Evaluation and treatment approaches for neurological post-acute sequelae of COVID-19: A consensus statement and scoping review from the global COVID-19 neuro research coalition

Jennifer A Frontera; Alla Guekht; Ricardo F Allegri; Mariam Ashraf; Betül Baykan; Lucía Crivelli; Ava Easton; David Garcia-Azorin; Raimund Helbok; Jatin Joshi; Julia Koehn; Igor Koralnik; M Netravathi; Benedict Michael; Annacarmen Nilo; Aynur Özge; Karanbir Padda; Gaia Pellitteri; Kameshwar Prasad; Marina Romozzi; Deanna Saylor; Adam Seed; Kiran Thakur; Derya Uluduz; Alberto Vogrig; Tamara M Welte; Erica Westenberg; Dmitry Zhuravlev; Mikhail Zinchuk; Andrea S Winkler

doi:10.1016/j.jns.2023.120827

Evaluation and treatment approaches for neurological post-acute sequelae of COVID-19: A consensus statement and scoping review from the global COVID-19 neuro research coalition

J Neurol Sci. 2023 Nov 15:454:120827. doi: 10.1016/j.jns.2023.120827. Epub 2023 Oct 13.

Authors

Jennifer A Frontera¹, Alla Guekht², Ricardo F Allegri³, Mariam Ashraf⁴, Betül Baykan⁵, Lucía Crivelli³, Ava Easton⁶, David Garcia-Azorin⁷, Raimund Helbok⁸, Jatin Joshi⁴, Julia Koehn⁹, Igor Koralnik¹⁰, M Netravathi¹¹, Benedict Michael¹², Annacarmen Nilo¹³, Aynur Özge¹⁴, Karanbir Padda¹⁵, Gaia Pellitteri¹³, Kameshwar Prasad¹⁶, Marina Romozzi¹⁷, Deanna Saylor¹⁸, Adam Seed¹⁹, Kiran Thakur²⁰, Derya Uluduz⁵, Alberto Vogrig²¹, Tamara M Welte²², Erica Westenberg²³, Dmitry Zhuravlev²⁴, Mikhail Zinchuk²⁴, Andrea S Winkler²⁵

Affiliations

¹ Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA. Electronic address: jennifer.frontera@nyulangone.org.
² Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia.
³ Department of Cognitive Neurology, Fleni, Buenos Aires, Argentina.
⁴ Department of Anesthesiology, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, NY, USA.
⁵ Department of Neurology, Istanbul University, Istanbul Faculty of Medicine, and EMAR Medical Center, Istanbul, Turkey.
⁶ The Encephalitis Society, Malton, UK; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.
⁷ Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
⁸ Department of Neurology, Neuro-Intensive Care Unit, Medical University of Innsbruck, Innsbruck, Austria; Department of Neurology, Johannes Kepler University, Linz, Austria.
⁹ Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany.
¹⁰ Departmentof Neurology, Northwestern Feinberg School of Medicine, Chicago, IL, USA.
¹¹ Department of Neurology, National Institute of Mental Health & Neurosciences, Bangalore, India.
¹² Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, UK; The Walton Centre NHS Foundation Trust, Liverpool, UK.
¹³ Clinical Neurology, Santa Maria della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy.
¹⁴ Department of Neurology, Faculty of Medicine, Mersin University, Mersin, Turkey.
¹⁵ Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA.
¹⁶ Chief Executive Office, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
¹⁷ Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Dipartimento Universitario Di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy.
¹⁸ Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia.
¹⁹ The Walton Centre NHS Foundation Trust, Liverpool, UK.
²⁰ Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA.
²¹ Clinical Neurology, Santa Maria della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy; Department of Medicine, University of Udine Medical School, Udine, Italy.
²² Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany; Department of Neurology, Center for Global Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
²³ Department of Neurology, Center for Global Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
²⁴ Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia.
²⁵ Department of Neurology, Center for Global Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway; Blavatnik Institute of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.

PMID: 37856998
DOI: 10.1016/j.jns.2023.120827

Abstract

Post-acute neurological sequelae of COVID-19 affect millions of people worldwide, yet little data is available to guide treatment strategies for the most common symptoms. We conducted a scoping review of PubMed/Medline from 1/1/2020-4/1/2023 to identify studies addressing diagnosis and treatment of the most common post-acute neurological sequelae of COVID-19 including: cognitive impairment, sleep disorders, headache, dizziness/lightheadedness, fatigue, weakness, numbness/pain, anxiety, depression and post-traumatic stress disorder. Utilizing the available literature and international disease-specific society guidelines, we constructed symptom-based differential diagnoses, evaluation and management paradigms. This pragmatic, evidence-based consensus document may serve as a guide for a holistic approach to post-COVID neurological care and will complement future clinical trials by outlining best practices in the evaluation and treatment of post-acute neurological signs/symptoms.

Keywords: COVID-19; Diagnosis; Evaluation; Management; Neurologic; SARS-COV-2; Therapeutics; Therapy; Treatment.

Publication types

Review
Research Support, N.I.H., Extramural

MeSH terms

Anxiety / etiology
Anxiety / therapy
COVID-19* / complications
Cognitive Dysfunction*
Consensus
Diagnosis, Differential
Disease Progression
Dizziness / diagnosis
Dizziness / etiology
Dizziness / therapy
Humans