ABSTRACT
Introduction: Since the beginning of the pandemic caused by SARS-Cov-2, we have observed an increase of patients referred for electroneuromyography (ENMG) studies complaining of neuropathic symptoms, and who share in common having suffered from the disease by coronavirus (Covid-19), in its different forms of presentation. Clinical, diagnostic, and epidemiological studies that identify possible risk factors of peripheral neuropathies are needed. Method(s): Retrospective and prospective multicenter study in which neurophysiologists from 10 Andalusian hospitals are currently participating. The risk factors analyzed are age, sex, date of infection, date of onset symptoms in relation to Covid infection, hospital admission, admission to intensive unit care (IUC), time of admission, prone position, if orotracheal intubation needed, body mass index (BMI), personal history of interest, if previously vaccinated and complications. The observed peripheral nervous system involvement, caused both directly and indirectly by the virus, has been taken into account. Result(s): A total of 73 patients with neuropathic involvement. Of this total, 39 polyneuropathies (11 Guillain-Barre syndrome, 1 small fiber and 27 other critical illness polyneuropathies associated with IUC patients, 1 of these with associated myopathy), 13 peroneal neuropathies (4 unilateral, 1 with suprascapular neuropathy concomitant and 7 bilateral), 7 brachial plexopathies, 5 neuropathies of the superior laryngeal nerve (3 with concomitant involvement of the inferior) in patients with a history of orotracheal intubation, 2 neuropathies of the femorocutaneous nerve, 2 mononeuritis multiplex, 2 phrenic neuropathies, 1 vagus nerve neuropathy with no history of orotracheal intubation, 2 axillary neuropathies (1 with associated spinal neuropathy). Conclusion(s): Covid-19 causes involvement of the peripheral nervous system. Possible risk factors include male gender, old age, longer hospital stay, IUC admission, orotracheal intubation, prone position, suffering from previous pathologies, and high BMI. The possible causes that we consider for neuropathic involvement are compressive and positional (more indirectly related to the disease) and inflammatory / immune-mediated as the most direct cause of involvement caused by the SARS-Cov-2 virus. Knowledge of the risk factors is important, for the prevention, early diagnosis, and the correct treatment of these neuropathies. Some patients are left with serious neurological sequelae, with the consequences that this entails (high social and economic costs). Copyright © 2022
ABSTRACT
At the end of January, the current outbreak of COVID-19 coronavirus disease was declared an important international public health emergency. In Spain, since the government declared the state of alarm on 14 March 2020, doctors responsible for carrying out neurophysiological tests have been performing them without any consensus criterion or clear safety guidelines for doctors, technicians or patients. The following recommendations, based on current knowledge of the disease and therefore liable to change in the future, are proposed when the pandemic appears to have entered a process of decreasing virulence and, with it, the strict containment measures established to date. However, in view of the possibility of a second wave of the pandemic, it seems necessary to establish basic and minimum recommendations to respect the patient's right to appropriate care, similar to that provided prior to the pandemic, and to maintain minimum safety standards for the patients themselves and for the doctors, technicians and health personnel carrying out these tests. These recommendations concern the constitution of a priority based on the reason for consultation, the establishment of calls to check the patient's clinical situation before going to the outpatient department and the rules for carrying out neurophysiological tests, which are generally based on the preservation of hospital circuits, respect for and observation of the known barriers to contagion of this disease, and the use of disposable material. These recommendations are of particular interest, especially given the uncertainty of not knowing the evolution of the SARS-CoV-2 infection in the coming weeks or months.
TITLE: Recomendaciones sobre estudios neurofisiológicos en tiempos de pandemia de COVID-19.A finales de enero, la Organización Mundial de la Salud declaró el brote actual de la enfermedad por coronavirus COVID-19 como emergencia de salud pública de importancia internacional. En España, desde que el 14 de marzo de 2020 el Gobierno decretase el estado de alarma, los médicos encargados de las pruebas neurofisiológicas las hemos estado realizando sin tener un criterio consensuado ni unas pautas adecuadas de seguridad claras para los facultativos, los técnicos ni los pacientes. Las siguientes recomendaciones, basadas en el actual conocimiento de la enfermedad y, por tanto, susceptibles de variaciones en el futuro, se proponen cuando la pandemia parece que ha entrado en un proceso de disminución de la virulencia y, con ello, las medidas estrictas de confinamiento hasta ahora mantenidas; sin embargo, ante la posibilidad de una segunda oleada de rebrotes de la pandemia, parece necesario establecer unas recomendaciones básicas y de mínimos para respetar el derecho del paciente a una atención adecuada, similar a la previa a la pandemia, y mantener unos mínimos de seguridad para los propios pacientes y los médicos, técnicos y personal sanitario que realizan estas pruebas. Se trata de recomendaciones sobre el establecimiento de una prioridad basándose en el motivo de consulta, el establecimiento de llamadas de comprobación de la situación clínica del paciente antes de acudir a la consulta externa y las normas de ejecución de las pruebas neurofisiológicas, que se basan, en general, en la preservación de circuitos hospitalarios, el respeto y el cuidado de las barreras de contagio conocidas de esta enfermedad, y la utilización de material desechable. Estas recomendaciones son de especial interés, sobre todo por la incertidumbre de no saber la evolución de la infección por el SARS-CoV-2 en las próximas semanas o meses.