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Intracortical GABAergic dysfunction in patients with fatigue and dysexecutive syndrome after COVID-19.
Versace, Viviana; Sebastianelli, Luca; Ferrazzoli, Davide; Romanello, Roberto; Ortelli, Paola; Saltuari, Leopold; D'Acunto, Alessia; Porrazzini, Francesco; Ajello, Valentina; Oliviero, Antonio; Kofler, Markus; Koch, Giacomo.
  • Versace V; Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy. Electronic address: viviana.versace@sabes.it.
  • Sebastianelli L; Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy.
  • Ferrazzoli D; Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy.
  • Romanello R; Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy.
  • Ortelli P; Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy.
  • Saltuari L; Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy.
  • D'Acunto A; Non-Invasive Brain Stimulation Unit/Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy.
  • Porrazzini F; Non-Invasive Brain Stimulation Unit/Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy.
  • Ajello V; Department of Cardiac Anesthesia, Tor Vergata University Hospital, Rome, Italy.
  • Oliviero A; FENNSI Group, Hospital Nacional de Parapléjicos, Servicio de Salud de Castilla La Mancha, Toledo, Spain.
  • Kofler M; Department of Neurology, Hochzirl Hospital, Zirl, Austria.
  • Koch G; Non-Invasive Brain Stimulation Unit/Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy; Department of Neuroscience and Rehabilitation, University of Ferrara, Italy.
Clin Neurophysiol ; 132(5): 1138-1143, 2021 05.
Article in English | MEDLINE | ID: covidwho-1128943
ABSTRACT

OBJECTIVE:

A high proportion of patients experience fatigue and impairment of cognitive functions after coronavirus disease 2019 (COVID-19). Here we applied transcranial magnetic stimulation (TMS) to explore the activity of the main inhibitory intracortical circuits within the primary motor cortex (M1) in a sample of patients complaining of fatigue and presenting executive dysfunction after resolution of COVID-19 with neurological manifestations.

METHODS:

Twelve patients who recovered from typical COVID-19 pneumonia with neurological complications and complained of profound physical and mental fatigue underwent, 9 to 13 weeks from disease onset, a psychometric evaluation including a self-reported fatigue numeric-rating scale (FRS, Fatigue Rating Scale) and the Frontal Assessment Battery (FAB). Intracortical activity was evaluated by means of well-established TMS protocols including short-interval intracortical inhibition (SICI), reflecting GABAA-mediated inhibition, long-interval intracortical inhibition (LICI), a marker of GABAB receptor activity, and short-latency afferent inhibition (SAI) that indexes central cholinergic transmission. TMS data were compared to those obtained in a control group of ten healthy subjects (HS) matched by age, sex and education level.

RESULTS:

Post-COVID-19 patients reported marked fatigue according to FRS score (8.1 ± 1.7) and presented pathological scores at the FAB based on Italian normative data (12.2 ± 0.7). TMS revealed marked reduction of SICI, and disruption of LICI as compared to HS. SAI was also slightly diminished.

CONCLUSIONS:

The present study documents for the first time reduced GABAergic inhibition in the M1 in patients who recovered from COVID-19 with neurological complications and manifested fatigue and dysexecutive syndrome.

SIGNIFICANCE:

TMS may serve as diagnostic tool in cognitive disturbances and fatigue in post-COVID-19 patients.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Transcranial Magnetic Stimulation / Fatigue / GABAergic Neurons / Cognitive Dysfunction / COVID-19 / Motor Cortex Type of study: Experimental Studies / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: Clin Neurophysiol Journal subject: Neurology / Psychophysiology Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Transcranial Magnetic Stimulation / Fatigue / GABAergic Neurons / Cognitive Dysfunction / COVID-19 / Motor Cortex Type of study: Experimental Studies / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: Clin Neurophysiol Journal subject: Neurology / Psychophysiology Year: 2021 Document Type: Article