Rehabilitation challenges in COVID-19 induced acute polyradiculoneuropathies

Introduction. SARS-COV 2 infection causes damage of the peripheral nervous system: loss of smell loss of taste and demyelination or axonal injury in the spinal roots and motor and sensory nerves with acute polyradiculoneuritis. As many people are affected by COVID-19, the number of patients with secondary peripheral nervous system damage is increasing. Material and method. There are a significant number of Guillain Barre syndrome (GBS) cases reported in COVID-19 positive patients, leading to the recognition of GBS as one of the peripheral nervous system complications of SARS-COV 2 infection. We are trying to summarise the particularities of specific rehabilitation in post-COVID patients. Results and discussions. The rehabilitation of a COVID patients has particularities, first – because of infectious risk carried by the patient during the procedures, second by the patient’s pulmonary and physical impairments induced by the Coronavirus. Conclusions. There is scarce evidence for rehabilitation interventions, and many recommendations are based on methods developed in other viral infections or chronic pulmonary and neurologic conditions. There is a urgent need for studies regarding the efficacy of interventions in COVID rehabilitation, as the number of patients is constantly increasing. Keywords: therapeutic plasma exchange, plasmapheresis, neuroimmune disorders,rehabilitation,

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Glucuronyl 3-sulfate occurs exclusively on distal unmyelinated terminals of selected sensory neurons in the peripheral nervous system

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100141160 ◽

1995 ◽

Vol 53 ◽

pp. 958-959

Author(s):

S.S. Spicer ◽

B.A. Schulte

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Cerebral Cortex ◽

Peripheral Nervous System ◽

Sensory Neurons ◽

Sensory Nerves ◽

Tissue Antigens ◽

The Central Nervous System ◽

The Brain ◽

Leu 7

Generation of monoclonal antibodies (MAbs) against tissue antigens has yielded several (VC1.1, HNK- 1, L2, 4F4 and anti-leu 7) which recognize the unique sugar epitope, glucuronyl 3-sulfate (Glc A3- SO4). In the central nervous system, these MAbs have demonstrated Glc A3-SO4 at the surface of neurons in the cerebral cortex, the cerebellum, the retina and other widespread regions of the brain.Here we describe the distribution of Glc A3-SO4 in the peripheral nervous system as determined by immunostaining with a MAb (VC 1.1) developed against antigen in the cat visual cortex. Outside the central nervous system, immunoreactivity was observed only in peripheral terminals of selected sensory nerves conducting transduction signals for touch, hearing, balance and taste. On the glassy membrane of the sinus hair in murine nasal skin, just deep to the ringwurt, VC 1.1 delineated an intensely stained, plaque-like area (Fig. 1). This previously unrecognized structure of the nasal vibrissae presumably serves as a tactile end organ and to our knowledge is not demonstrable by means other than its selective immunopositivity with VC1.1 and its appearance as a densely fibrillar area in H&E stained sections.

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COVID-19 Infection and Neurological Complications: Present Findings and Future Predictions

Neuroepidemiology ◽

10.1159/000508991 ◽

2020 ◽

Vol 54 (5) ◽

pp. 364-369 ◽

Cited By ~ 5

Author(s):

Ettore Beghi ◽

Valery Feigin ◽

Valeria Caso ◽

Paola Santalucia ◽

Giancarlo Logroscino

Keyword(s):

Nervous System ◽

Peripheral Nervous System ◽

Viral Infections ◽

Neurological Diseases ◽

Neurological Complications ◽

Influenza Viruses ◽

Surveillance Systems ◽

Care Needs ◽

The Past ◽

Immune Mediated

The present outbreak caused by SARS-CoV-2, an influenza virus with neurotropic potential, presents with neurological manifestations in a large proportion of the affected individuals. Disorders of the central and peripheral nervous system are all present, while stroke, ataxia, seizures, and depressed level of consciousness are more common in severely affected patients. People with these severe complications are most likely elderly with medical comorbidities, especially hypertension and other vascular risk factors. However, postinfectious complications are also expected. Neurological disorders as sequelae of influenza viruses have been repeatedly documented in the past and include symptoms, signs, and diseases occurring during the acute phase and, not rarely, during follow-up. Postinfectious neurological complications are the result of the activation of immune mechanisms and can explain the insurgence of immune-mediated diseases, including the Guillain-Barré syndrome and other diseases of the central and peripheral nervous system that in the past occurred as complications of viral infections and occasionally with vaccines. For these reasons, the present outbreak calls for the introduction of surveillance systems to monitor changes in the frequency of several immune-mediated neurological diseases. These changes will determine a reorganization of the measures apt to describe the interaction between the virus, the environment, and the host in areas of different dimensions, from local communities to regions with several millions of inhabitants. The public health system, mainly primary care, needs to be strengthened to ensure that research and development efforts are directed toward right needs and directions. To cope with the present pandemic, better collaboration is required between international organizations along with more research funding, and tools in order to detect, treat, and prevent future epidemics.

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DNA and RNA Viral Infections of the Nervous System

10.1093/med/9780197512166.003.0111 ◽

2021 ◽

pp. 996-1008

Author(s):

Michel Toledano ◽

Allen J. Aksamit Jr

Keyword(s):

Spinal Cord ◽

Nervous System ◽

Nucleic Acid ◽

Peripheral Nervous System ◽

Chronic Infection ◽

Classification Scheme ◽

Viral Infections ◽

Dna And Rna ◽

System P

Viruses may cause acute, subacute, or, rarely, chronic infection of the nervous system. The most common acute syndromes of nervous system infections are meningitis and encephalitis, but viruses can also affect the spinal cord and the peripheral nervous system. Viruses can be classified in many ways. One classification scheme assesses the type of nucleic acid (DNA or RNA), whether it is double or single stranded, its sense, and its method of replication.

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Immunofluorescence characterization of innervation and nerve-immune cell interactions in mouse lymph nodes

European Journal of Histochemistry ◽

10.4081/ejh.2019.3059 ◽

2019 ◽

Vol 63 (4) ◽

Cited By ~ 4

Author(s):

Dailun Hu ◽

Philip K. Nicholls ◽

Melissa Claus ◽

Yongkang Wu ◽

Zhongli Shi ◽

...

Keyword(s):

Nervous System ◽

Lymph Node ◽

Peripheral Nervous System ◽

Lymphoid Tissue ◽

Immune Cell ◽

Cell Interactions ◽

Sensory Nerves ◽

Immunofluorescent Staining ◽

Nerve Fibres ◽

Close Contacts

The peripheral nervous system communicates specifically with the immune system via local interactions. These interactions include the “hardwiring” of sympathetic/parasympathetic (efferent) and sensory nerves (afferent) to primary (e.g., thymus and bone marrow) and secondary (e.g., lymph node, spleen, and gut-associated lymphoid tissue) lymphoid tissue/organs. To gain a better understanding of this bidirectional interaction/crosstalk between the two systems, we have investigated the distribution of nerve fibres and PNS-immune cell associations in situ in the mouse lymph node by using immunofluorescent staining and confocal microscopy/ three-dimensional reconstruction. Our results demonstrate i) the presence of extensive nerve fibres in all compartments (including B cell follicles) in the mouse lymph node; ii) close contacts/associations of nerve fibres with blood vessels (including high endothelial venules) and lymphatic vessels/sinuses; iii) close contacts/associations of nerve fibres with various subsets of dendritic cells (e.g., B220+CD11c+, CD4+CD11c+, CD8a+CD11c+, and Mac1+CD11c+), Mac1+ macrophages, and B/T lymphocytes. Our novel findings concerning the innervation and nerve-immune cell interactions inside the mouse lymph node should greatly facilitate our understanding of the effects that the peripheral nervous system has on cellular- and humoral-mediated immune responses or vice versa in health and disease.

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Peripheral Nervous System Involvement in Sjögren’s Syndrome: Analysis of a Cohort From the Italian Research Group on Sjögren’s Syndrome

Frontiers in Immunology ◽

10.3389/fimmu.2021.615656 ◽

2021 ◽

Vol 12 ◽

Author(s):

Giacomo Cafaro ◽

Carlo Perricone ◽

Francesco Carubbi ◽

Chiara Baldini ◽

Luca Quartuccio ◽

...

Keyword(s):

Nervous System ◽

Peripheral Nervous System ◽

Sjögren’S Syndrome ◽

Sjögren's Syndrome ◽

Sjogren’S Syndrome ◽

Sjogren's Syndrome ◽

Accurate Information ◽

Prognostic Features ◽

Number Of Patients ◽

Sjögren‘S Syndrome

PurposeThe prevalence of peripheral nervous system (PNS) involvement in primary Sjögren’s syndrome (pSS) has been reported to range from 2% to over 50%. Bias in study designs, including low number of patients and unclearly defined rheumatological and neurological diagnosis could explain such variability. Consequently, the exact depiction of PNS involvement in pSS is still lacking. This study aimed at analyzing the prevalence and the clinical and laboratory factors associated with PNS involvement in a very large cohort of well-characterized pSS patients with a clearly defined neurological diagnosis.MethodsClinical and serological data of 1,695 pSS patients with specific and accurate information on PNS involvement were analyzed. Comparisons between patients with and without PNS involvement and between patients with distinct subsets of PNS manifestations were performed.ResultsPrevalence of PNS involvement was 3.7%. The most frequent types observed were pure sensory neuropathies and axonal sensorimotor polyneuropathies (SMP). Patients with PNS involvement exhibited a more active disease profile and were more frequently treated with immunosuppressants. Intriguingly, clinical and serological negative prognostic factors, including purpura, extra-glandular manifestations, leukopenia, low complement and cryoglobulinemia, principally characterized patients with SMP, while subjects with pure sensory neuropathy displayed a milder phenotype.ConclusionOur results highlight that PNS involvement is rather rare, but prognostically relevant in pSS. Main adverse prognostic features characterize patients with SMP, while pure sensory neuropathies are usually associated with a mild clinical picture. These findings, useful for patient stratification, may suggest protean pathogenic pathways underlying different types of PNS manifestations in pSS.

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Stimulating Swallowing: Essential Central and Peripheral Nervous System Targets

ASHA Leader ◽

10.1044/leader.ftr1.16092011.10 ◽

2011 ◽

Vol 16 (9) ◽

pp. 10-13 ◽

Cited By ~ 3

Author(s):

Ianessa A. Humbert

Keyword(s):

Nervous System ◽

Peripheral Nervous System

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Questions and Answers

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2000.marapr02 ◽

2000 ◽

Vol 5 (2) ◽

pp. 3-3

Author(s):

Christopher R. Brigham ◽

James B. Talmage

Keyword(s):

Nervous System ◽

Peripheral Nervous System ◽

Spinal Nerve ◽

Sensory Loss ◽

Residual Symptoms ◽

Additional Information ◽

Questions And Answers ◽

Motor Nerves ◽

Symptoms And Signs ◽

Limited Motion

Abstract Lesions of the peripheral nervous system (PNS), whether due to injury or illness, commonly result in residual symptoms and signs and, hence, permanent impairment. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) describes procedures for rating upper extremity neural deficits in Chapter 3, The Musculoskeletal System, section 3.1k; Chapter 4, The Nervous System, section 4.4 provides additional information and an example. The AMA Guides also divides PNS deficits into sensory and motor and includes pain within the former. The impairment estimates take into account typical manifestations such as limited motion, atrophy, and reflex, trophic, and vasomotor deficits. Lesions of the peripheral nervous system may result in diminished sensation (anesthesia or hypesthesia), abnormal sensation (dysesthesia or paresthesia), or increased sensation (hyperesthesia). Lesions of motor nerves can result in weakness or paralysis of the muscles innervated. Spinal nerve deficits are identified by sensory loss or pain in the dermatome or weakness in the myotome supplied. The steps in estimating brachial plexus impairment are similar to those for spinal and peripheral nerves. Evaluators should take care not to rate the same impairment twice, eg, rating weakness resulting from a peripheral nerve injury and the joss of joint motion due to that weakness.

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