Update on Neurological Manifestations of SARS-CoV-2

Aims: In response to the rapid spread of COVID-19, this paper provides health professionals with better accessibility to available evidence, summarising findings from a systematic overview of systematic reviews of the neurological symptoms seen in patients with COVID-19. Implications of so-called ‘Long Covid’ on neurological services and primary care and similarities with other neurological disorders are discussed. Methods: Firstly, a systematic overview of current reviews of neurological symptoms of COVID-19 was conducted. Secondly, the implications of these findings are discussed in relation to the potential effect on neurological services and the similarities in the experience of patients with COVID-19 and those with other neurological disorders. A total of 45 systematic reviews were identified within seven databases, published between 11 April 2020 and 15 October 2020, following a search in June 2020, updated on 20 October 2020. Results: The results indicated that COVID-19 exhibits two types of neurological symptoms; life-threatening symptoms such as Guillain–Barre Syndrome (GBS) and encephalitis, and less devastating symptoms such as fatigue and myalgia. Many of these so-called lesser symptoms appear to be emerging as longer-term for some sufferers and have been recently labelled Long Covid. When compared, these less devastating symptoms are very similar to other neurological conditions such as chronic fatigue syndrome (CFS) and functional neurological disorder (FND). Conclusion: Implications for neurological healthcare services in the United Kingdom (UK) may include longer waiting times and a need for more resources (including more qualified health professionals). There is also a possible change-effect on health professionals’ perceptions of other neurological conditions such as CFS and FND. Future research is recommended to explore changes in health professionals’ perceptions of neurological symptoms because of COVID-19.

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“…Finally, 45 systematic reviews met the inclusion criteria and were included in this overview. 11 – 55 …”

Section: Resultsmentioning

confidence: 99%

The neurological symptoms of COVID-19: a systematic overview of systematic reviews, comparison with other neurological conditions and implications for healthcare services

Wildwing

Holt

2021

Therapeutic Advances in Chronic Disease

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“…With interest we read the review article by Valiuddin et al about the neurological implications of coronavirus disease 2019 (COVID-19) (neuro-COVID). 1 The authors listed ischemic stroke, transverse myelitis, seizures, acute hemorrhaghic necrotising encephalopathy (AHNE), acute disseminated encephalo-myelitis (ADEM), posterior reversible encephalopathy syndrome (PRES), myasthenia, and sinus venous thrombosis as central nervous system (CNS) manifestations, and hyposmia/hypogeusia, Guillain-Barré syndrome, facial palsy, ophthalmoparesis, and neuropathy, as peripheral nervous system (PNS) manifestations of COVID-19. 1 We have the following comments and concerns.…”

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confidence: 99%

“…Finally, we do not agree with the listing of MG among the CNS disorders triggered by SARS-CoV-2 in Table 1. 1 Myasthenia gravis is a prototypic PNS disorder and should not be mentioned among the CNS but the PNS disorders.…”

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confidence: 99%

“…Disregarding this debate, there are indications that the virus enters the CNS via the blood brain barrier (BBB) or via retrograde invasion along peripheral nerves, as mentioned in the review. 1,15 There are even indications that the virus disrupts the BBB. 16 Interestingly, in most of the CNS disorders claimed to have been triggered by direct contact of the virus Klinik Landstrasse, Messerli Institute, Department of Neurology, Vienna, Austria with CNS structures, investigations of the cerebro-spinal fluid (CSF) did not confirm the presence of the virus in the CSF.…”

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confidence: 99%

“…Thus, this article cannot be taken as an example of SARS-CoV-2 triggered MG. 18 Finally, we do not agree with the listing of MG among the CNS disorders triggered by SARS-CoV-2 in Table 1. 1 Myasthenia gravis is a prototypic PNS disorder and should not be mentioned among the CNS but the PNS disorders. Overall, the interesting review has a number of limitations, which need to be accomplished before drawing final conclusions.…”

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confidence: 99%

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Presentation of Neuro-COVID is Broad and Pathogenesis Diverse

Finsterer¹

2021

WJEM

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Vocal outcomes after COVID-19 infection: acoustic voice analyses, durational measurements, self-reported findings, and auditory-perceptual evaluations

Gölaç

Atalık

Özcebe

et al. 2022

Eur Arch Otorhinolaryngol

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Purpose The ongoing literature suggests that COVID-19 may have a potential impact on voice characteristics during the infection period. In the current study, we explored how the disease deteriorates different vocal parameters in patients who recovered from COVID-19. Methods A total of 80 participants, 40 patients with a prior history of COVID-19 (20 male, 20 female) with a mean age of 39.9 ± 8.8 (range, 21–53) and 40 gender and age-matched healthy individuals (mean age, 37.3 ± 8.8; range, 21–54) were included to this study. The data of acoustic voice analyses, durational measurements, patient-reported outcomes, and auditory-perceptual evaluations were compared between the study group and the control group. Correlation analyses were conducted to examine the association between the clinical characteristics of the recovering patients and measured outcomes. Results Maximum phonation time (MPT) and the scores of both Voice Handicap Index-10 (VHI-10) and Voice-Related Quality of Life (V-RQOL) questionnaires significantly differed between the groups, which was more evident in female participants. The overall severity score of dysphonia was found to be higher in the study group than the control group ( p = 0.023), but gender-based comparisons reached significance only in males ( p = 0.032). VHI-10 and V-RQOL revealed significant correlations with the symptom scores of the disease. Conclusions Patients with a prior history of COVID-19 had significantly lower MPT, increased VHI-10 scores, decreased voice-related quality of life based on the V-RQOL questionnaire, and higher overall severity scores in the auditory-perceptual evaluation. Self-reported voice complaints disclosed close relationships with the symptom scores of COVID-19 disease.

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Update on Neurological Manifestations of SARS-CoV-2

Cited by 21 publications

References 51 publications

The neurological symptoms of COVID-19: a systematic overview of systematic reviews, comparison with other neurological conditions and implications for healthcare services

The neurological symptoms of COVID-19: a systematic overview of systematic reviews, comparison with other neurological conditions and implications for healthcare services

Presentation of Neuro-COVID is Broad and Pathogenesis Diverse

Vocal outcomes after COVID-19 infection: acoustic voice analyses, durational measurements, self-reported findings, and auditory-perceptual evaluations

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