Neurological Symptoms Mixed with COVID-19 May Mean Double the Worse Outcomes

It’s been documented that patients with preexisting conditions may have greater risks when it comes to COVID-19. Now, according to research, patients with neurological symptoms and COVID-19 may be at risk for not only more severe COVID-19 symptoms—but exacerbated neurological symptoms as well.

The authors of the study queried the MEDLINE and medRxiv databases for relevant studies that reported on patients with preexisting neurological disorders and COVID-19 that reported the severity of the latter and/or changes in symptoms of the former. Severe COVID-19 was defined as having severe/critical pneumonia or admission to the intensive care unit.

Of 1,702 total studies identified (866 from MEDLINE, 836 from medRxiv), 26 studies encompassing 2,278 total patients were included in the final analysis. The disorders represented in the studies included cerebrovascular disease, Parkinson’s disease, multiple sclerosis and related disorders, aquaporin-4 (AQP-4)-positive neuromyelitis optica spectrum disorder (NMOSD), dementia and cognitive disorder, epilepsy, spinal cord injury, systemic atrophy, myelopathy, intracranial mass, and unspecified disorders.

Not every study discussed both outcomes (the exacerbation of neurological symptoms and COVID-19 severity), so patients were stratified by those with preexisting neurological disorders and COVID-19 for where exacerbation of neurological symptoms was available (n=232) and where the severe COVID-19 course was available (n=2,618).

Among the patients whose neurological symptoms exacerbation was reported, 74 (31.9%) presented exacerbated preexisting neurological symptoms. This was observed in more than half of the patients with dementia (n=55/92; 59.5%) and Parkinson’s disease (n=10/17; 58.8%).

Among the patients whose COVID-19 severity course was reported, 478 (22%) presented worsening COVID-19 severity. This was observed in about one-fifth of patients with cerebrovascular disease (n=86/445; 19.3%) and dementia (n=70/316; 22.2%) and two in five patients with multiple sclerosis (n=28/71; 39.4%); it was also seen in patients Parkinson’s disease (25/214; 11.7%), epilepsy (10/98; 10.2%), spinal cord injury (5/7; 71.1%), and unspecified neurological disorders (254/1011; 25%).

The study was published in Clinical Neurology and Neurosurgery.

“Clinicians should be aware of the risks of an exacerbation of neurological symptoms and an increase in COVID-19 severity in patients with preexisting neurological diseases, and should focus on the prevention and early care of COVID-19,” the researchers concluded.