COVID-19 is not only a respiratory illness, but it can trigger several neurological disorders as well, says DR Rajnish Kumar
If you feel COVID-19 is a respiratory disease then you need to think again. As a day passes, it has been emerging as the biggest threat to trigger a huge range of neurological disorders. Stroke, anxiety, confusion and fatigue are the few names from the long list. There are many instances when people have complaint of challenges in staying focused, problems with the memory and extreme tiredness after the mild illness.
Neurological experts suggest that earlier nobody realised that the virus does cause problem in the brain and after much analysis they realised that there could be many factors including lack of oxygen flow to the brain, blood-clotting and a hyper-inflammatory response of the immune system that a patient might be going through. However, it is still not clear whether the novel virus itself is affecting the brain too. Though the recovery rate from the coronavirus infection has gone up, many believe that getting back home from the ICU is the beginning of much neurological disorder that a patient never had before.
There have been evidences from the past that how a massive lockdown had affected the brains of the people. During the end of World War I, a mysterious neurological syndrome known as encephalitis lethargica appeared and went on to affect more than a million people worldwide. There is limited evidence of its causes, and whether the trigger was influenza or a post-infectious autoimmune disorder is still unknown. Some patients had movement disorders that looked like Parkinson’s disease, which affected them for the rest of their lives.
What researchers say?
Neurologists are working hard to have a better understanding of how coronavirus infection is affecting their patients when various researches have estimated that the deadly virus is causing neurological impact. A recent researchers at the University College London (UCL) have studied the brain of 43 patients with confirmed or suspected COVID-19 infections who developed neurological symptoms, like inflammation, psychosis and delirium. The scientists identified 10 cases of temporary brain dysfunction with delirium, 12 cases of brain inflammation, eight cases of strokes and eight patients with nerve damage. Most of those with inflammation were diagnosed with acute disseminated encephalomyelitis (ADEM), a rare disease that the researchers said has increased in prevalence during the pandemic.
Whereas, when the research was conducted in aged patients, with an age group of 60 and above, it has been seen that they didn’t develop any respiratory problem but with the neurological disorder instead becoming “the first and main” symptom of COVID-19.
Even a study in China, has found out finds that the strokes, altered consciousness and other neurological issues are relatively common in more serious cases of COVID-19. They studied the 214 cases of severe coronavirus illness treated in Wuhan city during the early phase of the global pandemic, doctors reported that 36.4 per cent of patients displayed neurological symptoms including disorientation or confusion, headaches or even seizure. Some even had impairments in taste or smell
As the disease has been around for a matter of months, we might not yet know what long-term damage COVID-19 can cause. Doctors need to be aware of possible neurological effects, as early diagnosis can improve patient outcome. We’ve already seen evidence that COVID-19 can evoke an extremely strong immune response, which is called a cytokine storm. During a cytokine storm, the body overproduces immune cells and proteins to the point where they can attack tissues, leading to blood clots and organ failure in some cases. At this point, there’s so little data on these patients that these explanations are only ideas.
We now need detailed studies to understand the possible biological mechanisms ... so we can explore potential treatments. A prospective, observational study with a larger number of patients that includes more specific neuro-imaging and other diagnostic tests is warranted for more conclusive evidence. Research should focus on if responses like the cytokine storm can actually explain these neurological symptoms.
Similar to the UK, which has a surveillance programme called CoroNerve, India should also have such program on an urgent basis so that the physicians can report neurological symptoms of COVID-19 with the hope of better understanding the effect of the coronavirus on the brain.
The writer is Head of Department Neurology, Paras Hospitals, Gurugram