Sleep-Wake and Circadian Disorders after Tick-Borne Encephalitis

Chiffi, Gabriele; Grandgirard, Denis; Sendi, Parham; Dietmann, Anelia; Bassetti, C.; Leib, Stephen L.

doi:10.3390/microorganisms10020304

Cited by 12 publications

(8 citation statements)

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“…The mechanisms causing extensive fatigue in post-COVID-19 syndrome are still not fully understood. Albeit post-infectious fatigue is a common and sometimes long-lasting clinical phenomenon, e.g., following EBV infections or tick-borne encephalitis [ 45 , 46 ], the high frequency, the strong manifestation, and the persistence of fatigue in patients with post-COVID-19 argue in favor of distinct mechanisms. In addition, significant tissue hypoxemia as another potential cause of fatigue [ 47 ] appeared unlikely in our cohort since the assessment of blood oxygenation was normal in all patients.…”

Section: Discussionmentioning

confidence: 99%

Post-COVID-19 Syndrome is Rarely Associated with Damage of the Nervous System: Findings from a Prospective Observational Cohort Study in 171 Patients

et al. 2022

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Introduction The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can affect multiple organs. Reports of persistent or newly emergent symptoms, including those related to the nervous system, have increased over the course of the pandemic, leading to the introduction of post-COVID-19 syndrome. However, this novel syndrome is still ill-defined and structured objectification of complaints is scarce. Therefore, we performed a prospective observational cohort study to better define and validate subjective neurological disturbances in patients with post-COVID-19 syndrome. Methods A total of 171 patients fulfilling the post-COVID-19 WHO Delphi consensus criteria underwent a comprehensive neurological diagnostic work-up including neurovascular, electrophysiological, and blood analysis. In addition, magnetic resonance imaging (MRI) and lumbar puncture were conducted in subgroups of patients. Furthermore, patients underwent neuropsychological, psychosomatic, and fatigue assessment. Results Patients were predominantly female, middle-aged, and had incurred mostly mild-to-moderate acute COVID-19. The most frequent post-COVID-19 complaints included fatigue, difficulties in concentration, and memory deficits. In most patients (85.8%), in-depth neurological assessment yielded no pathological findings. In 97.7% of the cases, either no diagnosis other than post COVID-19 syndrome, or no diagnosis likely related to preceding acute COVID-19 could be established. Sensory or motor complaints were more often associated with a neurological diagnosis other than post-COVID-19 syndrome. Previous psychiatric conditions were identified as a risk factor for developing post-COVID-19 syndrome. We found high somatization scores in our patient group that correlated with cognitive deficits and the extent of fatigue. Conclusions Albeit frequently reported by patients, objectifiable affection of the nervous system is rare in post-COVID-19 syndrome. Instead, elevated levels of somatization point towards a pathogenesis potentially involving psychosomatic factors. However, thorough neurological assessment is important in this patient group in order to not miss neurological diseases other than post-COVID-19 .

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Section: Discussionmentioning

confidence: 99%

Post-COVID-19 Syndrome is Rarely Associated with Damage of the Nervous System: Findings from a Prospective Observational Cohort Study in 171 Patients

et al. 2022

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“…The current literature has identified changes to sleep–wake behavior after TBE in up to 73.9% of children suffering from fatigue while 27.4% of adults have reported extensive daytime sleepiness or somnolence. A recent in-depth literature review indeed confirm that sleep wake and circadian disorders are a relevant issue in TBE-affected patients [ 42 ].…”

Section: Discussionmentioning

confidence: 86%

Tick-borne encephalitis affects sleep–wake behavior and locomotion in infant rats

et al. 2022

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Background/Aims Tick-borne encephalitis (TBE) is a disease affecting the central nervous system. Over the last decade, the incidence of TBE has steadily increased in Europe and Asia despite the availably of effective vaccines. Up to 50% of patients after TBE suffer from post-encephalitic syndrome that may develop into long-lasting morbidity. Altered sleep–wake functions have been reported by patients after TBE. The mechanisms causing these disorders in TBE are largely unknown to date. As a first step toward a better understanding of the pathology of TBEV-inducing sleep dysfunctions, we assessed parameters of sleep structure in an established infant rat model of TBE. Methods 13-day old Wistar rats were infected with 1 × 106 FFU Langat virus (LGTV). On day 4, 9, and 21 post infection, Rotarod (balance and motor coordination) and open field tests (general locomotor activity) were performed and brains from representative animals were collected in each subgroup. On day 28 the animals were implanted with a telemetric EEG/EMG system. Sleep recording was continuously performed for 24 consecutive hours starting at day 38 post infection and visually scored for Wake, NREM, and REM in 4 s epochs. Results As a novelty of this study, infected animals showed a significant larger percentage of time spend awake during the dark phase and less NREM and REM compared to the control animals (p < 0.01 for all comparisons). Furthermore, it was seen, that during the dark phase the wake bout length in infected animals was prolonged (p = 0.043) and the fragmentation index decreased (p = 0.0085) in comparison to the control animals. LGTV-infected animals additionally showed a reduced rotarod performance ability at day 4 (p = 0.0011) and day 9 (p = 0.0055) and day 21 (p = 0.0037). A lower locomotor activity was also seen at day 4 (p = 0.0196) and day 9 (p = 0.0473). Conclusion Our data show that experimental TBE in infant rats affects sleep–wake behavior, leads to decreased spontaneous locomotor activity, and impaired moto-coordinative function.

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“…121 Furthermore, these disorders have been studied and identified in an animal model using juvenile rats. 121…”

Section: Long-term Sequelae and Post-encephalitic Syndromementioning

confidence: 99%

“…Subjectively reported sleep‐wake circadian disorders are more frequently reported after TBE infection. These long‐term sequelae have previously been reviewed in detail 121 . Furthermore, these disorders have been studied and identified in an animal model using juvenile rats 121 …”

Section: Clinical Signs and Symptoms Of Tick‐borne Encephalitismentioning

confidence: 99%

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Tick‐borne encephalitis: A comprehensive review of the epidemiology, virology, and clinical picture

Chiffi

Grandgirard

Leib

et al. 2023

Reviews in Medical Virology

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Tick‐borne encephalitis virus (TBEV) is a flavivirus commonly found in at least 27 European and Asian countries. It is an emerging public health problem, with steadily increasing case numbers over recent decades. Tick‐borne encephalitis virus affects between 10,000 and 15,000 patients annually. Infection occurs through the bite of an infected tick and, much less commonly, through infected milk consumption or aerosols. The TBEV genome comprises a positive‐sense single‐stranded RNA molecule of ∼11 kilobases. The open reading frame is > 10,000 bases long, flanked by untranslated regions (UTR), and encodes a polyprotein that is co‐ and post‐transcriptionally processed into three structural and seven non‐structural proteins. Tick‐borne encephalitis virus infection results in encephalitis, often with a characteristic biphasic disease course. After a short incubation time, the viraemic phase is characterised by non‐specific influenza‐like symptoms. After an asymptomatic period of 2–7 days, more than half of patients show progression to a neurological phase, usually characterised by central and, rarely, peripheral nervous system symptoms. Mortality is low—around 1% of confirmed cases, depending on the viral subtype. After acute tick‐borne encephalitis (TBE), a minority of patients experience long‐term neurological deficits. Additionally, 40%–50% of patients develop a post‐encephalitic syndrome, which significantly impairs daily activities and quality of life. Although TBEV has been described for several decades, no specific treatment exists. Much remains unknown regarding the objective assessment of long‐lasting sequelae. Additional research is needed to better understand, prevent, and treat TBE. In this review, we aim to provide a comprehensive overview of the epidemiology, virology, and clinical picture of TBE.

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Sleep-Wake and Circadian Disorders after Tick-Borne Encephalitis

Cited by 12 publications

References 50 publications

Post-COVID-19 Syndrome is Rarely Associated with Damage of the Nervous System: Findings from a Prospective Observational Cohort Study in 171 Patients

Post-COVID-19 Syndrome is Rarely Associated with Damage of the Nervous System: Findings from a Prospective Observational Cohort Study in 171 Patients

Tick-borne encephalitis affects sleep–wake behavior and locomotion in infant rats

Tick‐borne encephalitis: A comprehensive review of the epidemiology, virology, and clinical picture

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