Peripheral Neuropathy Evaluations of Patients with Prolonged Long COVID
Neurology (American Academy of Neurology) Journal: Published on March,
2022
Severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2) can cause long-term disability (long COVID)
with new neurologic manifestations after even mild infections.
Reports of peripheral
neuropathy include Guillain-Barré syndrome, mononeuritis multiplex, brachial
plexitis, cranial neuropathies, and orthostatic intolerance, although some
studies included patients with potentially contributory conditions.
Various long COVID symptoms overlap with those of small-fiber polyneuropathy (SFN). Neuromuscular evaluations proved useful in most of these patients with long COVID. Authors prospectively analyzed a cross-section of patients with long COVID evaluated for incident neuropathy.
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This study investigated the clinical features
of peripheral neuropathy in long COVID syndrome. The authors enrolled patients
with long COVID and no history of neuropathy, who were referred to a tertiary
center for neuropathy evaluation. After a thorough neuropathy evaluation, 59%
of the patients were found to have an objective evidence of neuropathy in skin
biopsy, electrodiagnostic tests, or autonomic function tests. Interestingly,
most patients in this cohort had mild COVID-19.
The average age was 43.3 years and 68.8% of
the participants were female.
The pain score average was 4.8/10 and the
typical neuromuscular examination findings were a distal sensory loss to
pinprick and vibration and/or loss of the Achilles reflex.
The most common neuropathy phenotype was small fiber neuropathy (59%).
The treatment response was variable and
averaged 50% of the recovery (based on the patients' impressions of their
symptoms). Treatments comprised corticosteroids in 35.3% and IV immunoglobulins
(IVIg) in 35.3%. No complete recovery was noted in any of the patients.
Disabling small fiber neuropathy with an
inadequate response to immune therapy and incomplete recovery was observed in
patients with long COVID syndrome.
Interestingly, most of the patients in this cohort only had a mild COVID-19 infection. Clinicians should be aware of peripheral neuropathy, predominantly small fiber neuropathy, as part of long COVID syndrome.
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Background and objectives: Recovery from severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2) infection appears exponential, leaving a
tail of patients reporting various long COVID symptoms including unexplained
fatigue/exertional intolerance and dysautonomic and sensory concerns. Indirect
evidence links long COVID to incident polyneuropathy affecting the small-fiber
(sensory/autonomic) axons.
Methods: We analyzed cross-sectional and
longitudinal data from patients with World Health Organization (WHO)-defined
long COVID without prior neuropathy history or risks who were referred for
peripheral neuropathy evaluations. We captured standardized symptoms, examinations,
objective neurodiagnostic test results, and outcomes, tracking participants for
1.4 years on average.
Results: Among 17 patients (mean age 43.3
years, 69% female, 94% Caucasian, and 19% Latino), 59% had ≥1 test
interpretation confirming neuropathy. These included 63% (10/16) of skin
biopsies, 17% (2/12) of electrodiagnostic tests and 50% (4/8) of autonomic
function tests. One patient was diagnosed with critical illness axonal
neuropathy and another with multifocal demyelinating neuropathy 3 weeks after
mild COVID, and ≥10 received small-fiber neuropathy diagnoses. Longitudinal
improvement averaged 52%, although none reported complete resolution. For
treatment, 65% (11/17) received immunotherapies (corticosteroids and/or IV
immunoglobulins).
Discussion: Among evaluated patients with long
COVID, prolonged, often disabling, small-fiber neuropathy after mild SARS-CoV-2
was most common, beginning within 1 month of COVID-19 onset. Various evidence
suggested infection-triggered immune dysregulation as a common mechanism.
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