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1.
Front Neurol ; 13: 902502, 2022.
Article in English | MEDLINE | ID: covidwho-1952458

ABSTRACT

Objectives: Fatigue is a frequent and often disabling symptom in patients with post-COVID syndrome. To better understand and evaluate the symptom of motor fatigue in the context of the post-COVID syndrome, we conducted treadmill walking tests to detect the phenomenon of motor fatigability or to evaluate whether evidence of organic lesions of the motor system could be found, similar to patients with multiple sclerosis. Method: Twenty-nine non-hospitalized patients with post-COVID syndrome completed the Fatigue Scale for Motor and Cognitive Function (FSMC) questionnaire to determine the trait component of subjective fatigue before they were tested on a treadmill walking at a moderate speed for up to 60 min or until exhaustion. During the walking test oxygen uptake, ventilation and acceleration data of both feet were collected. To determine motor performance fatigability, the Fatigue Index Kliniken Schmieder (FKS) was calculated using the attractor method. Results: The average walking duration was 42.7 ± 18.6 min with 15 subjects stopping the walking test prematurely. The FSMC score revealed a severe cognitive (37.6 ± 8.2) and motor (37.1 ± 7.8) fatigue averaged over all subjects but only two subjects showed an FKS above the normal range (>4), representing performance fatigability. There was no significant correlation between subjective fatigue (FSMC) and FKS as well as walking time. Absolute values of oxygen uptake and ventilation were in the normal range reported in literature (r = 0.9, p < 0.05), although eight subjects did not produce a steady-state behavior. Conclusion: Almost all patients with post-COVID syndrome and subjectively severe motor fatigue, did not show motor fatigability nor severe metabolic anomalies. This is argued against organic, permanent damage to the motor system, as is often seen in MS. Many of the patients were - to our and their own surprise - motorically more exertable than expected.

2.
Front Aging ; 2: 648567, 2021.
Article in English | MEDLINE | ID: covidwho-1933920

ABSTRACT

One year after the start of the COVID-19 pandemic, its secondary impacts can be globally observed. Some of them result from physical distancing and severe social contact restrictions by policies still imposed to stop the fast spread of new variants of this infectious disease. People with Alzheimer's disease (AD) and other dementias can also be significantly affected by the reduction of their activity programs, the loss of partners, and social isolation. Searching for the closest translational scenario, the increased mortality rates in male 3xTg-AD mice modeling advanced stages of the disease can provide a scenario of "naturalistic isolation." Our most recent work has shown its impact worsening AD-cognitive and emotional profiles, AD-brain asymmetry, and eliciting hyperactivity and bizarre behaviors. Here, we further investigated the psychomotor function through six different psychomotor analysis in a set of 13-month-old 3xTg-AD mice and their non-transgenic counterparts with normal aging. The subgroup of male 3xTg-AD mice that lost their partners lived alone for the last 2-3 months after 10 months of social life. AD's functional limitations were shown as increased physical frailty phenotype, poor or deficient psychomotor performance, including bizarre behavior, in variables involving information processing and decision-making (exploratory activity and spontaneous gait), that worsened with isolation. Paradoxical muscular strength and better motor performance (endurance and learning) was shown in variables related to physical work and found enhanced by isolation, in agreement with the hyperactivity and the appearance of bizarre behaviors previously reported. Despite the isolation, a delayed appearance of motor deficits related to physical resistance and tolerance to exercise was found in the 3xTg-AD mice, probably because of the interplay of hyperactivity and mortality/survivor bias. The translation of these results to the clinical setting offers a guide to generate flexible and personalized rehabilitation strategies adaptable to the restrictions of the COVID-19 pandemic.

3.
Front Aging Neurosci ; 14: 921081, 2022.
Article in English | MEDLINE | ID: covidwho-1933725

ABSTRACT

Background: Freezing of gait (FOG) is a common clinical manifestation of Parkinson's disease (PD), mostly occurring in the intermediate and advanced stages. FOG is likely to cause patients to fall, resulting in fractures, disabilities and even death. Currently, the pathogenesis of FOG is unclear, and FOG detection and screening methods have various defects, including subjectivity, inconvenience, and high cost. Due to limited public healthcare and transportation resources during the COVID-19 pandemic, there are greater inconveniences for PD patients who need diagnosis and treatment. Objective: A method was established to automatically recognize FOG in PD patients through videos taken by mobile phone, which is time-saving, labor-saving, and low-cost for daily use, which may overcome the above defects. In the future, PD patients can undergo FOG assessment at any time in the home rather than in the hospital. Methods: In this study, motion features were extracted from timed up and go (TUG) test and the narrow TUG (Narrow) test videos of 50 FOG-PD subjects through a machine learning method; then a motion recognition model to distinguish between walking and turning stages and a model to recognize FOG in these stages were constructed using the XGBoost algorithm. Finally, we combined these three models to form a multi-stage FOG recognition model. Results: We adopted the leave-one-subject-out (LOSO) method to evaluate model performance, and the multi-stage FOG recognition model achieved a sensitivity of 87.5% sensitivity and a specificity of 79.82%. Conclusion: A method to realize remote PD patient FOG recognition based on mobile phone video is presented in this paper. This method is convenient with high recognition accuracy and can be used to rapidly evaluate FOG in the home environment and remotely manage FOG-PD, or screen patients in large-scale communities.

4.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927834

ABSTRACT

A 27- year-old previously healthy man presented to the emergency department with a 3-day history of confusion, urinary retention, cough, slurred speech, intermittent vertigo, and unsteady gait after being started on outpatient abx for diagnosis of community acquired pneumonia at an outside facility. On presentation, his vital signs were significant for a Temp. of 102.4 F, a HR of 118 bpm, a RR of 22 bpm, a BP of 135/75 mmHg, O2 sats down to the 80s% with a new oxygen requirement of 3 L/min. His neurological exam was remarkable for dysarthria, a wide based and unsteady gait, forward drift on standing, bilateral dysmetria and was otherwise non-focal. Bilateral basilar rales were noted on lung exam. Initial workup was significant for a sodium level of 129, potassium 3.1, AST 178, ALT 31. His urine legionella antigen test was positive and COVID-19 PCR test was negative. CT of the chest demonstrated multifocal pneumonia. The predominant neurological picture on presentation warranted a lumbar puncture as well as an MRI of the brain, both of which came back negative. HIV test was negative as well. The spectrum of neurological manifestations of legionnaire's disease is quite wide ranging from simple headaches to acute disseminated encephalomyelitis (ADEM). While up to 40% of patients may present with headaches and some confusion, the specific cerebellar presentation is quite rare and has been described in case reports. According to Shelburne(1), there has been instances where the neurological manifestations have lasted up to 3 years after resolution of the pulmonary disease. In a review article detailing 29 cases of cerebellar dysfunction in Legionnaire's disease, a lumbar puncture performed in 16 of the cases showed that the majority had no abnormalities in CSF studies. The propensity for Legionella to specifically manifest as cerebellar Sx remains to be studied. Interestingly, another case report of two patients with neurological symptoms, showed hypoperfusion of the cerebellar and frontal lobes on single photon emission while CT and MRI imaging of the brain were normal. We add to the literature another 'cerebellar' presentation of Legionnaire's disease.

5.
Movement Disorders Clinical Practice ; 9(SUPPL 1):S42, 2022.
Article in English | EMBASE | ID: covidwho-1925964

ABSTRACT

Objective: Alexander technique (AT) is a cognitive embodiment approach applied during daily life. We tested the feasibility and potential of online AT-based group courses for people living with PD (PwP) and included care partners to enhance dyadic relationship and retention of benefits. Background: An RCT showed that 1:1 AT sessions reduced motor symptoms in PwP with retention of benefits at 6 months [1-2]. Recent data suggest in-person AT-based group courses also hold promise. The COVID-19 pandemic gave an opportunity to test synchronous online AT-based courses. Methods: Design: Uncontrolled feasibility trial;3 groups met for 105 min, twice/wk, for 8 or 9 wks. Participants: 16 PwP and 14 care partners began the course. Intervention: Courses were delivered in-home via Zoom. Coursework included functional anatomy and self-management strategies via verbal instruction, anatomical models and images, demonstration, and activities. AT principles were embedded in everyday acts such as gait, sit-to-stand, speech, and IADLs. Review handouts and session recordings were provided. Outcome Measures: Functional reach, one-leg stance, TUG, 7-item Physical Performance Test, symptommanagement self-report, anonymous course evaluations, posture photos, audio interviews. Results: 94% of PwP completed the course (c.f. 65% for in-person course). Average course attendance by PwP was 86% (c.f. 91% in-person). PwP improved functional reach (p = .03) and simulated eating (p = .06). Subjectively, PWP reported improved physical self-control and ability to manage falls, shuffling gait, upright posture, garbled speech, and anxiety (all p < .05). On a 0-10 scale, evaluations averaged >9 for novelty of ideas and practicality of tools for physical symptom-management and for care partners' likelihood to remember and use what they had learned, and > 8.5 for everyone feeling better prepared to meet the daily demands of living with PD. Conclusion: AT training shows promise to improve selfmanagement of PD motor and non-motor symptoms. Online classes can increase accessibility and retention for PwP and their care partners. Larger RCTs are needed to statistically verify improvement, optimize delivery, compare to other approaches, and investigate AT combined with exercise. Six-month follow-up data are being collected for presentation, along with subjective data from care partners about their partners' symptom management.

6.
Movement Disorders Clinical Practice ; 9(SUPPL 1):S39, 2022.
Article in English | EMBASE | ID: covidwho-1925961

ABSTRACT

Objective: We aimed to assess whether SARS-CoV2 vaccines have any positive or negative impact on motor symptoms in PD patients. Background: Studies focusing on the relationship between SARSCoV- 2, COVID-19 and PD have provided conflicting results (1). Recently, few cases of severe dyskinesia after receiving BNT162b2 mRNA vaccine have been reported but there is no data about impact of vaccines on motor symptoms in larger series of PD patients (2). Methods: We reviewed the charts of the last two months of consecutive PD patients who were attended monthly by telemedicine during the pandemic and who had received one or two doses of any of the SARSCoV- 2 vaccines available in Peru (BNT162b2, Pfizer/BioNTech and BBIBP-CorV, Sinopharm). We specifically searched for any reported variation on motor symptoms including dyskinesia during a period of at least three days after any of each dose. Results: One hundred eighty-one PD patients met inclusion criteria. 107 males and 74 females were included. Mean age was 65 years old (range 31-99). 178 patients received two doses of SARSCoV2 vaccine (177 Pfizer/BioNTech and 1 Sinopharm respectively) and three patients received only one dose of Pfizer/BioNTech vaccine. Eleven patients (6%) had COVID19 infection during the pandemic. The effect of the infection on parkinsonian symptoms was not evaluated in this report. Only two patients (1.1%) reported some degree of exacerbation following one of the dose of the vaccine. First one presented with increased rigidity and gait impairment soon after the first dose and the second case presented with increased resting tremor that lasted for two weeks also after the first dose. In both cases exacerbation improved spontaneously. Conclusion: The approved mRNA-based vaccines and viral vector vaccines are not expected to interact with the neurodegenerative process nor modify motor symptoms in PD. SARS-CoV-2 vaccines are not known neither to interfere with the current therapies for PD. Some patients have developed exacerbation of motor symptoms or severe dyskinesia after vaccination and the reasons remain unclear but they might be explained by triggering a systemic inflammatory response, by stress or excessive anxiety or due to modification of habitual medication response. These very low incidence should not discourage patients to receive vaccines and we recommend COVID-19 vaccination with approved vaccines for persons with PD, unless there is a specific contraindication.

7.
Movement Disorders Clinical Practice ; 9(SUPPL 1):S12-S13, 2022.
Article in English | EMBASE | ID: covidwho-1925959

ABSTRACT

Objective: To highlight the importance of caregivers based on results from TeleSCOPE, a real-world study of telehealth during COVID-19 in patients with tardive dyskinesia (TD) and other drug-induced movement disorders (DIMDs). Background: Given the importance of engaging caregivers (family members or other persons of support) when treating patients with TD [1], TeleSCOPE included items related to the effects of caregiver presence during virtual visits. neurology (Neuro) and psychiatry (Psych) physicians and advanced practice providers who met the following criteria: ≥3 years of practice with ≥70% of time spent in clinic;prescribed a vesicular monoamine transporter two inhibitor or benztropine for DIMD at least once in the past six months;and conducted telehealth visits with ≥15% of their patients from Dec-2020 to Jan-2021. Participants responded to items regarding DIMD assessment and management, including the impact of caregivers in these areas. Results: 277 clinicians responded (Neuro = 109, Psych = 168). For both specialties, caregiver participation was greater in video versus phone-only visits (Neuro = 51% vs 37%, Psych = 29% vs 15%). Any mention of tics/ movements by caregivers was the top prompt for further DIMD evaluation (Neuro = 82%, Psych = 89%), followed by trouble with gait/falls/walking/ standing (Neuro = 77%, Psych = 85%) and difficulty swallowing/eating (Neuro = 69%, Psych = 78%). Furthermore, patients without a participating caregiver had the highest risk of a missed DIMD diagnosis (Neuro = 89%, Psych = 83%). Other at-risk patients were lower functioning (Neuro = 86%, Psych = 80%), primarily lived in a group home (Neuro = 68%, Psych = 37%), or were new to the practice (Neuro = 28%, Psych = 51%). Conclusion: Although caregivers were not often present during telehealth visits (especially phone-only visits), active caregiver participation alleviated some of the challenges of virtual DIMD assessment. Caregiver mention of tics/movements or physical impact increased the likelihood of DIMD evaluation and reduced the risk of missed diagnosis. In-person visits remain the gold standard for assessing and treating DIMDs. However, when telehealth is necessary, caregivers can significantly improve the quality of virtual visits. Given this potential for improved outcomes, the role of caregivers in DIMD management merits more research and support.

8.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925576

ABSTRACT

Objective: To describe a case of rhombencephalitis secondary to severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) Background: Rhombencephalitis is an inflammation of the brainstem and cerebellum. Etiologies include infectious, inflammatory, and autoimmune causes. Rhombencephalitis has varied presentations but frequently includes encephalopathy, cranial neuropathies, long tract signs and cerebellar dysfunction. To date, SARS-CoV-2 has been reported as the cause of rhombencephalitis in 4 cases. Design/Methods: Authors searched PubMed and Google Scholar for articles using the keywords: “COVID-19”, SARS-CoV-2', “Rhomboencephalitis”, “Rhombencephalitis”. Results: 30-year-old African American man with poorly controlled type 1 diabetes mellitus presented with dysgeusia, slurred speech, night sweats, left-sided hypoesthesia, paresthesias, ataxic gait, and light-headedness. Exam was notable for, left-sided hypoesthesia of the face and left upper extremity weakness as well as ataxia. MRI brain revealed diffuse pontine edema and central areas of diffusion restriction. COVID-19 nasal PCR and COVID-19 IgG antibodies were positive. Extensive infectious, autoimmune and paraneoplastic workup was unrevealing. Pulse-dose steroids resulted in improvement of edema and patient was discharged with diagnosis of a monophasic infectious rhombencephalitis due to COVID-19. Patient re-presented 8 days following discharge with acute left-sided headache and vomiting. Exam was notable for mild cranial nerve seven palsy and ataxia in all extremities. MRI brain displayed increased edema, mass effect and enhancement throughout the brainstem extending superiorly to include optic tracts and hypothalamus. CSF studies were remarkable for leukocytosis and increased protein. Repeat infectious, autoimmune and paraneoplastic studies again negative. Re-treatment with pulse-dose steroids followed by prolonged taper resulted in clinical and radiographic improvement at 1 month follow-up. Conclusions: The complete picture of neurological sequelae from COVID-19 is developing as the pandemic continues. Our case adds to the literature of SARS-CoV-2 associated rhombencephalitis and highlights the need for close monitoring and slow titration of immunotherapies such as steroids to minimize the potentially devasting effects of rhombencephalitis.

9.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925572

ABSTRACT

Objective: We aim to report clinical characteristics of an extremely rare case of myelitis with Guillain-Barré syndrome (GBS) and cerebellar ataxia (CA) after COVID-19 infection. Background: There have been many reports about neurological complications following the world pandemic of COVID-19. We found about 100 GBS, 50 myelitis, and 10 CA cases after COVID-19 infection. To best our knowledge, this is the first report of myelitis with GBS and CA accompanied by multiple autoantibodies. Design/Methods: NA Results: A 60-year-old man with fever and cough was diagnosed with mild COVID-19 infection. Fourteen days later from the onset, he developed gait disturbance and fell frequently. On hospitalization, he exhibited fever, hypoxemia, mild consciousness disturbance, flaccid paraplegia, mild numbness and severe deep sensory disturbance in the lower limbs, bladder and bowel disturbance, mild muscle weakness in the fingers, myoclonus in the extremities, and CA. The PCR of COVID-19 was negative. Blood investigations showed elevated inflammatory markers with dehydration, rhabdomyolysis, and hypercoagulation. Cerebrospinal fluid (CSF) analysis presented mild pleocytosis and elevated protein without anti-COVID-19 antibodies. Contrast-enhanced CT showed massive pulmonary embolisms and deep venous thromboses. Brain SPECT showed cerebellar hypoperfusion despite no abnormalities in brain MRI. Spine MRI revealed longitudinal hyperintense lesions mainly in the dorsal white matter, compatible with myelitis. Additional investigations of autoantibodies realized anti-GM3, TPI, GluR, and NMDAR IgG antibodies in serum, and anti-GluR and NMDAR IgG antibodies with increased granzyme B in CSF. Treatments of corticosteroid and intravenous immunoglobulin resulted in complete recovery to consciousness disturbance, muscle weakness of fingers, myoclonus, and CA, while paraparesis with deep sensory and bladder and bowel disturbance remained. Conclusions: We highlight the possibility of the coexistence of several post-infectious autoimmune neurological complications in patients of COVID-19. It is important to search autoantibodies carefully corresponding to clinical manifestations for appropriate treatments and understanding of pathophysiology.

10.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925553

ABSTRACT

Objective: COVID-19 pandemic public health interventions upended many aspects of daily life. However, the effects on outcomes in Parkinson's Disease (PD) patients remained unclear. This study was conducted to determine the impact those interventions had on the mood, movement, and quality of life (QOL) of PD patients. Background: Several studies have demonstrated an association between certain lifestyle behaviors, including exercise and social interaction, and positive PD outcomes. This study investigated specific PD patient outcome changes following both the disruption of many of those behaviors and the introduction of tele-medicine as the mainstay of outpatient visits. Design/Methods: Comprehensive clinical assessments were conducted for 150 PD patients both before and after the onset of COVID-19 public health interventions. Through a retrospective chart review, quantitative disease markers and qualitative lifestyle changes were recorded and analyzed to determine changes in disease outcomes and QOL measures between the two subsequent visits. These changes were also differentiated by visit type: in-person versus video versus telephone call. Results: The paired analysis showed an increase in Hoehn and Yahr scale in the post-COVID patient visit in comparison to the pre-COVID visit from 1.86 to 2.02 (n = 122, p = 0.006.) Several non-movement PD symptoms worsened in the subsequent visits, including activities of daily living status, exercise frequency, and sleep disturbance frequency. Overall movement symptoms did not worsen, including bradykinesia, rigidity, resting tremor, gait abnormality, and falls, and patients did not have greater Levodopa needs. Outcome changes differentiated by visit type is pending. Conclusions: The implementation of COVID-19 public health interventions was associated with worsening sleep habits and exercise frequency, as well as greater dependency in daily living among patients with PD. While QOL measures and non-movement PD symptoms worsened, no association was demonstrated between the pandemic interventions and worsening movement symptoms or greater levodopa needs.

11.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925478

ABSTRACT

Objective: NA Background: Creutzfeldt-Jakob disease (CJD) is an extremely rare but fatal neurodegenerative disease with incidence of one in a million worldwide, and few than 1000 cases per year in the United States per year. Design/Methods: NA Case Summary: We present two probable CJD cases seen in the same hospital within one month. Case one was a 67-year-old white female, former psychology practice manager, presenting with worsening cognition, vertigo, behavioral changes and 15 lb weight loss over 6 months. Exam findings significant for MoCA of 17/30 (decreased to 15/30 after one week), constant right eye shut, mild dysmetria in both lower extremities, a wide based gait with small strides. Blood work and initial Spinal fluid studies were negative. Continuous EEG showing occasional right temporal slow, frequent generalized rhythmic theta and delta slowing. MRI brain findings were suggestive of CJD with hyperintensities in bilateral caudate nucleus and putamen. Patient did not respond to high dose steroid. Case two was a 78-year-old white male, admitted for deterioration in cognition, gait, speech, fatigue and intermittent body jerking. Progression of his symptoms was so rapid, from a highly functional retired funeral director, he became minimal speech, loss of ADL within 3 months. Exam was significant for orientation to self only, global aphasia, muscle weakness and startle myoclonus. Blood work and initial spinal fluid studies were negative. MRI brain showed asymmetric cortically based diffuse restriction within cingulate, caudate nucleus also left temporoparietal. EEG showed generalized rhythmic delta activity. CSF from both cases eventually showed positive RT-QuIC, 14-3-3 protein and highly elevated T-Tau protein. Conclusions: CJD is a transmittable, reportable disease. Two cases seen in the same hospital within one month skews from the previously known CJD prevalence. Surveillance and investigation on the reason of regional CJD arise during COVID-19 pandemic may prove to be important and urgent.

12.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925323

ABSTRACT

Objective: To present an unusual presentation of CLIPPERS that was responsive to rituximab Background: CLIPPERS (chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids) is a neuroinflammatory disorder typically affecting the brainstem and cerebellum with clinical and radiographic improvement with steroids. One reported case showed improvement with rituximab. We present a case of CLIPPERS with supra- and infratentorial involvement that improved with rituximab. Design/Methods: A 30-year-old male presented with several months of headaches, dizziness, and face and arm numbness, then developed diplopia and gait ataxia. Serial MRI's showed worsening punctate enhancing and T2-hyperintense lesions in the brainstem and supratentorial white matter over months. Workup showed normal CSF cell count, and negative CSF cytology, ACE, VDRL, oligoclonal bands, serologic IgG4, Coccidioidomycosis, Lupus, rheumatoid arthritis, and COVID. Vascular imaging showed no evidence of vasculitis. Biopsy showed a dense perivascular lymphocytic infiltrate including B and T cells, without evidence of vasculitis or lymphoma. He received IVIG and IV solumedrol, with symptom resolution and some improvement on imaging. Rituximab was started with subsequent resolution of the lesions on MRI. Results: NA Conclusions: CLIPPERS has a variable clinical presentation but typically includes gait ataxia and diplopia. MRI shows multiple punctate/curvilinear enhancing lesions in the brainstem and cerebellum, rarely in the spinal cord or supratentorially. Differential diagnoses include neurosarcoidosis, Behcet's disease, vasculitis, lymphoma, chronic infections, glioma, and demyelinating disease. It is characterized by responsiveness to steroids, and patients require long-term steroid or steroid-sparing agent treatment, at least until resolution of enhancement. Methotrexate, hydroxychloroquine, and cyclophosphamide are most commonly used. There was one report of treatment with rituximab with 4 years stability. Our case was unusual as he had supra and infratentorial lesions, and he had good response to rituximab. Rituximab should be considered in the treatment of CLIPPERS.

13.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925293

ABSTRACT

Objective: N/A Background: COVID-19 infection has been shown to be associated with a number of neurologic sequelae in the post-infection period. There have been rare cases of autoimmune neurologic disease associated with COVID-19 infection. Here we present a case of myelin oligodendrocyte glycoprotein (MOG)-associated encephalomyelitis two months after COVID-19 infection. Design/Methods: N/A Results: A 44-year old female presented to the hospital with progressive decline in mentation and fevers for 1 week. Three months prior, she tested positive for COVID-19 by nasopharyngeal PCR testing, had mild symptoms and recovered at home. On presentation, neurologic examination showed sensory level at T8, lower extremity hyperreflexia. and gait instability. MRI of the neuroaxis showed bilateral white matter lesions in the brain and longitudinal cord lesions at multiple cervical and thoracic spinal levels. CSF showed lymphocyte-predominant pleocytosis. Patient was diagnosed with encephalomyelitis and started on plasma exchange and high dose steroids on alternating days with improvement in her symptoms. Patient was positive for serum MOG antibody. She was discharged on a prolonged prednisone taper. Conclusions: This case highlights the importance of testing for MOG antibody disease in patients presenting with findings of brain and spinal cord lesions after COVID-19 infection. The course of MOG-associated antibody disease in post-COVID patients is unknown and warrants further investigation.

14.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925124

ABSTRACT

Objective: NA Background: The etiology of MOGAD post-COVID-19 infection is not well understood and there are limited publications describing cases in pediatric patients. Here we report a case of a 14-year-old male with MOG antibody positive ADEM (Acute Disseminated Encephalomyelitis) and positive COVID-19 PCR. Design/Methods: NA Results: The patient presented to our hospital in December of 2020 with acute onset of ataxia and lower extremity weakness. His exam was pertinent for mild and symmetric weakness in bilateral hip flexors, dysmetria with ataxic gait, as well as bilateral patellar and ankle hyporeflexia. MRI brain showed symmetric areas of T2 signal hyperintensity, predominantly adjacent to the fourth ventricle as well as the peri-insular and frontal regions. MRI of the lumbosacral spine demonstrated T2 signal hyperintensity within the conus medullaris without enhancement. CSF studies revealed an increased white blood cell count of 74 (90% lymphocyte), elevated protein of 51, elevated kappa free light chain (0.12) and positive oligoclonal bands (3). He was also found to be serum anti-MOG antibody positive (1:100) and COVID-19 positive (PCR). He received 1000 mg of intravenous methylprednisolone daily for 5 days and 2 g/kg IVIG. He was subsequently placed on a 6 week taper of oral prednisone. 2 months after his initial presentation, his neurologic symptoms have completely resolved, and he has been asymptomatic since. Repeat MRI brain 4 months later showed improvement in his multifocal supratentorial FLAIR signal abnormalities. Conclusions: Here we describe a case of a 14-year-old male with MOGAD post-COVID-19, with complete resolution of his symptoms after high dose corticosteroid and IVIG treatment.

15.
Vox Sanguinis ; 117(SUPPL 1):223, 2022.
Article in English | EMBASE | ID: covidwho-1916309

ABSTRACT

Background: Acute Transverse Myelitis (ATM) is a very uncommon neurological syndrome, characterized by acute or subacute spinal cord dysfunction that can lead to paresthesias, sensory/autonomic impairment and paralysis. The aetiology is often unclear, but infectious, para-infectious, systemic autoimmune diseases, paraneoplastic, ischemic diseases and drugs are potential causes. Vaccine administration can also trigger an immune response and induce an autoimmune response;however, ATM has rarely been reported as a complication of COVID-19 infections or vaccination. The treatment mainly consists of steroids and plasmapheresis, which often reverses any neurologic symptoms. The therapeutic plasmapheresis is a highly complex procedure. It separates the patient's blood components replacing the plasma removed by solution that can be fresh frozen plasma or albumin, allowing the removal of the autoantibody, immune complex, lipoprotein or endotoxin that's causing the pathology. Aims: Clinical case report. Methods: A 46-year-old male patient, with personal history of hypertension and obesity, 3 weeks after COVID-19 vaccination, presented to the emergency department due to urinary complaints (urgency and pollakiuria), progressive numbness, paresthesias and decreased muscle strength in the lower limbs and decreased sensibility in the perineal region. Physical examination revealed total gait disability, decreased sensation and strength in the right lower limb, loss of sensation and plegia in the left lower limb and urinary incontinence. Initial laboratory workup and CT imaging of the brain, cervical, dorsal and lumbar spine were normal. The patient was admitted to Neurology internment for further study and treatment. During hospitalization, lumbar puncture and MRI of the dorsal and lumbosacral neuraxis were performed, but only allowed us to exclude infectious and compressive etiologies. The inflammatory aetiology was assumed as the most probable, so acute therapy with pulses of methylprednisolone was initiated. In the remaining study, weakly positive anti-MOG (Myelin Oligodendrocyte Glycoprotein) antibodies were detected in the serum. Therapeutic plasmapheresis using a cell separator (which use centrifugal force to separate components according to their density) was proposed as additional therapy. Seven sessions were performed without intercurrences. Results: During acute therapy, there was a partial improvement in sensitivity and strength in lower limbs. The patient started a rehabilitation program with favourable neurological recovery. At the time of hospital discharge, he still needed crutch support for walking and had muscle strength grade 4-/5 bilaterally. Summary/Conclusions: Although the patient maintained some functional limitation and there was not a complete resolution of the neurological symptoms, he showed a good response to acute therapy. The plasmapheresis, by permitting the antibody to be removed faster than would occur by its endogenous clearance, proved to be fundamental in the clinical recovery of the patient. No relationship between COVID-19 vaccination and the event was established.

16.
CNS Spectrums ; 27(2):250, 2022.
Article in English | EMBASE | ID: covidwho-1915241

ABSTRACT

Introduction. As a result of COVID-19, patients and clinicians rapidly shifted to telehealth. An observational survey study, Real- World Tele-Health Evaluation of Tardive Dyskinesia (TD) Symptoms Communication/Observation Procedure Evaluation in Outpatient Clinical Settings (TeleSCOPE), was conducted to better understand how this shift affected the evaluation of druginduced movement disorders (DIMDs), including TD. Methods. Twenty-minute online quantitative surveys were conducted with neurology and psychiatry specialists (physicians and advanced practice providers) who met the following criteria: ≥3 years of practice with ≥70% of time spent in a clinic;prescribed a vesicular monoamine transporter 2 (VMAT2) inhibitor or benztropine for DIMD at least once in the past 6 months;and conducted telehealth visits with ≥15% of their patients from December 2020 to January 2021. Results. Respondents included 277 clinicians (neurology = 109, psychiatry = 168). Telehealth visits increased after COVID-19, with significantly greater increases in psychiatry vs neurology: phone (38% vs 21%);video (49% vs 42%). Across both specialties, top drivers/prompts for further DIMDevaluation were as follows: mention of tics or movements by family members or others (86%);trouble with gait, falls, walking, or standing (82%);difficulty swallowing or eating (74%);and difficulty writing, using phone, computer (71%). However, in the 6 months prior to June 2021, virtual evaluation, diagnosis, and monitoring of patients were challenging. For both specialties, many at-risk patients (ie, taking a dopamine receptor blocking agent) were not evaluated for DIMDs via video-based visits (psychiatry = 45%, neurology = 70%) or phone-only visits (psychiatry = 76%, neurology = 91%). Clinicians listed evaluation of gait/falls/walking/ standing as the most challenging aspect of virtual assessment for phone-only visits (psychiatry = 53%, neurology = 57%) and video-based visits (psychiatry = 26%, neurology = 31%). Additional challenges included limited access to computers, insufficient training for clinicians and staff, and greater difficulty obtaining reimbursements (especially for complex telehealth visits). Patients without a participating caregiver, along with lower functioning patients, were at the highest risk of a missed DIMD diagnosis. Conclusions. During the COVID-19 pandemic, telehealth significantly reduced clinicians' ability or willingness to evaluate, diagnose, and monitor DIMDs. Clinicians stated multiple factors increased the risk of a missed or incorrect diagnosis. Challenges to optimal telehealth effectiveness included lack of patient access to computers, need for more clinician/staff training, lack of awareness of coverage, need for sufficient fee reimbursement. In-person evaluation continues to be the gold standard for assessing and treating DIMDs. However, if telehealth is necessary, the use of specific questions and directions is recommended for better communication and more accurate assessments.

17.
Swiss Medical Weekly ; 152(SUPPL 258):31S, 2022.
Article in English | EMBASE | ID: covidwho-1913215

ABSTRACT

We report a 15-year-old boy presenting at our emergency department with acute onset of dysarthria and prior headache, rotary vertigo, nausea, vomiting and gait disturbance for 2 days. 18 days earlier he was tested positive for SARS CoV-19. Physical examination showed pronounced dys-arthria, nystagmus, absent reflexes, dysmetria and ataxia. Laboratory findings showed relative lymphocytosis with a negative C-reactive pro-tein, normal coagulation and elevated liver enzymes (AST, ALT, GGT). Drug screening was negative. First suspicion was postinfectious cerebellitis and he was admitted to IMC for observation. Subsequently, vomiting fre-quency rose, hence cMRI was performed, but showed no abnormalities. Miller-Fisher syndrome was suspected, however CSF examination showed no cytoalbumin dissociation, but discrete mononuclear cell count eleva-tion. Ceftriaxone and acyclovir were administered empirically. In addition, intravenous immunoglobulin and corticosteroids were given to treat viral cerebellitis/encephalitis. Due to suggestive atypical lymphocytes in the blood count, EBV testing was performed and serologies were positive. Multiple CSF viral/bacterial testings (Borrelia burgdorferi, Enterovirus, VZV, HSV 1/2) showed slightly positive EBV (PCR), congruent with blood results. Additionally, SARS-CoV-19 IgG were positive. The patient's condi-tion barely improved, a follow up cMRI showed no changes. Mobilization was fostered with a wheel chair and physical therapy. After two and a half weeks, he was discharged to pediatric neurorehabilitation in order to im-prove dysarthria, ataxia and address neuropsychological abnormalities. Two months after the diagnosis he is walking without aids but still shows trunk ataxia and dysarthria. He is still making constant progress and will hopefully recover completely. Neurological manifestation of EBV infection is extremely rare with the ma-jority of cases described in children. Nevertheless, some neurological manifestations have already been described including encephalitis, cere-bellitis, meningitis, transverse myelitis, and Guillain-Barré syndrome. These manifestations can occur alone or in the setting of infectious mon-onucleosis. In our case a co-infection of SARS-Cov-19 and EBV or a reactivation of EBV due to SARS-Cov-19 is possible as cause of the cerebellitis. Treatment op-tions were fully employed, but the recovery presented a slow course.

18.
Artificial Organs ; 46(3), 2022.
Article in English | EMBASE | ID: covidwho-1912833

ABSTRACT

The proceedings contain 53 papers. The topics discussed include: evoked sensations with sinusoidal transcutaneous electrical stimulation at different frequencies;IMU triggered FES for robotic gait training;trans-spinal electrical stimulation for improving trunk and sitting function in tetraplegics with cervical cord injury;a combined approach to CNS excitation for hand rehabilitation: a case study using spinal stimulation and BCI;analysis of the movements generated by a multi-field FES device for upper extremity rehabilitation;and neuromuscular and functional electrical stimulation for motor recovery after COVID-19: systematic review.

19.
BMC Geriatr ; 22(1): 446, 2022 05 21.
Article in English | MEDLINE | ID: covidwho-1902357

ABSTRACT

BACKGROUND: Muscle health decline with age, but its deterioration in older persons with type-2 diabetes mellitus (T2DM) over time is not well-established. This study aimed to determine the change in muscle mass, handgrip strength and gait speed over time among community-dwelling ambulatory older multi-ethnic Asian patients with T2DM and their associated factors. METHODS: Among 387 eligible patients aged 60-89 years who were recruited at baseline, 348 (89.9%) were reviewed at a public primary care clinic in Singapore in the subsequent 9 to 34 months. The change in their clinical and functional status, levels of physical activity and muscle status (mass, grip strength and gait speed based on the Asian Working Group for Sarcopenia criteria) were recorded and compared. Their physical activity levels were assessed using the Physical Activity Scale for the Elderly (PASE) and International Physical Activity Questionnaire (IPAQ). Their quality of life was evaluated based on the World Health Organization Quality of Life (WHOQOL) domains. Linear regression analysis was used to identify the factors associated with muscle health change. RESULTS: The study population comprised men (52.9%), Chinese (69.3%), mean age of 68.4 ± SD5.6 years and had at least secondary education (76.4%). Their mean muscle mass significantly decreased by 0.03 ± SD0.06 kg/m2/month, mean handgrip strength by 0.06 ± SD0.26 kg/month and negligible change in gait speed of 0.002 ± SD0.01 m/sec/month. Their mean weight significantly decreased by 0.5 ± SD3.9 kg, waist and hip circumferences by 2.5 ± SD6cm and 3.2 ± SD5.1 cm respectively, with no change in BMI. Linear regression shows significant associations between muscle mass change and education level (ß = 0.36,p = 0.012, 95% CI = 0.08-0.64), BMI (ß = 0.11,p = < 0.001, 95% CI = 0.05-0.17), change in medication class (ß = 0.39,p = < 0.001, 95% CI = 0.06-0.71) and review interval (ß = - 0.003, p < 0.001, 95% CI = -0.004--0.002). Gait speed change was associated with singlehood (ß = - 0.13,p = 0.029, 95% CI = -0.25--0.01) and WHOQOL physical health (ß = 0.01,p = 0.024, 95% CI = 0.00-0.02) domain. No factor was associated with handgrip strength change. CONCLUSIONS: The study population with T2DM showed significant decline in their mean weight, waist and hip circumferences, mean muscle mass and mean grip strength but gait speed was unaffected. Muscle mass change was associated with education level, BMI and length of review interval. Handgrip strength change was not significantly correlated with any factor. Gait speed change was associated with singlehood and physical health.


Subject(s)
Diabetes Mellitus, Type 2 , Sarcopenia , Aged , Aged, 80 and over , Asians , Diabetes Mellitus, Type 2/diagnosis , Hand Strength/physiology , Humans , Independent Living , Longitudinal Studies , Male , Muscle Strength , Muscles , Quality of Life , Sarcopenia/epidemiology , Walking Speed
20.
Human and Veterinary Medicine ; 14(2):81-84, 2022.
Article in English | ProQuest Central | ID: covidwho-1897981

ABSTRACT

COVID19 is an infectious disease caused by the SARS CoV-2 virus that emerged in Wuhan, China, in 2019. Common complaints are dry cough, dyspnea, fever, myalgia, headache, anosmia, and ageusia. This influenza-like virus has a nootropic potential, as seen in patients complaining of various neurological symptoms in the course of the disease or shortly after resolution. Autoimmune diseases in the nervous system can occur as a complication of viral infection. Mechanisms including molecular mimicry, bystander activation, epitope spreading can activate viral-linked autoimmunity. Therefore, we present a case of classical chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) with onset one month after being diagnosed with a mild form of COVID19 in a patient with a history of diabetes and obesity. The case has been followed up for a year, being investigated thoroughly, including nerve conduction studies, spinal tap, and blood tests. The patient received periodical courses of intravenous immunoglobulin therapy.

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