Management of neurological care during the COVID-19 pandemic

Matías‐Guiu, Jorge; Porta‐Etessam, J.; López‐Valdés, Eva; García‐Morales, Irene; Guerrero-Solá, A.

doi:10.1016/j.nrleng.2020.04.001

Cited by 19 publications

(34 citation statements)

References 22 publications

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“…Many of them can be worsened by Covid-19 disease and the use of personal protective equipment makes its management arduous. Covid-19 should be prevented and detected early in CND patients, whose close monitoring could prevent complications and improve the prognosis ( 34 ). In addition, the worse prognosis of patients with CND could be linked with immuno-senescence, an enhanced inflammatory state, favored by an angiotensin II induced vasoconstriction and inflammatory response, leading to lymphopenia, cytokine release and macrophage activation ( 35 ).…”

Section: Discussionmentioning

confidence: 99%

Neurological Comorbidity Is a Predictor of Death in Covid-19 Disease: A Cohort Study on 576 Patients

et al. 2020

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Introduction: Prognosis of Coronavirus disease 2019 (Covid-19) patients with vascular risk factors, and certain comorbidities is worse. The impact of chronic neurological disorders (CND) on prognosis is unclear. We evaluated if the presence of CND in Covid-19 patients is a predictor of a higher in-hospital mortality. As secondary endpoints, we analyzed the association between CND, Covid-19 severity, and laboratory abnormalities during admission. Methods: Retrospective cohort study that included all the consecutive hospitalized patients with confirmed Covid-19 disease from March 8th to April 11th, 2020. The study setting was Hospital Clínico, tertiary academic hospital from Valladolid. CND was defined as those neurological conditions causing permanent disability. We assessed demography, clinical variables, Covid-19 severity, laboratory parameters and outcome. The primary endpoint was in-hospital all-cause mortality, evaluated by multivariate cox-regression log rank test. We analyzed the association between CND, covid-19 severity and laboratory abnormalities. Results: We included 576 patients, 43.3% female, aged 67.2 years in mean. CND were present in 105 (18.3%) patients. Patients with CND were older, more disabled, had more vascular risk factors and comorbidities and fewer clinical symptoms of Covid-19. They presented 1.43 days earlier to the emergency department. Need of ventilation support was similar. Presence of CND was an independent predictor of death (HR 2.129, 95% CI: 1.382–3.280) but not a severer Covid-19 disease (OR: 1.75, 95% CI: 0.970–3.158). Frequency of laboratory abnormalities was similar, except for procalcitonin and INR. Conclusions: The presence of CND is an independent predictor of mortality in hospitalized Covid-19 patients. That was not explained neither by a worse immune response to Covid-19 nor by differences in the level of care received by patients with CND.

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Section: Discussionmentioning

confidence: 99%

Neurological Comorbidity Is a Predictor of Death in Covid-19 Disease: A Cohort Study on 576 Patients

et al. 2020

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“…Only a few living persons have limited experience of dealing with such a huge pandemic, spreading like wildfire as the last worldwide influenza pandemic occurred nearly 100 years back. The SARS CoV-2 predominantly causes a respiratory illness, which culminates in severe pneumonia, acute respiratory distress syndrome (ARDS), and cytokine storm response and death in 5-10 % of affected patients [2]. Primary neurological illness including seizures, encephalitis, and stroke has only been shown in anecdotal case reports, but not proven in the larger epidemiological studies till now.…”

Section: Introductionmentioning

confidence: 99%

“…1 All the author contributed equally and share joint first authorship. T deprived of antiepileptic drugs (AEDs), health care advice, emergency consultation, and other supports at this challenging time because of lockdown implemented by governments of most countries [2][3][4][5][6]. As COVID-19 has been proven to be many times more infectious as compared to previous coronavirus epidemics, these lockdown measures implemented by the government are justified.…”

Section: Introductionmentioning

confidence: 99%

“…Primary neurological illness including seizures, encephalitis, and stroke has only been shown in anecdotal case reports, but not proven in the larger epidemiological studies till now. But children with epilepsy are deprived of antiepileptic drugs (AEDs), health care advice, emergency consultation, and other supports at this challenging time because of lockdown implemented by governments of most countries [ [2] , [3] , [4] , [5] , [6] ]. As COVID-19 has been proven to be many times more infectious as compared to previous coronavirus epidemics, these lockdown measures implemented by the government are justified.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility and effectiveness of teleconsultation in children with epilepsy amidst the ongoing COVID-19 pandemic in a resource-limited country

Panda

Sharawat

Panda

2020

Seizure

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The ongoing COVID-19 pandemic and the lockdown measures employed by the government have forced neurologists across the world to look upon telemedicine as the only feasible and practical option to continue providing health care towards children with epilepsy in home isolation. Children with epilepsy are challenging for teleconsultation as direct information from the patient is missing, regarding seizures and adverse effects, especially behavioral and psychological side effects. Methods: Clinical and epilepsy-related details of telephonic consultations for children 1 month-18 years, performed between 26th March and 17th May 2020 in a tertiary care teaching hospital in Uttarakhand (a state of India known for hilly terrains with low per capita income) were recorded. Suitable changes in the dose/commercial brand of antiepileptic drug (AED) regimen were performed, along with the addition of new AED and referral to local practitioners for immediate hospitalization, when urgent health care issues were detected. Voice call, text message, picture/video message, and all other possible measures were employed to accumulate maximum clinical information in real-time. Results: A total of 153 children(95 males [62 %], 9.45 ± 3.24 years, 140 lower/middle socioeconomic status) were enrolled after screening 237 children with various neurological disorders, whose caregivers contacted for teleconsultation. A total of 278 telephone consultations performed for these 153 children (1-5 telephone calls per patient). Hundred-thirteen children were identified to have a total of 152 significant clinical events (breakthrough seizure/uncontrolled epilepsy (108), AED related (13), and unrelated systemic adverse effects (24), worsening of associated co-morbidities (7). In rest of the patients, the query of the caregiver included unavailability of AED/prescribed commercial brand in the locality, query related to the dose of drugs, proxy for a scheduled routine visit (no active issues), and concern regarding COVID-19 related symptoms and effect of COVID-19 and lockdown in children with epilepsy. Ninety-three (60 %) patients required hiking up of AED dose, whereas 29 (17 %) patients required the addition of a new AED/commercial brand. Five children were advised immediate admission to a nearby hospital. Overall, 147 (96 %) caregivers were satisfied with the quality of medical advice. Conclusion: Teleconsultation is one of the few feasible options with good effectiveness for providing medical advice to children with epilepsy during pandemic times.

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“…El tamaño de nuestra serie es menor al de otras publicadas, como la de nuestros colegas del registro ALBACOVID 14 , o el estudio multicéntrico madrileño sobre alteraciones del olfato y del gusto publicado al inicio de la pandemia 31 , probablemente en relación con el modelo de hospital (nuestro centro es un hospital pequeño de nivel secundario con 270 camas para una población de 325.000 habitantes aproximadamente, frente a los hospitales terciarios de las publicaciones más amplias) 14 , 31 , 32 , 33 , 34 . Sin embargo, la ventaja de nuestra serie es su homogeneidad: pacientes jóvenes, sin patología neurológica previa, sin apenas otros antecedentes salvo HTA o DM-2, que han sufrido una afectación respiratoria grave, y que han requerido ingreso en UCI.…”

Section: Discussionunclassified

Complicaciones neurológicas en pacientes críticos por SARS-CoV-2

et al. 2020

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Introducción Nos proponemos analizar las complicaciones neurológicas de los pacientes con infección grave por SARS-CoV-2 que han requerido ingreso en unidad de cuidados intensivos (UCI). Pacientes y métodos Estudio descriptivo retrospectivo, observacional, de pacientes consecutivos ingresados en UCI por infección respiratoria grave por SARS-CoV-2 desde el 1 de abril hasta el 1 de junio de 2020. Resultados Registramos 30 pacientes con síntomas neurológicos, 21 hombres (72,40%), edad media: 57,41 años ± 11,61 desviación estándar (DE). Estancia media en UCI: 18,83 ± 14,33 DE. A nivel sindrómico: 28 pacientes (93,33%) con síndrome confusional agudo, 15 (50%) con patología neuromuscular, 5 (16,66%) con cefalea, 4 (13,33%) con patología cerebrovascular y 4 (13,33%) con encefalopatías/encefalitis. Punción lumbar normal en 6 pacientes (20%). La RMN craneal o TAC craneal mostró alteraciones en 20 casos (66,6%). Se realizó EEG en todos los pacientes (100%), alterado en 8 pacientes (26,66%). En 5 de los 15 pacientes con miopatía clínica se ha podido confirmar con ENMG. Hemos encontrado relación entre la mayor edad y los días de ingreso en UCI (p = 0,002; IC 95%: 4,032-6,022; OR: 3,594). Conclusiones La infección grave por COVID-19 afecta mayoritariamente a hombres, similar a lo descrito en otras series. La mitad de nuestros pacientes presenta una miopatía aguda, y casi la totalidad de los pacientes salen de la UCI con síndromes confusionales agudos que evolucionan a una resolución completa, sin correlacionarse con los resultados del EEG o de pruebas de neuroimagen. La mayor edad se asocia con un mayor número de días de estancia en UCI.

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Management of neurological care during the COVID-19 pandemic

Cited by 19 publications

References 22 publications

Neurological Comorbidity Is a Predictor of Death in Covid-19 Disease: A Cohort Study on 576 Patients

Neurological Comorbidity Is a Predictor of Death in Covid-19 Disease: A Cohort Study on 576 Patients

Feasibility and effectiveness of teleconsultation in children with epilepsy amidst the ongoing COVID-19 pandemic in a resource-limited country

Complicaciones neurológicas en pacientes críticos por SARS-CoV-2

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