ABSTRACT
Background: Case study: Conclusion(s): The purpose of the study was twofold: (1) to present post-COVID-19 syndrome, which involves a variety of ongoing neurological, neuropsychiatric, neurocognitive, emotional and behavioral disorders resulting from SARS-CoV-2 infection followed by a severe course of COVID-19 treated in long term pharmacologically induced coma in a visual artist, which impacted on her artwork;(2) to present QEEG/ERP results and neuropsychological testing results in the evaluation of the effectiveness of a comprehensive neurotherapy program, with individualized EEG-Neurofeedback, and art-therapy in the reduction of post-COVID-19 syndrome in this artist. Ms. G., 42, a visual artist, portraitist, with good health, became ill in May 2022. Allegedly flu symptoms appeared first. After a few days, shortness of breath joined in. The PCR test for SARS-CoV-2 was positive. The patient was hospitalized, referred to the ICU, put on a respirator and treated over 11days of a pharmacologically induced coma. Two months after leaving hospital the patient developed post-COVID-19 syndrome. She was diagnosed by an interdisciplinary team: a neurologist, neuropsychiatrist and neuropsychologist. A PET scan of her brain revealed extensive changes involving a loss of metabolism in various brain areas. The presence of complex post-COVID, neurological, neuropsychiatric, neurocognitive, emotional and behavioral disorders was found and a neuropsychiatrist suggested a diagnosis of post-COVID schizophrenia. She was refered to the Reintegration and Training Center of the Polish Neuropsychological Society.We tested the working hypothesis as to the presence of schizophrenia and there was no reduction in the difference of ERPs waves under GO/NOGO task conditions, like in the reference group with schizophrenia (see also Pachalska, Kaczmarek and Kropotov 2021). The absence of a functional neuromarker for schizophrenia allowed us to exclude this diagnosis and to propose a new disease entity, that being post-COVID-19 syndrome. She received a comprehensive two-component program of neurotherapy: (1) program A consisting in goal-oriented neuropsychological rehabilitation, including art therapy (see also: Pachalska 2008;2022b), and (2) program B, based on the most commonly used form of EEG-Neurofeedback: frequency/ power EEG-Neurofeedback, using 2 bipolar surface electrodes, with the protocols written for her specific needs (see also Thompson & Thompson 2012;Kropotov 2016). The comprehensive neurotherapy program lasted 10 weeks, EEG Neurofeedback and art therapy classes were conducted 3 times a week for 45 minutes each. We found that after the completion of the comprehensive neurotherapy program there was a statistically significant reduction in high beta activity compared to the normative HBI database, which is associated with a reduction of anxiety. Also, we observed the improvement of neurocognitive functioning in neuropsychological testing (a significant reduction of anxiety and a noticeable improvement in neurocognitive functions). It should be stressed that the artist was happy that she had regained the ability to create, and even sells her artwork, although her style of painting had changed. Almost all the neurological, psychiatric, neurocognitive, emotional and behavioral disturbances, were reduced in their severity. The artist showed marked improvement and was able to return to painting. The artwork she produced after her illness is in high demand with art collectors. It can be also helpful in the reintegration of the Self System, and the improvement in her quality of life. Human Brain Index (HBI) methodology might be very useful in diagnosing and developing therapies for patients with post-COVID-19 syndrome.Copyright © 2023, MEDSPORTPRESS Publishing House. All rights reserved.
ABSTRACT
The purpose of the study was twofold: 1) to evaluate the effectiveness of goal-oriented neuropsychological rehabilitation, with EEG-Neurofeedback, devel-oped for a visual artist with PTSD resulting from infection with SARS-CoV-2, followed by a severe course of neuroCovid and sequelae of long term phar-macological coma, 2) to evaluate QEEG/ERP results showing a reduction of late-onset PTSD symptoms (as defined by DSM-5) over the course of the sub-ject's rehabilitation. The present study describes a 67-year-old right-handed visual artist with PTSD after infection with SARS-CoV-2, resulting in severe course of COVID-19 com-plicated by acute respiratory distress syndrome (ARDS). She was referred to the ICU, put on a respirator and treated during 13 weeks of pharmacologically induced coma. After returning home she received rehabilitation to improve motor functioning, and was referred for further diagnosis and therapy to the Reintegration and Training Center of the Polish Neuropsychological Society. In neuropsychological diagnosis she presented with neurocognitive dysfunc-tions, including lost ability to paint. In the course of rehabilitation she received a program of rehabilitation with two components: 1. Program A, consisting in goal-oriented neuropsychological rehabilitation, including art therapy, aimed at the reduction of the neurocognitive dysfunctions (Pąchalska 2008). This program lasted for 9 months (from the beginning of March till the end of November 2022). 2. Program B, based on the most commonly used form of EEG-Neurofeed-back: frequency/ power EEG-Neurofeedback, using 2 bipolar surface elec-trodes, called "surface neurofeedback” (Kropotov 2016). She received Theta/ Beta, SMR training, including (1) at C3, strengthening Beta1 and inhibiting Theta + inhibiting Beta 2,and (2) at C4, strengthening SMR and inhibiting Theta + inhibiting Beta, based on the international 10-20 system (Thompson & Thompson 2012). This program was given after a diagnosis of PTSD with late onset (as defined by DSM-5), from the beginning of August till the end of No-vember, twice a week. Almost all the short and the long-term side effects of neuroCOVID (including the PTSD) were reduced in severity. The artist showed marked improvement and was able to return to painting. The artwork she made after her illness is in high demand with art collectors, which has improved the patient's quality of life. Goal-oriented neuropsychological rehabilitation, with art therapy, supported with EEG-Neurofeedback administered for a visual artist with PTSD with de-layed onset (as defined by DSM-5) resulting from infection with SARS-CoV-2, followed by severe neuroCovid symptoms and the sequelae of long-term phar-macologically-induced coma, canbe helpful in the reduction of short term side effects, such as neurocognitive dysfunctions (attention, memory, dysexecutive symptoms) and long-term side effects, such as various physical and mental symptoms, including PTSD. It can be also helpful in the reintegration of the Self System. © 2022, MEDSPORTPRESS Publishing House. All rights reserved.
ABSTRACT
Background: There is growing evidence to support the view that a variety of neurologi-cal, neurocognitive and neuropsychiatric sequelae occur following SARS-CoV-2 infection and NeuroCovid 19. Furthermore, scholars report that various syndromes, including Parkinson's disease (PD), can develop within a short period of time following on from COVID-19. Although the mechanism of this phenomenon is not fully understood and it is not known whether this is in fact an acceleration of the development of PD already 'smouldering' in the body or related to a viral infection, these patients need rehabilitation assistance. Recently, as adjuvant therapy, transcranial direct current stimulation (tDCS) has been shown to improve the motor and non-motor function of patients with Parkinson's disease (PD), including neurocogni-tive impairment and therefore potentially change their quality of life. The aim of this article is to show the effectiveness of tDCS in the treatment of the patient with newly diagnosed Parkinson's disease after infection with the SARS-CoV-2 virus and the contracting of NeuroCovid 19, and equally developing long COVID. The motivation would be to help other patients with a similar situation during the COVID-19 pandemic. Case study: A 62-year-old man, an academic Art Teacher, was infected with SARS-CoV-2 and contracted NeuroCOVID-19 on November 11, 2021. Initially, he lost his sense of smell (anosmia), of taste (ageusia), developed hea-daches, and dizziness. After 10 days of illness, the patient developed se-vere, level two infextion (according to Wise 2020), and he was hospitalized, sedated and mechanically ventilated for 30 days. After discharge from hos-pital, the patient was still weak with different symptoms. Four months later he was diagnosed with long COVID and also the neurodegenerative disease PD (according to the DSM-5 criteria). He received levodopa the-rapy, and was referred to the Reintegration and Training Center of the Polish Neuropsychological Society for further treatment. The functional neuromar-ker, that is hypoactivation of the left dorsolateral prefrontal cortex (DLPFC), obtained with the use of QEEG/ERPs was helpful in choosing the approp-riate tDCS protocol. Neurostimulation with the use of anodal tDCS over these area of the brain was administered systematically for 20 days. He also received individual sessions of art therapy for 20 day. After the treatment the patient improved and returned to his previous work as a university art tea-cher. The proposed anodal tDCS over the left dorsolateral prefrontal cortex (DLPFC), in combination with goal-oriented individual art therapy, offered to the patient, was effective in the reduction of all his syndromes. Conclusions: ERPs can be useful in the diagnosis and treatment of patients following infection by SARS-CoV-2 who contracted COVID-19, developed long COVID and additionally PD. It allows for the detection of the functional neuromarker of PD (e.g., hypoactivation of the dorsolateral prefrontal cortex, DLPFC) and enabled the choosing of a proper tDCS protocol with the anode over these region of the brain, and also the selection of effective neurostimulation. The proposed protocol of tDCS tailored by the neuromarker offered to our patient, was effective in the reduction of longCOVID symptoms as well as early PD symptoms.