Peripheral neuropathy in COVID-19 is due to immune-mechanisms, pre-existing risk factors, anti-viral drugs, or bedding in the Intensive Care Unit

Abstract

Background: This mini-review aims to summarize and discuss previous and recent advances in the clinical presentation, pathophysiology, diagnosis, treatment, and outcome of SARS-CoV-2-associated peripheral neuropathies. Methods: Literature review. Results: Altogether, 105 articles about SARS-CoV-2-associated neuropathy describing 261 patients were retrieved. Peripheral neuropathy in patients with COVID-19 is frequent and predominantly due to immune mechanisms or neurotoxic side effects of drugs used to treat the symptoms of COVID-19 and, to a lesser extent, due to the compression of peripheral nerves resulting from prolonged bedding in the Intensive Care Unit (ICU) and pre-existing risk factors such as diabetes. SARS-CoV-2 does not cause viral neuropathy. Neurotoxic drugs such as daptomycin, linezolid, lopinavir, ritonavir, hydro-chloroquine, cisatracurium, clindamycin, and glucocorticoids should be administered with caution and patients should be appropriately bedded in the ICU to prevent SARS-CoV-2-associated neuropathy. Patients with Guillain-Barré syndrome (GBS) benefit from immunoglobulins, plasma exchange, and steroids. Conclusions: Neuropathies of peripheral nerves in patients with COVID-19 are frequent and mostly result from immune mechanisms or neurotoxic side effects of drugs used to treat the symptoms of COVID-19 and, to a lesser extent, from the compression of peripheral nerves due to prolonged bedding on the ICU. SARS-CoV-2 does not cause infectious neuropathy.

Current evidence of neurological features, diagnosis, and neuropathogenesis associated with COVID-19

“…Marzia Puccioni-Sohler [1], [2]  , André Rodrigues Poton [1]  , Milena Franklin [1]  , Samya Jezine da Silva [2]  , Rodrigo Brindeiro [3]  and Amilcar Tanuri [3] …”

Kynurenines in the Pathogenesis of Peripheral Neuropathy During Leprosy and COVID-19

“…Several studies have identified a number of neuropathologies associated with SARS-CoV-2, including pain-related conditions ( McFarland et al, 2021 ) but recent evidence suggests that SARS-CoV-2 does not cause viral neuropathy ( Finsterer et al, 2021 ). At present, there is evidence that neural damage during COVID-19 is associated with secondary immune mechanisms ( Finsterer et al, 2021 ). It is hypothesized that the systemic hyperinflammation seen in severe COVID-19 has the potential to contribute to nociceptor sensitization.…”

Correlations between Electro-Diagnostic Findings, the Severity of Initial Infection, and the Rehabilitation Outcomes among COVID-19 Patients

“…However, since both central and peripheral nervous system dysfunctions may be present, etiologies supported by inflammatory or autoimmune studies are also considered [ 6 ]. It was also suggested that peripheral neuropathies might result from neurotoxic side effects of drugs applied to treat COVID-19, e.g., Daptomycin, Linezolid, and Lopinavir [ 9 ].…”