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  • Gonzalo Laje

Neurologic Symptoms and Treatment In COVID-19 and Long COVID



The COVID-19 SARS pandemic has passed its peak global virulence, but the effects are still being felt

with continued new infections as well as a cadre of patients who have post-acute sequelae of SARS CoV-2 infection (PASC), commonly known as “long COVID.” The World Health Organization (WHO) has

defined it as “the continuation or development of new symptoms three months after the initial SARS-

CoV-2 infection, with these symptoms lasting for at least two months with no other explanation.”

According to Yale Medicine, one study has estimated that 65 million people worldwide are suffering

from long COVID.


Neurologic Complications Related to COVID-19


Numerous neurologic and psychiatric symptoms are associated with COVID-19:

Anosmia (loss of smell)

Dysgeusia (loss of taste)

Headaches

Impaired consciousness

Coma

Abnormal sleep

Confusion

Agitation

Delirium

Ataxia (loss of motor skills)

Impaired executive function

Seizures


In addition to psychiatric features such as depression, anxiety, hallucinations, psychosis, and suicidality,

COVID-19 can also cause spinal disease, such as acute myelitis, with corresponding neurologic signs and symptoms. There have been rare cases where a patient with COVID-19 has also been diagnosed with autoimmune encephalitis. When a patient with COVID-19 presents with, or develops, severe

neuropsychiatric signs and symptoms consistent with encephalitis, a thorough clinical evaluation should

begin immediately, including investigation for sera and autoantibodies. As with many symptoms of

COVID-19, treatment of the neuropsychiatric symptoms of COVID-19 has followed the treatment of

these symptoms as they present in other circumstances where autoimmune


Long COVID Neuropsychiatric Issues


The course of COVID-19 generally lasts from 1-6 weeks, depending on the severity of the case. However, vaccinated people have a 5-10% chance of getting long COVID thereafter and a higher rate of 15-20% for unvaccinated people. Additional risk factors associated with the risk of developing neuropsychiatric symptoms include prior history of mental illness, the severity of COVID-19, female gender, the existence of comorbidities, and elevation in inflammatory markers.


While over 200 symptoms have been associated with long COVID, the WHO identifies two

neuropsychiatric symptoms, fatigue and cognitive dysfunction, as well as shortness of breath as the

most common among them. Additional neuropsychiatric symptoms associated with Long COVID are

depression, headaches, anxiety, sleep disturbance, psychosis, PTSD, executive dysfunction, and

attention and memory deficits. These symptoms are more likely to occur in older patients, particularly

those with a preexisting diagnosis of dementia.


The principal complaint of fatigue may be treated pharmacologically with stimulants along with

cognitive behavioral therapy and exercise-focused interventions. There is a growing body of data that

supports the efficacy of using low-dose neuroleptics and alpha-adrenergic blockers for managing

symptoms. An alternative treatment to “brain fog” is melatonin; however, this has not been clinically

demonstrated to be effective. As the understanding and presentation of long COVID continues,

additional treatments and interventions may prove to be effective as well.


The current treatment protocols for the neuropsychiatric symptoms of long COVID call for a

combination of pharmacological and other interventions. An effective team treating a patient with long

COVID should be able to offer these treatments in an integrated manner. To learn more about long

COVID and its treatment, contact Washington Behavioral Medicine Associates to schedule an

appointment to speak with one of our practitioners.



 

Director, WBMA

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