Neurologic Symptoms in People With Long COVID

welcome to Medscape I'm your host Dr Andrew Wilner today I have the pleasure of welcoming Dr Igor corralnick to the program Dr Corral Nick is the Archibald Church professor of Neurology and chief of neuro-infectious disease and Global neurology at the Feinberg School of Medicine at Northwestern Medicine in Chicago Illinois today we are going to discuss a relatively new medical challenge a disorder that has been termed long coveted welcome Dr coralnik good morning everyone thank you for inviting me on this program thanks for joining us to get started please describe the phenomenon of long covid the general hypothesis that we have and others have as well for the cause of blancovid it's at that is a new autoimmune syndrome which it may be caused by persistent infection of the virus in Hidden Reservoir that leads to confuse the immune system that something is wrong with the in the body that needs to be attacked and the reason we think this is the case is by because 70 of patients who are not hospitalized for covid-19 will come to see us in the clinic are women we know that women are more likely than men to develop autoimmune diseases like multiple sclerosis rheumatoid arthritis lupus and so on and that there is a higher prevalence of autoimmune diseases in the lung with patient compared to the U.S population in addition we have seen patients developing autoimmune disease after developing long covid at a time where there that was not supposed to happen for example an 80 year old lady who developed develops rheumatoid arthritis after you know developing lung codeine as of today I've seen more than 1650 patients in my neurocabit clinic at Northwestern Medicine and they all have neurologic manifestation of long covid which is also called post-acute sequela of sarskov-2 infection or pasque about 15 of patients were previously hospitalized uh in the uh with the severe pneumonia uh sometimes requiring intubation in the ICU during which uh they had a number of complication affecting their nervous system and then when they come out of the hospital they still have some neurogic problem of various sorts however 85 percent of the patients in the clinic never was hospitalized in because of covered pneumonia they had a mild case of let's say sore throat or a bit of fever that went away but thereafter they've developed those lingering and debilitating manifestation of long covid which include brain fog headache dizziness problem with smell and taste muscle pain tingling blurry vision and ringing in the ears associated with intense fatigue those people who were never hospitalized are usually female in their 40s previously healthy who did not have any uh you know major neurologic problem before they developed those manifestation of broncoving wow so I think it's easy to understand that if somebody's in the ICU and they have a stormy course that afterwards they might have some sequelae but it's a lot more difficult to understand that someone who just had mild symptoms and you know a flu-like illness that was coveted suddenly doesn't get better and this lasts for months or longer certainly so we opened the clinic in May 2020 during the lockdown in Chicago and we have seen patients who develop those symptoms back in the spring of 2020 who still have those symptoms we ask patients who come to the clinic how much percent recovered you are compared to before Kobe if you say 100 you're back to normal and we see that some patients tend to improve quickly especially if they only have this sort of smell and taste with them to improve faster but if they had brain fog or headache or other manifestation these tend to last longer everybody tends to improve over time but going on their own pace and we can't predict based on a group that long covered is only going to last for a certain period of time some patients still have long covid more than two years after being sick in the first place sometime with a very mild illness now I think there was I don't know I've definitely heard some talk that these symptoms you know they're kind of vague I'm tired I have brain fog is there any way to objectify these findings to Sir to demonstrate that they're not just psychosomatic excellent question and unfortunately a lot of people who come to our Clinic uh tell us that uh they've not been taken seriously but mental establishment um and that those non-specific symptoms have been choked to stress you know uh especially during pandemic time um or psychosomatic issues which is really not the case what we do we give patients a questionnaire which are validated patient reported outcome measure information system or promise questionnaire asking them for their quality of life for their self-perceived concave ability fatigue anxiety depression and sleep disturbance and based on those valid measures that have been you know asked to a very large number uh of people in the US population we can tell that their quality of life is worse than a U.S normative population for the same you know uh questions the same domains now as a neurologist my instinct would be if I were to see a patient like this to do a neurologic examination and probably follow up with an MRI of the brain and an EEG and maybe even spinal fluid what's the likelihood I'm going to find any abnormality that I can describe um in these patients every patient who come to the clinic either in person or Intel exit has a one hour appointment with us where we do a complete neurologic history um in a complete nordical exam and uh in most cases especially in patients who are never hospitalized with pneumonia the Nordic exam is unremarkable except for their cognitive dysfunction patients who have an MRI really have abnormal findings and unless there were severely certainly six uh sorry unless they were severely sick in the hospital with coveted pneumonia intubated in the ICU or they may be older and had some other you know brain issues prior to kovid and uh patients who get a spinal tap really have abnormal finding on the CSF exam as well and so we don't perform those tests routinely in our patient population you mentioned the EEG we only perform an EG if we think that there may be a risk of seizures but we haven't seen that in our local population unless they had seizures before Kobe all right well Dr krolic I want to push you a little bit um I understand that there are objective cognitive findings on these various questionnaires but isn't it true that these could also occur in patients who have depression for example that would have objective cognitive deficits certainly and we ask patients if they had depression and anxiety before covid and we see that there is a higher prevalence of depression and anxiety in patients who are never hospitalized with covid-19 40 of them said that they had some depression anxiety before covid Which is higher than the general U.S population whereas the rate of the personal anxiety is about 10 in those who were hospitalized with coveted pneumonia so this is something that is relevant for this population of patients but that still means that 60 percent of patients who come to see us never had depression and anxiety before kovid and then the develop debility in brain fog and the communities function that prevent them in their daily activity and that can be being a nurse in the ICU being a business person managing hundreds of people or being a teacher in high school and this is something that is real unfortunately um and that leads to severely decreased quality of life in those people and also economic hardship as they are not able to function the way they were before Kobe all right so given that is there any way to prevent long covid for example vaccination you can still get coveted once vaccinated and it's generally less severe does that help prevent the sequela of covid so we always encourage our patients to follow the guidelines of the CDC that says that should be vaccinated and boosted um they have been some um urban legends coming around saying that vaccination either cures long covid or either or otherwise makes long kovid worse we have looked at that in our population of the the first hundred patients who came to the clinic who are not hospitalized and we follow them up you know after the for a second visit and we saw that vaccination did not do either did not you know cure long covet or did not make long covet worse um we on large population of patients that have been studied it looks like a long covid which was occurring about 30 percent of people who survived covid-19 before vaccination has that vaccination or boosting has only decreased the incident by 15 percent so that means that you know despite vaccination and boosting you still have about 25 percent risk of developing kovid it varies from population to population obviously right now we don't know what is the exact number of people who get infected because most people get diagnosed with the rapid test at home but unfortunately vaccination boosting does not prevent long covid people can also get first second or third infection with covid-19 and develop blancovin and we see those patients in our clinic right let me follow that up with another question some patients with covert get treatment with Pax lovid or antibodies does that seem to have any uh relevance to whether they get long coveted or not well you've heard about uh cases of patients who got treated with taxlobin and then got a rebound of their covet symptoms um and uh right now you know those patients have not been studied in uh organized fashion um you may hear about some cases who come to the clinic and you know they may be uh interesting but that they haven't been studied uh as a group the National Institute of Health is currently organizing a treatment trial of uh two weeks of tax lovid for patients with long covid um and this is at the development phase so we don't have you know any information based uh you know in addition that the the trial is in the works now we do have treatments we have many treatments for autoimmune diseases is that something you would consider so this is something that should be looked at um if lonkovid is indeed an autoimmune disease it would may be amenable to immunomodulation but um further research is needed and I have an active basic science laboratory that he is looking at those issues comparing the immune response of long-covid patients compared to those who got covered cut over it and don't have any other symptoms also known as asymptomatic covet convalescent and we see striking difference between immune response against saroscopal protein in those two groups are you still seeing patients in your covet Clinic is that something patients should consider we are seeing between 50 and 70 new patients a month in the neural Clinic as well as in the comprehensive covet Center at Northwestern Medicine which was created for the total care of patients with long covid this is a 12 specialty clinics these are 12 specialty clinics including pulmonology Cardiology GI Endocrinology ENT Rheumatology Psychiatry and endocrinology among others where we have specialists in these different disciplines that are seeing patients with various various complications of broncovid in their clinics since long kobit is a multi-system syndrome Dr kralik I think we're running out of time is there anything you'd like to add before we close an important aspect is that at the people need to be aware that or a physician need to be aware that at the beginning of the pandemic in the spring of 2020 patients could not get tested by nasal swab unless they were hospitalized in the hospital you know hospitalized we covid-19 pneumonia and we estimate that about 10 million people in the U.S got covered got long covered but could not be diagnosed in time and those patients are suffering just the same as the Kobe positive long holders but they get even more rejected and stigmatized and since those patients are mainly female in their 40s it is really unfortunate we see those patients in our Clinic we do not request physician referral or a positive copy test to come to see us at our comprehensive covet Center and we take care of those patients just the same they are just diagnosed with the post-viral syndrome which uh but they are taken care of just the same as the covet positive patients Dr quranic I want to thank you very much for sharing your insights experience and research with Medscape I I'm Dr Andrew Wilner thanks for watching [Music] [Music]

Channel: Medscape

Views: 51,698

Keywords:

Id: L4I023nDxlA

Length: 16min 48sec (1008 seconds)

Published: Thu Jan 19 2023