The Evolution and Treatment Options of Patients with Covid-19 and Neurological Manifestations - a Narrative Review

COVID-19 is a multisystem disease with considerable heterogeneity of manifestations, including neurological. Neurological manifestations occur in up to 2/3 of patients in the acute phase and include non-specific, central nervous system and peripheral nervous system disorders. This is potentially explained because the SARS-CoV-2 virus has neuroinvasive properties, either directly by retrograde transport via nerve terminations or hematogenous dissemination, and induces neuroinflammation. The persistence of the SARS-CoV-2 in the nervous tissue for an extended period combined with secondary changes determined by neuroinflammation and hypoxia could be potential explanatory mechanisms for the longCOVID neurological manifestations, which occur even more often than those in the acute phase of COVID-19. Since available specialized therapies against neurological manifestations are still lacking, existing treatment options directed against viral invasiveness, the effects of immune dysregulation and hypercoagulable state, along with supportive measures to combat hypoxia, could serve as an efficient treatment for patients with COVID-19 and neurological manifestations. By preventing the SARS-CoV-2 from affecting the nervous tissue in the acute phase, it could also be possible to avoid longCOVID neurological impairment and probably the potential development of neurodegenerative diseases. Copyright © 2022, Romanian Society for Pharmaceutical Sciences. All rights reserved.

CLINICAL AND PSYCHOLOGICAL IMPACT OF SARS-COV-2 INFECTION IN BURNING-MOUTH SYNDROME PATIENTS: A COMPARATIVE STUDY

Burning mouth syndrome (BMS) is a chronic disease characterized by the presence of persistent oral mucosa pain, mainly burning sensation without any detectable clinical cause or modified general investigations. Coronavims infections, in some patients, caused sensations of oral burning, of a neuropathic nature, which mimicked the symptoms of BMS. In addition, the psychiatric manifestations associated with the COVID-19 pandemic have exacerbated the symptoms of patients already diagnosed with burning mouth syndrome. Based on these observations, we conducted a longitudinal study to assess the changes in depressive and anxiety symptoms in BMS patients during the pandemics. We recruited two groups of age and gender-matched BMS patients. The first group included patients with BMS diagnosed with coronavirus infection and the second one without coronavims infection. The study concluded that in patients with coronavims infection there was an intensification of anxiety-depressive symptoms more pronounced in the first 6 months after infection (duration being associated with the infection severity and long-COVID symptoms), followed by a recurrence or even decrease in symptoms compared to the initial examination Oral symptomatology had a similar evolution, the intensity being determined by the severity of the COVID-19 infection episode and by the prolonged use of antivirals. The lack of a larger number of studies and patients with BMS and COVID-19 infection limited the possibility of comparative analyses.

The COVID-19 Pandemic: a Study on Its Impact on Patients with Dystonia and Related Conditions Treated with Botulinum Toxin in a Tertiary Centre in Romania

Background and Objectives: The COVID-19 pandemic triggered significant delays in the treatment of people with movement disorders who depend on face-to-face clinic encounters for receipt of their regular botulinum toxin injections. Against this background, it was the aim of this study to look into pandemic-related characteristics of patients with dystonia and hemifacial spasm treated with botulinum toxin at a tertiary centre in Romania and identify potential correlations between delays in treatment and health perceptions. Materials and Methods: A cross-sectional, questionnaire-based, study was conducted between May-September 2021 on the 175 patients in the centre’s botulinum toxin database. Results: Of the 90 patients who qualified for inclusion most were late middle-aged females with long-standing dystonia, of which torticollis and blepharospasm were the most common phenotypes. Treatment was delayed by an average of 8.5 months, whereas the overall quality-of-life health score was 61.1, with 60% of respondents rating themselves above 50. No statistically significant correlation was identified between delays in treatment and overall healthscores. Instead, statistically significant differences were uncovered based on type of disorder (dystonia vs. hemifacial spasm). Conclusion: The results of this study may go on to show that, in the event of similar pandemic surges, patient micromanagement by type of disorder may be part of a well-balanced restriction-cum-access health policy. © 2022 Medicina Moderna. All rights reserved.

Beta interferons as immunotherapy in multiple sclerosis: a new outlook on a classic drug during the COVID-19 pandemic.

Beta interferons (IFN-ß) are pleiotropic cytokines with antiviral properties. They play important roles in the pathogenesis of multiple sclerosis (MS), an incurable immune-mediated disorder of the central nervous system. The clinical expression of MS is heterogeneous, with relapses of neuroinflammation and with disability accrual in considerable part unrelated to the attacks. The injectable recombinant IFN-ß preparations are the first approved disease-modifying treatments for MS. They have moderate efficacy in reducing the frequency of relapses, but good long-term cost-efficacy and safety profiles, so are still widely used. They have some tolerability and adherence issues, partly mitigated in recent years by the introduction of a PEGylated formulation and use of 'smart' autoinjector devices. Their general impact on long-term disability is modest but could be further improved by developing accurate tools for identifying the patient profile of best responders to IFN-ß. Here, we present the IFN-ß-based immunomodulatory therapeutic approaches in MS, highlighting their place in the current coronavirus disease (COVID-19) pandemic. The potential role of IFN-ß in the treatment of COVID-19 is also briefly discussed.

Influence of tocilizumab on the outcome of patients with covid-19. Retrospective observational study

Cytokine storm seems to be one of the main culprits for developing a severe form of COVID-19, IL-6 being one of its basic components. Therefore, currently, tocilizumab is widely studied as a powerful treatment in patients with severe forms of COVID-19. Our aim was to determine whether it could potentiate a favourable outcome in such patients. We conducted a retrospective observational study including all consecutive admitted patients with confirmed SARS-CoV-2 infection that received treatment with tocilizumab in the period between 01.05-23.08.2020 in Matei Bals National Institute for Infectious Diseases and Neurology Department of the Colentina Clinical Hospital in Bucharest, Romania. 22 patients were enrolled with a severe form of COVID-19, predominantly women, with an average age of of 61.72 ± 14.5 years. The fatality rate was 31.81%. It was observed that following tocilizumab administration, patients presented improvement in the majority of the studied parameters, statistically significant in the case of fibrinogen, C reactive protein and blood oxygen level (p < 0.05). Tocilizumab might be regarded as a valuable drug in the management of severe SARS-CoV-2 infection. © 2020, Romanian Society for Pharmaceutical Sciences. All rights reserved.

Treatment with hydroxychloroquine in patients with covid-19. Experience of a neurology department

The novel coronavirus has generated the Coronavirus Disease 2019 (COVID-19) pandemic, which has become the new challenge for the healthcare systems, since there is no etiological treatment and the infectiousness of SARS-CoV2 is exceeding the expectations. Therefore, various treatments have been tried in an attempt to stop the spread of the virus and to enhance the early recovery of the patients. Hydroxychloroquine, an antimalarial drug used for decades, has been one of the first drugs tried to reduce the infectivity of the virus. First data were promising, but afterwards, adverse events and long-term evolution of patients outweighed the potential benefits, and its utility was questioned. In this article we are reviewing literature regarding the use of Hydroxychloroquine during the COVID-19 pandemic and we present the experience of its use in the Neurology Department in Colentina Clinical Hospital, Bucharest, Romania.