In this systematic review, we will discuss the evidence on the occurrence of central nervous system (CNS) involvement and neurological manifestations in patients with COVID-19.
MEDLINE (accessed from ...PubMed) and Scopus from December 01, 2019 to March 26, 2020 were systematically searched for related published articles. In both electronic databases, the following search strategy was implemented and these key words (in the title/abstract) were used: “COVID 19” OR “coronavirus” AND “brain” OR “CNS” OR “neurologic”.
Through the search strategy, we could identify two articles about neurological involvement by COVID-19. One of these publications was a narrative review and the other one was a viewpoint. However, the authors scanned the reference lists of the included studies and could identify multiple references. One study, specifically investigated the neurological manifestations of COVID-19 and could document CNS manifestations in 25% of the patients. Most of the studies investigated the manifestations of COVID-19 in general.
While neurological manifestations of COVID-19 have not been studied appropriately, it is highly likely that some of these patients, particularly those who suffer from a severe illness, have CNS involvement and neurological manifestations. Precise and targeted documentation of neurological symptoms, detailed clinical, neurological, and electrophysiological investigations of the patients, attempts to isolate SARS-CoV-2 from cerebrospinal fluid, and autopsies of the COVID-19 victims may clarify the role played by this virus in causing neurological manifestations.
•Some patients with COVID-19 may show nonspecific neurological symptoms, such as confusion and headache.•A few patients with COVID-19 showed more specific neurological manifestations, such as seizure or cerebrovascular problems.•Neuroinvasion of SARS-CoV2 may partially explain why some patients develop respiratory failure.
Long COVID syndrome‐associated brain fog Asadi‐Pooya, Ali A.; Akbari, Ali; Emami, Amir ...
Journal of medical virology,
March 2022, Volume:
94, Issue:
3
Journal Article
Peer reviewed
Open access
We investigated the frequency of brain fog in a large cohort of patients with documented coronavirus disease‐2019 (COVID‐19) who have survived the illness. We also scrutinized the potential risk ...factors associated with the development of brain fog. Adult patients (18–55 years of age), who were referred to the healthcare facilities anywhere in Fars province from February 19, 2020 to November 20, 2020 were included. All patients had a confirmed COVID‐19 diagnosis. In a phone call, at least 3 months after their discharge from the hospital, we obtained their current information. A questionnaire was specifically designed for data collection. In total, 2696 patients had the inclusion criteria; 1680 (62.3%) people reported long COVID syndrome (LCS). LCS‐associated brain fog was reported by 194 (7.2%) patients. Female sex (odds ratio OR: 1.4), respiratory problems at the onset (OR: 1.9), and intensive care unit (ICU) admission (OR: 1.7) were significantly associated with reporting chronic post‐COVID “brain fog” by the patients. In this large population‐based study, we report that chronic post‐COVID “brain fog” has significant associations with sex (female), respiratory symptoms at the onset, and the severity of the illness (ICU admission).
Objective
To determine whether patients with epilepsy (PWE) are particularly over‐represented in a very large cohort of patients with COVID‐19. We also investigated whether COVID‐19 is associated ...with a different clinical picture or a more severe course of illness in PWE (compared with others).
Methods
All consecutive patients who referred to and admitted at healthcare facilities anywhere in Fars province (located in the south of Iran with a population of 4,851,000 people) from February 19, 2020 until November 20, 2020 were included.
Results
A total of 37,968 patients were studied. Eighty‐two patients (0.2%) had pre‐existing epilepsy. Seizures were significantly more frequent among PWE as a presenting manifestation of COVID‐19 compared with that in people without epilepsy (Odds Ratio = 27; p = 0.0001). Furthermore, PWE less often reported cough (significantly) and more often had gastrointestinal symptoms (vomiting and anorexia; as trends) compared with those in people without epilepsy. Patients with epilepsy were not differently likely to be intubated or admitted at ICUs. Case fatality rates were not different between the two groups 9.8% in PWE and 8.5% in people without epilepsy; p = 0.690.
Conclusion
Patients with epilepsy are not susceptible to contracting COVID‐19 more than other individuals. Furthermore, COVID‐19 in PWE is not associated with a more severe illness or a poorer prognosis. However, PWE and COVID‐19 may present somewhat differently than others with such an illness. Why PWE less often present with cough and more often present with gastrointestinal symptoms is not clear yet and should be investigated and clarified in the future studies.
•Seizures have been reported in patients with various coronavirus infections.•However, seizures seem to be a rare occurrence in people with COVID-19.•Patients with COVID-19 may have hypoxia, ...multiorgan failure, and metabolic disarrangements.•It is plausible to expect acute symptomatic seizures to happen in these patients.•One should be prepared to treat seizures appropriately.
Neurotropic and neuroinvasive capabilities of coronaviruses have been described in humans. Neurological problems found in patients with coronavirus infection include: febrile seizures, convulsions, loss of consciousness, encephalomyelitis, and encephalitis. Coronavirus disease (COVID-19) is caused by SARS-CoV2. In severe cases, patients may develop severe pneumonia, acute respiratory distress syndrome, and acute cardiac injury. While seizures and status epilepticus have not been widely reported in the past five months since the onset of COVID-19 pandemic, patients with COVID-19 may have hypoxia, multiorgan failure, and severe metabolic and electrolyte disarrangements; hence, it is plausible to expect clinical or subclinical acute symptomatic seizures to happen in these patients. One should be prepared to treat seizures appropriately, if they happen in a patient who is already in a critical medical condition and suffers from organ failure.
We systematically reviewed the existing literature on the safety of the use of smartphone, mobile phone/Internet, and Wi‐Fi by people with epilepsy (PWE), according to the recommendations of the ...Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement. Scopus, MEDLINE, and Google Scholar from the inception to April 9, 2021 were searched. These key words were used “epilepsy” OR “seizure” AND “Mobile Phone” OR “Cell Phone” OR “Smartphone” OR “Wi‐Fi” OR “Electromagnetic” OR “Radiation.” The primary search yielded 7766 studies; 33 studies were related. In total, 19 manuscripts were based on animal/computational studies and 14 articles reported human investigations. Among animal studies, 10 articles suggested detrimental effects by electromagnetic fields (EMFs) on brain function/seizure activity, while nine studies negated this hypothesis. Among human studies, seven studies suggested detrimental effects by EMFs on brain function/seizure activity, while seven studies negated this hypothesis. None of the studies provided a good level of evidence. In one human study, all seven patients with epilepsy and abnormal EEG during the sham exposure, had an increase in the number of epileptic events with exposure to mobile phone radiation. In another study of the detrimental effects of smart technology device overuse among school students, an association was found between reporting seizures and the hours of smart technology device use. While high‐quality evidence on the safety of the use of smartphone, mobile phone/Internet, and Wi‐Fi in PWE is lacking, prudent use of these technologies, including using wired hand‐free sets or other exposure‐reducing measures is recommended.
Objective
To investigate the effects of COVID‐19 pandemic on patients' perceptions of hardship in obtaining their drugs and if this pandemic and the social restrictions in response to that has ...resulted in any changes in their seizure control status. We also investigated factors potentially associated with the perceptions of difficulty in obtaining their drugs (eg, polytherapy vs monotherapy, taking imported drugs, and seizure status worsening).
Methods
We surveyed a random sample of patients with epilepsy, who were registered in our database at Shiraz Epilepsy Center, Iran, on their perceptions on two issues: (a) What has been your experience on obtaining your antiseizure medications in the past 4 weeks (compared to before)? (b) Have you experienced any changes in your seizure control status in the past 4 weeks?
Results
We included 100 patients (53 male and 47 female patients). In response to the question “Have you had any difficulties in the past 4 weeks to obtain your drugs?,” 31 people (31%) expressed hardship obtaining their drugs. In response to the question “How has been your seizure control status compared with before?,” six people (6%) expressed worsening of their seizure control status in the past 4 weeks. None of the patients reported symptoms of coronavirus infection.
Conclusion
About one‐third of patients with epilepsy expressed significant hardship obtaining their drugs after the intensification of the COVID‐19 outbreak in Iran. The current COVID‐19 pandemic could be considered as a major shock to a nation that has already been under significant pressure (ie, Iran).
Objective
Antiseizure medications (ASMs) are the first‐line treatment for epilepsy. Many ASMs are available; this offers the opportunity to improve therapy by tailoring it to individual ...characteristics, but also increases the possibility of healthcare professionals making inappropriate treatment choices. To assist healthcare professionals, we developed a pragmatic algorithm aimed at facilitating medication selection for individuals whose epilepsy begins at age 10 years and older.
Methods
Utilizing available evidence and a Delphi panel−based consensus process, a group of epilepsy experts developed an algorithm for selection of ASMs, depending on the seizure type(s) and the presence of relevant clinical variables (age, gender, comorbidities, and comedications). The algorithm was implemented into a web‐based application that was tested and improved in an iterative process.
Results
The algorithm categorizes ASMs deemed to be appropriate for each seizure type or combination of seizure types into three groups, with group 1 ASMs considered preferred, group 2 considered second line, and group 3 considered third line. Depending on the presence of relevant clinical variables, the ranking of individual ASMs is adjusted in the prioritization scheme to tailor recommendations to the characteristics of the individual. The algorithm is available on a web‐based application at: https://epipick.org/#/.
Significance
The proposed algorithm is user‐friendly, requires less than 2 minutes to complete, and provides the user with a range of appropriate treatment options from which to choose. This should facilitate its broad utilization and contribute to improve epilepsy management for healthcare providers who desire advice, particularly those who lack special expertise in the field.
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