Neurological associations: Is there more to COVID-19 than we think?
The predominant symptoms of COVID-19 are widely recognised as being respiratory in nature (a high temperature, a new, continuous cough and a loss or change to the senses of smell and taste), but recent research funded by the National Institute for Health Research has highlighted a growing number of case reports recognising neurological manifestations.
A recent paper published in Lancet Neurology looks at a series of case reports and, whilst acknowledging a lack of detail in some reports, notes a number of neurological complications arising from COVID-19, including:
- Encephalopathy/encephalitis (inflammation of the brain caused by an infection or through the immune system mistakenly attacking the brain)
- Guillain-Barre syndrome (a rare disorder in which the body’s immune system attacks the peripheral nervous system)
- Anosmia (loss or change in sense of smell)
- Ageusia (loss or change in sense of taste)
- Cerebrovascular disease (a group of conditions, diseases and disorders that affect the blood vessels and blood supply to the brain).
The research group calls for careful clinical, diagnostic and epidemiological studies to help explain the implications of the neurological diseases directly or indirectly caused by the COVID-19 virus.
The psychological stress of the pandemic will have been experienced by most people to a greater or lesser degree – the fear of becoming severely ill, isolation from friends and family, the impact of social distancing, the effect on employment and income and the implications of an economic recession.
History tells us that following previous pandemics, the medical profession reported a rise in cases of mental health conditions in the population, including depression, anxiety and insomnia.
But what about conditions directly caused by the virus? A network of the major UK neuroscience bodies, including the Association of British Neurologists, the British Association of Stroke Physicians and the Royal College of Psychiatrists, has developed an online report portal from which they identified broad clinical syndromes associated with COVID-19, classified as:
- A cerebrovascular event
- Altered mental status
- Peripheral neurology
Just under a third of the patients within the clinical dataset presented with altered mental status, comprising encephalopathy or encephalitis or a new psychiatric or neuropsychiatric diagnosis (eg, psychosis, neurocognitive syndrome or affective disorder).
Implications for health and social care
The COVID-19 virus could lead to complications not only for those already living with neurological conditions, such as Parkinson’s disease, motor neurone disease, multiple sclerosis and cerebral palsy, but also for previously healthy patients who contract the virus.
We have already seen the challenges and the enormous impact on health and medical services as result of the COVID-19 virus, but what about the impact for the medium and longer term?
The British Society of Rehabilitation Medicine recently published a report highlighting the critical importance of rehabilitation in the acute care pathway, helping to relieve pressure on frontline services. To ensure seamless care, critical care, acute medical and specialist rehabilitation teams, with an identified Rehabilitation Medicine Consultant as an integral part of the acute pathway team, should work closely together to develop rehabilitation pathways for patients who are recovering following treatment in intensive and high dependency care.
With so many of the population infected by the virus, the number of neurological and psychiatric patients will have a huge effect on the UK’s future health and social care provision. The situation is rapidly evolving, and these surveillance studies provide valuable data that are critical to not only the clinicians treating patients, but also to health, social care and rehabilitation planners and policymakers.
At Clarke Willmott we work closely with our brain injured clients and their families. Understanding the stressors and implications of COVID-19 for our clients and the wider community is key to ensuring that the right care, support and rehabilitation is available to those whom we work with. If you have concerns about COVID-19 and acquired brain injury contact our team on 0800 316 8892 or contact us online.