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Intravenous immunoglobulin therapy in COVID-19-related encephalopathy.
Muccioli, Lorenzo; Pensato, Umberto; Bernabè, Giorgia; Ferri, Lorenzo; Tappatà, Maria; Volpi, Lilia; Cani, Ilaria; Henry, Olivia J; Ceccaroni, Francesca; Cevoli, Sabina; Stofella, Gloria; Pasini, Elena; Fornaro, Giacomo; Tonon, Caterina; Vidale, Simone; Liguori, Rocco; Tinuper, Paolo; Michelucci, Roberto; Cortelli, Pietro; Bisulli, Francesca.
  • Muccioli L; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bellaria Hospital, Via Altura 3 40139, Bologna, Italy.
  • Pensato U; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bellaria Hospital, Via Altura 3 40139, Bologna, Italy.
  • Bernabè G; Infermi Hospital, AUSL Romagna, Rimini, Italy.
  • Ferri L; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bellaria Hospital, Via Altura 3 40139, Bologna, Italy.
  • Tappatà M; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
  • Volpi L; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
  • Cani I; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bellaria Hospital, Via Altura 3 40139, Bologna, Italy.
  • Henry OJ; Karolinska Institutet, Stockholm, Sweden.
  • Ceccaroni F; Infermi Hospital, AUSL Romagna, Rimini, Italy.
  • Cevoli S; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
  • Stofella G; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
  • Pasini E; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
  • Fornaro G; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
  • Tonon C; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bellaria Hospital, Via Altura 3 40139, Bologna, Italy.
  • Vidale S; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
  • Liguori R; Infermi Hospital, AUSL Romagna, Rimini, Italy.
  • Tinuper P; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bellaria Hospital, Via Altura 3 40139, Bologna, Italy.
  • Michelucci R; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
  • Cortelli P; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bellaria Hospital, Via Altura 3 40139, Bologna, Italy.
  • Bisulli F; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
J Neurol ; 268(8): 2671-2675, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-841658
ABSTRACT

OBJECTIVE:

To report on efficacy and safety of intravenous immunoglobulin (IVIg) therapy in a case series of patients with COVID-19-related encephalopathy.

METHODS:

We retrospectively collected data on all patients with COVID-19 hospitalized at two Italian hospitals who developed encephalopathy during disease course and were treated with IVIg.

RESULTS:

Five patients (two females, mean age 66.8 years) developed encephalopathy after a mean of 12.6 days, since the onset of respiratory/constitutional symptoms related to COVID-19. Four patients suffered severe respiratory distress, three of which required invasive mechanical ventilation. Neurological manifestations included impaired consciousness, agitation, delirium, pyramidal and extrapyramidal signs. EEG demonstrated diffuse slowing in all patients. Brain MRI showed non-specific findings. CSF analysis revealed normal cell count and protein levels. In all subjects, RT-PCR for SARS-CoV-2 in CSF tested negative. IVIg at 0.4 g/kg/die was commenced 29.8 days (mean, range 19-55 days) after encephalopathy onset, leading to complete electroclinical recovery in all patients, with an initial improvement of neuropsychiatric symptoms observed in 3.4 days (mean, range 1-10 days). No adverse events related to IVIg were observed.

CONCLUSIONS:

Our preliminary findings suggest that IVIg may represent a safe and effective treatment for COVID-19-associated encephalopathy. Clinical efficacy may be driven by the anti-inflammatory action of IVIg, associated with its anti-cytokine qualities.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Brain Diseases / COVID-19 Type of study: Observational study / Prognostic study Limits: Aged / Female / Humans Language: English Journal: J Neurol Year: 2021 Document Type: Article Affiliation country: S00415-020-10248-0

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Brain Diseases / COVID-19 Type of study: Observational study / Prognostic study Limits: Aged / Female / Humans Language: English Journal: J Neurol Year: 2021 Document Type: Article Affiliation country: S00415-020-10248-0