Neurological aspects of COVID-19

The coronavirus disease COVID-19 began to spread worldwide in December 2019 from the city of Wuhan (China). COVID-19 is often accompanied by fever, hypoxemic respiratory failure and systemic complications (for example, gastrointestinal, renal, cardiac, neurological, and hepatic lesions), thrombotic phenomena. Central nervous system damage is caused by the primary effect on it, direct neuroinvasion of the virus, and more often by secondary effect due to systemic hyperinflammation. Neurological manifestations include fatigue, headache, insomnia, and olfactory/taste disorders. Neurological manifestations and complications of COVID-19 are diverse: (1) cerebral circulatory disorders, including ischemic stroke and macro/microhemorrhages; (2) encephalopathy; (3) para/postinfectious autoimmune complications, such as GuillainBarre syndrome; (4) meningoencephalitis; (5) neuropsychiatric complications (psychosis and mood disorders). In terms of pathogenesis, neurological disorders in COVID-19 can be caused by neurotropicity and neurovirulence of SARS-CoV-2, cytokine storm, hypoxemia, homeostasis disorders, as well as their combined effects. COVID-19 adversely affects the course and prognosis of chronic neurological disorders in comorbid patients. The review highlights the need for vigilance to early neurological complications in patients infected with SARS-CoV-2 and other coronaviruses, especially since some neurological complications may precede respiratory manifestations.

Post Covid-19 Complications: A New Dimension of Awareness for Healthcare Workers

Novel Coronavirus (COVID-19), a highly infectious disease, is currently affecting whole of globe with no region untouched. This Public health emergency is one of the leading causes of mortality in many of the regions of the world. Although many patients are recovering from this illness, the concern regarding Post COVID-19 complications still prevails. Various follow up studies have reported Lung fibrosis, ARDS, cardiovascular diseases, neurological and neuropsychiatric complications, multiorgan damage, and gastrointestinal complications among recovered COVID-19 patients. Thus, this evidence-based review was done focussing on published articles from the Medline, CINAHL, Social Sciences Citation Index, Psych INFO, a hand search through selected published journals and from references lists. This article provides information regarding complications experienced by recovered COVID-19 patients after being discharged from hospital, affecting their quality of life.

Homoeopathy in the Treatment of Post-Stroke Complications: A Case Report

Background Long-term muscular and neuropsychiatric complications are common in stroke survivors. The main aim of therapeutic modalities for such cases is to limit the extent of disabilities and subsequent increase in the activity of daily living. Every case is different in pathology and manifestation, so requires an individualistic approach. Case A 63-year-old man presented with right upper limb weakness, dysarthria and memory weakness after stroke. He had been undergoing conventional physical rehabilitation therapy but due to feasibility issues, he could not continue and opted for homoeopathic treatment. Following a thorough clinical and psychological evaluation, he was treated with homoeopathic medicines tailored to his specific needs. The Medical Research Council scale for muscle power, the Modified Ashworth Scale for muscle spasticity and the Stroke Impact Scale for quality of life after stroke were used to assess outcomes at various time points. Different physical and cognitive domains showed gradual improvement. Conclusion This case demonstrates the complexities of clinical outcomes following a stroke and how those can be improved through the individualistic approach of homoeopathy. Nevertheless, a firm conclusion regarding causal attribution cannot be drawn from a single case, but a detailed clinical approach may be followed. Large-sample randomised controlled trials are impractical for the individualised approach of therapy or complex clinical conditions; thus, the ‘n-of-1’ trial may be adopted in the long run.

Lithium neurotoxicity with electroencephalogram changes

Lithium is a medication with a variety of medical usage for various diseases including bipolar mood disorder. As the therapeutic window of lithium is narrow, its usage is commonly associated with toxicity. Lithium toxicity affects multiple systems especially the central nervous system, leading to neuropsychiatric complications. Haemodialysis is an effective method for lithium removal especially in severe lithium toxicity such as neurotoxicity with electroencephalogram changes. We describe a case of lithium neurotoxicity with electroencephalographic abnormalities which was reversed following haemodialysis.

Green tea might be effective in alleviating COVID-19 associated psychiatric complications: preliminary results from a pilot randomized controlled trial

Purpose It is argued that COVID-19 patients show various neuropsychiatric symptoms, including fatigue, depression and anxiety. On the other hand, epidemiological and experimental evidence indicated that green tea could potentially have antiviral effects and ameliorate psychiatric disorders. However, there is a lack of clinical evidence. The purpose of this study was to investigate whether drinking green tea can clinically improve psychiatric complications of COVID-19 infection. Design/methodology/approach This study included 40 patients with laboratory confirmed mild-to-moderate COVID-19 disorder in the current randomized open-label controlled trial. Patients were instructed to include three cups/day of green tea (intervention) or black tea (control) to their usual diet for four weeks immediately after diagnosis of the disease. At the study baseline and after the intervention, the enrolled patients’ fatigue, depression and anxiety were assessed by the Chalder Fatigue Scale, Beck Depression Inventory-Fast Screen and State-Trait Anxiety Inventory questionnaires. Findings A total of 19 COVID-19 cases in the intervention group (mean age = 52 years) and 14 cases (mean age = 50 years) in the control group completed the study. Analysis of covariance adjusted for baseline levels, and confounders revealed that those who consumed three cups/day of green tea compared to the patients who received black tea experienced significantly lower fatigue, depression and state and trait anxiety levels (adjusted means for fatigue = 12.3 vs 16.2 (P = 0.03), depression = 0.53 vs 1.8 (P = 0.01), 37.4 vs 45.5 (P < 0.01) and 37.9 vs 45.2 (P < 0.01)). Research limitations/implications The open-label design may bias the evaluation of the self-reported status of fatigue, depression or anxiety as the main outcomes assessed. Moreover, as this study did not include patients with severe COVID-19, this might affect the generalizability of the present results. Thus, the recommendation of daily drinking green tea may be limited to the subjects diagnosed with mild-to-moderate type of infection or those with long-term neuropsychiatric complications owing to COVID-19. Besides, considering the ethical issues, this study could not exclude the drug therapy’s confounding effects; thereby, this point should be considered when interpreting the current results. Besides, it is worth noting that Guilan province in the north of Iran is recognized as a tea (and particularly green tea) producing region; thereby, it is an available and relatively inexpensive product. Considering this issue, the recommendation to consume this medicinal plant in adjunct to the routine treatment approach among patients with mild-to-moderate COVID-19 based on its beneficial effects may be widely accepted. Practical implications Green tea consumption could be considered an option to combat COVID-19 associated psychological complications, including fatigue, depression and anxiety among patients suffering from mild-to-moderate type of this viral infection. Originality/value To the best of the authors’ knowledge, in this study, for the first time, the effects of green tea compared to black tea on COVID-19 associated fatigue, depression and anxiety status within an open-label controlled trial have been investigated.

Reliability of multi-modal MRI-derived brain phenotypes for multi-site assessment of neuropsychiatric complications of SARS-CoV-2 infection

Background: Magnetic resonance imaging (MRI) of the brain could be a key diagnostic and research tool for understanding the neuropsychiatric complications of COVID-19. For maximum impact, multi-modal MRI protocols will be needed to measure the effects of SARS-CoV2 infection on the brain by diverse potentially pathogenic mechanisms, and with high reliability across multiple sites and scanner manufacturers. Methods: A multi-modal brain MRI protocol comprising sequences for T1-weighted MRI, T2-FLAIR, diffusion MRI (dMRI), resting-state functional MRI (fMRI), susceptibility-weighted imaging (swMRI) and arterial spin labelling (ASL) was defined in close approximation to prior UK Biobank (UKB) and C-MORE protocols for Siemens 3T systems. We iteratively defined a comparable set of sequences for General Electric (GE) 3T systems. To assess multi-site feasibility and between-site variability of this protocol, N=8 healthy participants were each scanned at 4 UK sites: 3 using Siemens PRISMA scanners (Cambridge, Liverpool, Oxford) and 1 using a GE scanner (Kings College London). Over 2,000 Imaging Derived Phenotypes (IDPs) measuring both data quality and regional image properties of interest were automatically estimated by customised UKB image processing pipelines. Components of variance and intra-class correlations were estimated for each IDP by linear mixed effects models and benchmarked by comparison to repeated measurements of the same IDPs from UKB participants. Results: Intra-class correlations for many IDPs indicated good-to-excellent between-site reliability. First considering only data from the Siemens sites, between-site reliability generally matched the high levels of test-retest reliability of the same IDPs estimated in repeated, within-site, within-subject scans from UK Biobank. Inclusion of the GE site resulted in good-to-excellent reliability for many IDPs, but there were significant between-site differences in mean and scaling, and reduced ICCs, for some classes of IDP, especially T1 contrast and some dMRI-derived measures. We also identified high reliability of quantitative susceptibility mapping (QSM) IDPs derived from swMRI images, multi-network ICA-based IDPs from resting-state fMRI, and olfactory bulb structure IDPs from T1, T2-FLAIR and dMRI data. Conclusion: These results give confidence that large, multi-site MRI datasets can be collected reliably at different sites across the diverse range of MRI modalities and IDPs that could be mechanistically informative in COVID brain research. We discuss limitations of the study and strategies for further harmonization of data collected from sites using scanners supplied by different manufacturers. These protocols have already been adopted for MRI assessments of post-COVID patients in the UK as part of the COVID-CNS consortium.

Combined therapy with Medotilin/Elfunat for the prevention and treatment of neuropsychiatric complications after open-heart surgery

After open-heart surgery, postoperative neuropsychiatric complications often develop: stroke — in 4.8 % of cases, diffuse encephalopathy — in 12 %, behavior changes — in 5–40 %, cognitive impairment — in 12–79 %, mental disorders — in 13–64 %. The causes of their development are acetylcholine deficiency with subsequent dysfunction of the cholinergic system and oxidative stress, which result from hypoxia, hypoperfusion, and a systemic inflammatory reaction. In this regard, the appointment of drugs that restore the acetylcholine synthesis – choline alfoscerate (Medotilin), and drugs that suppress oxidative stress – mexidol (Elfunate) is considered a promising direction for the prevention and treatment of neuropsychiatric complications. The study conducted on the basis of the regional cardiac surgery center of the Odessa Regional Hospital demonstrated that the combined use of Medotilin and Elfunate can reduce the frequency of neuropsychiatric complications, as well as reduce the duration of treatment in the hospital.

The neuropsychiatric effects of nitrous oxide and low vitamin B12

SUMMARY This narrative review article aims to update knowledge on the neuropsychiatric complications of nitrous oxide use and low vitamin B12. We consider common forms and uses of nitrous oxide (N2O) and review its mechanism of action, and then explore the potential impacts of use. In particular, neuropsychiatric effects mediated by low vitamin B12 are considered and the correct interpretation of laboratory results explored. This is of particular importance as where vitamin B12 is inactivated by chronic nitrous oxide use, blood test levels of vitamin B12 may not reflect the quantity of functional B12 in patients.