with flu/respiratory symptoms admitted to Fondazione Policlinico Gemelli hospital from 14 March 2020 to 20 April 2020 were retrospectively enrolled. The frequency of neurological manifestations of patients with SARS-CoV-2 infection was compared with a control group. Results: In all, 213 patients were found to be positive for SARS-CoV-2, after reverse transcriptase polymerase chain reaction on nasal or throat swabs, whilst 218 patients were found to be negative and were used as a control group. Regarding central nervous system manifestations, in SARS-CoV-2-positive patients a higher frequency of headache, hyposmia and encephalopathy always related to systemic conditions (fever or hypoxia) was observed. Furthermore, muscular involvement was more frequent in SARS-CoV-2 infection. Conclusions: Patients with COVID-19 commonly have neurological manifestations but only hyposmia and muscle involvement seem more frequent compared with other flu diseases.

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“…Individuals with MS and neuromuscular disorders may be prescribed medications which suppress the immune system and thus are at a higher risk of developing severe COVID-19. 84 However, guidelines specifically recommend having discussions with neurologists prior to modifying any courses of medication. 85 Patients who suffer with CVD have a 2.5-fold higher risk of getting severe COVID-19.…”

Section: Covid-19 In Patients With Diagnosed Neurological Disordersmentioning

confidence: 99%

Neurological manifestations in COVID-19: A narrative review

et al. 2020

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COVID-19, a respiratory viral infection, has affected more than 10 million individuals worldwide. Common symptoms include fever, dry cough, fatigue and shortness of breath. Some patients show neurological manifestations such as headache, dizziness, cerebrovascular disease, peripheral nerve and muscle symptoms and smell and taste impairment. In previous studies, SARS-CoV-1 and MERS-CoV were found to affect the nervous system. Given the high similarity between SARS-CoV-1 and SARS-CoV-2, effects on the nervous system by SARS-CoV-2 are a possibility. We have outlined the common neurological manifestations in COVID-19 (information are up-to-date as of June 2020) and discussed the possible pathogenetic mechanisms and management options.

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COVID-19 and neuromuscular disorders

Cited by 275 publications

References 58 publications

Side Effects of Chloroquine and Hydroxychloroquine on Skeletal Muscle: a Narrative Review

Side Effects of Chloroquine and Hydroxychloroquine on Skeletal Muscle: a Narrative Review

Assessment of neurological manifestations in hospitalized patients with COVID‐19

Neurological manifestations in COVID-19: A narrative review

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