BRAIN And COVID-19- M.A.Aleem Neurologist #Trichy #Tamilnadu #India

COVID-19 and BRAIN

-PROF DR.M.A.ALEEM M.D., D.M.,(NEURO)

EMERITUS PROFESSOR OF NEUROLOGY

THE TAMILNUDU DR.M.G.R. MEDICAL UNIVERSITY

PAST PRESIDENT TAMILNADU PONDICHERY ASSOCIATION OF NEUROLOGISTS

FORMER OF VICE PRINCIPAL HOD& PROFESSOR OF NEUROLOGY KAPV GOVERNMENT MEDICAL COLLEGE& MGM GOVERNMENT HOSPITAL

CONSULTANT NEUROLOGIST AND EPILEPTOLOGIST (TRAINED AT INSTITUTION OF NEUROLOGY QUEEN`S SQUARE . LONDON.UK.) ABC HOSPITAL, ANNAMALAI NAGAR , TRICHY -620018

SECRETARY NEUROLOGIST ASSOCIATION TIRUCHIRAPPALLI

DIRECTOR ABC HOSPITAL TRICHY

drmaaleem@hotmail.com

COVID-19 is the infectious disease caused by the most recently discovered coronavirus. This new virus and disease were unknown before the outbreak began in Wuhan, China, in December 2019 . It predominantly affects the lungs and the direct evidence of this viral infection in the nervous system is rare. But the nonhuman coronaviruses that they are capable of being neurotropic.

However COVID-19 can affect anyone whose neurologic condition causes breathing problems, such as amyotrophic lateral sclerosis (ALS), Parkinson’s disease, and some muscular dystrophies. People whose immune systems are compromised or who take immune-suppressing drugs—such as those with multiple sclerosis (MS), myasthenia gravis, and neuromyelitis optica—are also vulnerable. Other than this patients with neurological disorders like epilepsy , headache and dementia should also need some attention with COVID-19 infection

A. Neurological symptoms in COVID-19

The most common symptoms of COVID-19 infection are fever, tiredness, and dry cough. Some patients may have headache,body pain, nasal congestion, runny nose, sore throat or diarrhea. These symptoms are usually mild and begin gradually.

Some people become infected but don’t develop any symptoms and don't feel unwell. Most people (about 80%) recover from the disease without needing special treatment. Around 1 out of every 6 people who gets COVID-19 becomes seriously ill and develops difficulty breathing. Older people, and those with underlying medical problems like high blood pressure, heart problems or diabetes, are more likely to develop serious illness.

Neurological complications in COVID-19 infected patients have not been widely reported. Since elderly patients with chronic medical conditions are at an increased risk of altered mental status in the setting of any acute infections like COVID-19.

COVID-19 infected patients can have other neurological symptoms, manifested as acute stroke (6%), consciousness impairment (15%), and skeletal muscle injury (20%) . Elderly patients with chronic conditions are at an increased risk of altered mental status in the setting of acute infections. Since COVID-19 affects more the elderly and those with preexisting conditions, patients with prior neurological conditions and acute respiratory symptoms are at an increased risk of encephalopathy on initial presentation.

Alterations in mental status in 15% of severe cases and nonspecific symptoms, including headache and dizziness, in nearly 20% of cases are reported.

In the coronavirus epidemic most of the patients fall into high-risk categories that include older persons (generally 60 or older) and those with underlying medical conditions such as heart disease, lung disease, and diabetes.

People with neurologic conditions such as multiple sclerosis (MS), Parkinson's disease, Alzheimer's disease, amyotrophic lateral sclerosis (ALS), and myasthenia gravis, could also be on high risk side.

At the end stage of the coronavirus infection patients can get multi organ failure with brain involvement and the deaths attributed to respiratory failure with COVID-19 infection may due to brainstem involvement .

B. Epilepsy and COVID-19

Epilepsy is a common chronic neurological disorder, as such it doesn't increases the risk of getting COVID-19 infection and it will not increases the severity of COVID-19.

Until now, there is no evidence of a direct effect of COVID-19 on seizures or epilepsy. However, patients may experience worsening of seizures due to systemic illnesses, drug interactions, decreased access to antiseizure medications and increased stress. People with epilepsy require appropriate counselling and attention in these areas.

There are a few factors which may increases the risk from COVID-19 for a person with epilepsy

Some people with epilepsy regardless of their seizure control may have other health conditions and that may put them at higher risk from COVID-19. Sometime epileptic patients may take the medicines to control the seizures that can affects their immunesystem (for example, ACTH ,steroids, Everolimus and immunotherapies).

It is important to note that the most seizure medicine as such do not affect the immune system.

Some people with epilepsy may have other neurological or developmental issues that may affect their immunity. People in these situations are at greater risk of developing more severe symptoms with viral illnesses.

In some other situations, people with epilepsy may have other medical problems and that could place them at higher risk of developing more severe symptoms with COVID-19

For example, people who have problems of swallowing or frequently inhale food or liquids into their lungs (aspiration) are at higher risk for pneumonia. This may also sometime happen during seizure episode.

Epileptic patients with diabetes or underlying heart or lung problems are also appear to be at a higher risk for severe COVID-19.

C. Parkinson's disease and COVID-19

Parkinson's disease (PD) is the one of the common neurological problem in aged population. Symptoms of Stress and anxiety due to COVID-19 infection definitely increases both the motor- and non-motor symptoms can be exacerbated the PD symptoms.

If a PD patient is on a ventilator due to COVID-19, medications for PD should be given through a endotrachial tube which is placed through the nose and into the gastro-intestinal tract for delivery of medication and food.

Sometime in patients with PD , hallucinations may start in a person who never experienced that symptom before in the presence of viral infection like COVID-19.

In addition, people with PD may have the restrictive lung disease which refers to an inability of the lungs to fully expand with air. Restrictive lung disease can occur in PD because of rigidity of the muscles of the chest wall as well as due to bradykinesia, or slowness of the muscles responsible for chest wall expansion and contraction. People with PD may also have abnormalities in the posturing of their trunk including head drop, stooped posture, tilting of the trunk and bending at the waist. These postures can restrict the amount that the lungs can fill up. PD can also predispose a person to dysfunction of swallow and difficulty in clearing the secretions from their airway. These issues could contribute to development of complications during a respiratory illness like COVID-19 pneumonia.

People with more moderate PD can also start to experience decreased mobility, with more risk of falls with viral infections. As PD advances it can also cause additional problems including urinary dysfunction and weight loss. All of these elements can contribute to general frailty and increased risk of infection, including increased risk from COVID-19.

D. Dementia and COVID-19

Dementia is a common neurological disorder with memory loss in elderly and which does not increases the risk for COVID-19,

However, dementia-related behaviors, increased age and common other health conditions that often accompany dementia may increases the risk.

In addition, diseases like COVID-19 may worsen the cognitive impairment due to dementia.

For example, people with Alzheimer's disease and all other dementia in addition to cognitive impairment may forget to wash their hands or take other recommended precautions to prevent the COVID-19 illness.

E. Stroke and COVID-19

With COVID-19 infection the risk for cerebrovascular events, including both the ischemic and the hemorrhagic strokes are high . It's not surprising to see that the incidence of these disorders in direct proportion to COVID-19 disease severity.

F. Headache and COVID-19

Those living with migraine and other disabling headache disorders will continue to require care in the presence of COVID-19 infection.

As mentioned above, each patient with headache should work closely with their health care provider to determine the optimal treatment for their acute migraine attacks. This includes options for ‘rescue therapies’ for headache pain that doesn’t respond to their usual first-line acute treatments. Having first-line, second-line, and rescue treatment options may prevent the need to visit an emergency department or urgent care where the risk of exposure to and transmission of COVID-19 is increased.

Anyone taking non-steroidal anti-inflammatory (NSAID) drugs (for example, ibuprofen) should know that no evidence suggests NSAIDs will worsen COVID-19 infections, but they might suppress a fever thus masking one of the warning signs of COVID-19, according to the World Health Organization

G. Smell and taste

COVID-19 could target the central nervous system, possibly infecting neurons in the nasal passage and disrupting the senses of smell and taste.

loss of sense of smell or taste may also be clues to COVID-19

As of now the data are still limited on whether coronaviruses have a significant neurologic component.

H.Facts About COVID-19

1.COVID-19 virus can be transmitted in areas with hot and humid climates

2. Cold weather and snow CANNOT kill the new coronavirus.

3.Taking a hot bath does not prevent the new coronavirus disease

4.The new coronavirus CANNOT be transmitted through mosquito bites.

5. Hand dryers not effective in killing the new coronavirus.

6.An ultraviolet should not be used asdisinfection lamp to kill the new coronavirus

7. Spraying alcohol or chlorine all over your body will not kill the new coronavirus

8. Regularly rinsing your nose with saline will not help to prevent infection with the new coronavirus

9. Eating garlic have no evidence to help toprevent infection with the new coronavirus

10.Wash your hands frequentl

11. Maintain social distancing

12. Avoid touching eyes, nose and mouth

13.Practice respiratory hygiene