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Letter to the editor regarding “Coexistence of neurological diseases with Covid-19 pneumonia during the pandemic period”

Acceso Abierto

Idioma: Inglés

Publicado: 31/07/2021

APC (est): $3,720 USD

Abstract:

•Post-COVID 19 neurological syndrome modifies the prognosis of COVID-19 patients.•Neurological complications increase risk of death in COVID-19 patients.•The development of neurorehabilitation is an imperative need in the third world. We read with great interest the article published recently by Gorgulu et al. [[1]Gorgulu U. Bayındır H. Bektas H. Kayipmaz A.E. San İ. Coexistence of neurological diseases with Covid-19 pneumonia during the pandemic period.J Clin Neurosci. 2021; 91: 237-242Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar] "Coexistence of neurological diseases with Covid-19 pneumonia during the pandemic period", where the authors investigated the prevalence of COVID-19 in patients presenting to the emergency department for neurological symptoms during the pandemic period, observing that out of 1098 neurological patients, 42 (3.8%) had definitive diagnosis through RT-PCR, and these had an average age of 73 years and had comorbidities, leading to 88% being admitted to the intensive care unit and a fatality rate of 40.5% (17) [[1]Gorgulu U. Bayındır H. Bektas H. Kayipmaz A.E. San İ. Coexistence of neurological diseases with Covid-19 pneumonia during the pandemic period.J Clin Neurosci. 2021; 91: 237-242Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar]. We thank the authors for providing us with such valuable evidence, however, we would like to make a few comments on two fundamental aspects in the prognosis of the COVID-19 patient with or without a history of neurological disorders, and the need to design and implement strategies to promote neurorehabilitation in low- and middle-income countries Post-COVID-19 neurological syndrome was recently described [2Camargo-Martínez W. Lozada-Martínez I. Escobar-Collazos A. Navarro-Coronado A. Moscote-Salazar L. Pacheco-Hernández A. et al.Post-COVID 19 neurological syndrome: Implications for sequelae's treatment.J Clin Neurosci. 2021; 88: 219-225https://doi.org/10.1016/j.jocn.2021.04.001Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar, 3Wijeratne T. Crewther S. COVID-19 and long-term neurological problems: Challenges ahead with Post-COVID-19 Neurological Syndrome. Aust.J Gen Pract. 2021; 50https://doi.org/10.31128/AJGP-COVID-43Crossref Scopus (25) Google Scholar], characterized by the persistence of neurological symptoms or development of mild or severe acute neurological events following the active phase of COVID-19, leading to high rates of morbidity, mortality, disability and health care costs [2Camargo-Martínez W. Lozada-Martínez I. Escobar-Collazos A. Navarro-Coronado A. Moscote-Salazar L. Pacheco-Hernández A. et al.Post-COVID 19 neurological syndrome: Implications for sequelae's treatment.J Clin Neurosci. 2021; 88: 219-225https://doi.org/10.1016/j.jocn.2021.04.001Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar, 3Wijeratne T. Crewther S. COVID-19 and long-term neurological problems: Challenges ahead with Post-COVID-19 Neurological Syndrome. Aust.J Gen Pract. 2021; 50https://doi.org/10.31128/AJGP-COVID-43Crossref Scopus (25) Google Scholar, 4Nuzzo D. Cambula G. Bacile I. Rizzo M. Galia M. Mangiapane P. et al.Long-Term Brain Disorders in Post Covid-19 Neurological Syndrome (PCNS) Patient.Brain Sci. 2021; 11: 454https://doi.org/10.3390/brainsci11040454Crossref PubMed Scopus (35) Google Scholar]. It is a challenge to define neurological syndrome post-COVID 19, since most of the patients who develop neuroinflammation due to the infection are elderly people with cardiometabolic and neurovascular risk factors, making it difficult to differentiate the etiology precisely [[4]Nuzzo D. Cambula G. Bacile I. Rizzo M. Galia M. Mangiapane P. et al.Long-Term Brain Disorders in Post Covid-19 Neurological Syndrome (PCNS) Patient.Brain Sci. 2021; 11: 454https://doi.org/10.3390/brainsci11040454Crossref PubMed Scopus (35) Google Scholar]. This is even more complex in young patients with severe phenotype development of COVID-19, who may present with cryptogenic stroke during hospital stay or in the short term after the acute phase of COVID-19 [[5]Picón-Jaimes Y.A. Lozada-Martinez I.D. Janjua T. Moscote-Salazar L.R. Cryptogenic stroke: Much and nothing at the same time.Eur J Neurol. 2021; 28: e50-e51https://doi.org/10.1111/ene.14880Crossref PubMed Scopus (1) Google Scholar]. One of the major concerns and that should be a primary objective today, is the careful approach and rehabilitation in this type of patients, who may lose functional capacity due to difficulties in physical therapy, neurocognitive, nutritional, psychological and neurophysiological, due to prolonged stay in intensive care [2Camargo-Martínez W. Lozada-Martínez I. Escobar-Collazos A. Navarro-Coronado A. Moscote-Salazar L. Pacheco-Hernández A. et al.Post-COVID 19 neurological syndrome: Implications for sequelae's treatment.J Clin Neurosci. 2021; 88: 219-225https://doi.org/10.1016/j.jocn.2021.04.001Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar, 3Wijeratne T. Crewther S. COVID-19 and long-term neurological problems: Challenges ahead with Post-COVID-19 Neurological Syndrome. Aust.J Gen Pract. 2021; 50https://doi.org/10.31128/AJGP-COVID-43Crossref Scopus (25) Google Scholar]. Frontera et al [[6]Frontera J.A. Yang D. Lewis A. Patel P. Medicherla C. Arena V. et al.A prospective study of long-term outcomes among hospitalized COVID-19 patients with and without neurological complications.J Neurol Sci. 2021; 426: 117486https://doi.org/10.1016/j.jns.2021.117486Abstract Full Text Full Text PDF PubMed Scopus (119) Google Scholar] conducted a prospective study where they followed 382 patients who developed neurological complications during the acute phase of COVID-19 for 6 months, observing that 91% at least persisted with 1 abnormal outcome, 56% had limitations in performing activities of daily living, 50% had cognitive impairment, 47% were unable to return to work, and 62% scored worse than average on ≥ 1 Neuro-QoL scale (worse anxiety 46%, sleep 38%, fatigue 36%, and depression 25%) [[6]Frontera J.A. Yang D. Lewis A. Patel P. Medicherla C. Arena V. et al.A prospective study of long-term outcomes among hospitalized COVID-19 patients with and without neurological complications.J Neurol Sci. 2021; 426: 117486https://doi.org/10.1016/j.jns.2021.117486Abstract Full Text Full Text PDF PubMed Scopus (119) Google Scholar]. The authors concluded that those who present any type of neurological complication during the acute phase of COVID-19 have a worse prognosis at 6 months compared to those who do not. However, it is observable that almost all of those who present neurological manifestations persist in the long term [[6]Frontera J.A. Yang D. Lewis A. Patel P. Medicherla C. Arena V. et al.A prospective study of long-term outcomes among hospitalized COVID-19 patients with and without neurological complications.J Neurol Sci. 2021; 426: 117486https://doi.org/10.1016/j.jns.2021.117486Abstract Full Text Full Text PDF PubMed Scopus (119) Google Scholar]. Therefore, it is expected that the prognosis in those with a history of neuropsychiatric disorders will be worse [[4]Nuzzo D. Cambula G. Bacile I. Rizzo M. Galia M. Mangiapane P. et al.Long-Term Brain Disorders in Post Covid-19 Neurological Syndrome (PCNS) Patient.Brain Sci. 2021; 11: 454https://doi.org/10.3390/brainsci11040454Crossref PubMed Scopus (35) Google Scholar]. Cerebrovascular diseases, neuroendocrine and neuroimmune disorders are the most frequent complications in this type of patients, and these disorders, in turn, may involve extracranial organs through systemic axes (for example, the neuro-respiratory-inflammasome axis, which produces pulmonary injury) [4Nuzzo D. Cambula G. Bacile I. Rizzo M. Galia M. Mangiapane P. et al.Long-Term Brain Disorders in Post Covid-19 Neurological Syndrome (PCNS) Patient.Brain Sci. 2021; 11: 454https://doi.org/10.3390/brainsci11040454Crossref PubMed Scopus (35) Google Scholar, 7Moghimi N. Di Napoli M. Biller J. Siegler J.E. Shekhar R. McCullough L.D. et al.The Neurological Manifestations of Post-Acute Sequelae of SARS-CoV-2 infection.Curr Neurol Neurosci Rep. 2021; 21https://doi.org/10.1007/s11910-021-01130-1Crossref Scopus (90) Google Scholar]. In this order of ideas, it is imperative to propose solutions to what is expected to be an epidemic of unspecific neurological disorders that may compromise the functional capacity of those affected by COVID-19. For this, the implementation and creation of specialized neurorehabilitation units are indispensable [8Mila-Grande J.C. Granadillo-Daza R.L. Agudelo-Rios D.A. Lozada-Martínez I.D. Regarding: Management of unfavorable outcome after mild traumatic brain injury: Review of physical and cognitive rehabilitation and of psychological care in post-concussive syndrome.Neurochirurgie. 2021; (S0028-3770(21)00165-X)https://doi.org/10.1016/j.neuchi.2021.06.004Crossref PubMed Scopus (2) Google Scholar, 9Ortega-Sierra M.G. Durán-Daza R.M. Carrera-Patiño S.A. Rojas-Nuñez A.X. Charry-Caicedo J.I. Lozada-Martínez I.D. Neuroeducation and neurorehabilitation in the neurosurgical patient: programs to be developed in Latin America and the Caribbean.J Neurosurg Sci. 2021; https://doi.org/10.23736/S0390-5616.21.05439-4Crossref PubMed Scopus (4) Google Scholar], especially in low- and middle-income countries, where, despite being a concept proposed approximately two decades ago, it is still emerging in these regions [8Mila-Grande J.C. Granadillo-Daza R.L. Agudelo-Rios D.A. Lozada-Martínez I.D. Regarding: Management of unfavorable outcome after mild traumatic brain injury: Review of physical and cognitive rehabilitation and of psychological care in post-concussive syndrome.Neurochirurgie. 2021; (S0028-3770(21)00165-X)https://doi.org/10.1016/j.neuchi.2021.06.004Crossref PubMed Scopus (2) Google Scholar, 9Ortega-Sierra M.G. Durán-Daza R.M. Carrera-Patiño S.A. Rojas-Nuñez A.X. Charry-Caicedo J.I. Lozada-Martínez I.D. Neuroeducation and neurorehabilitation in the neurosurgical patient: programs to be developed in Latin America and the Caribbean.J Neurosurg Sci. 2021; https://doi.org/10.23736/S0390-5616.21.05439-4Crossref PubMed Scopus (4) Google Scholar]. In this way, we can reduce the burden of neurological diseases in the near future, and recover or maintain the capacity of those affected. Unfortunately the evidence on this situation is limited and the exact prognostic progress of this particular group of patients is not known, so an international epidemiological registry is needed to estimate the degree of severity and to set new goals for global neurology. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. None. The author(s) received no financial support for the research, authorship, and/or publication of this article.

Tópico:

Long-Term Effects of COVID-19

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Información de la Fuente:

FuenteJournal of Clinical Neuroscience	Cuartil año de publicaciónNo disponible	Volumen93
IssueNo disponible	Páginas282 - 283	pISSNNo disponible
ISSN1532-2653	Perfil OpenAlexhttps://openalex.org/S145023809

Enlaces e Identificadores:

Pmid URL	https://pubmed.ncbi.nlm.nih.gov/34362648	Pmcid URL	https://www.ncbi.nlm.nih.gov/pmc/articles/8324405	Scholar URL	https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=info%3Aiy15k_PLf-sJ%3Ascholar.google.com&btnG=
Doi URL	https://doi.org/10.1016/j.jocn.2021.07.056	Pdf URL	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8324405/	Openalex URL	https://openalex.org/W3190620813
Open_access URL	http://www.jocn-journal.com/article/S0967586821004070/pdf

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