2023-07-24 15:50:35
The neurological disorders associated with Covid-19 have become less frequent in the successive pandemic waves, up to now being classified as “very rare”. Up to more than 70% of those who have experienced them have shown a complete resolution of the symptoms, which however have continued for more than 6 months since the infection in about 30% of patients. Cognitive problems are the most persistent, and for this reason included among the manifestations of the Long Covid syndrome. These are the main results of the ‘Neuro-Covid Italy’ study which investigated the neurological complications of Sars-CoV-2 infection, involving 38 Neurology Operating Units in Italy and in the Republic of San Marino, for a total of 160 neurologists and 2 thousand patients. The work was published in ‘Neurology’, the official journal of the American Academy of Neurology.
Promoted by the Italian Society of Neurology (Sin), the project was coordinated by Carlo Ferrarese, director of the Neurological Clinic of the University of Milano-Bicocca at the Irccs San Gerardo dei Tintori Foundation in Monza. Creators the researchers of the State University of Milan Vincenzo Silani (director of the Neuroscience Department of the Irccs Auxologico of Milan) and Alberto Priori (director of the School of Specialization in Neurology and of the Neurological Clinic at the San Paolo University Pole of the Asst Santi Paolo e Carlo of Milan), and of Milano-Bicocca (Ferrarese). The study was presented to the Auxologico Ethics Committee on March 26, 2020 and lasted 70 weeks, from March 2020 to June 2021, with a subsequent follow-up in December 2021.
“The neurological disorders associated with Covid-19, collectively referred to by the term ‘neuro-Covid’, are among the most alarming, controversial and least understood aspects of the recent pandemic,” the experts recall. These are “different symptoms and diseases – they list – from acute encephalopathy (severe confusional state, with disorientation and hallucinations) to ischemic stroke, cerebral hemorrhage, concentration and memory difficulties, chronic headache, reduction of smell and taste, some forms of epilepsy and inflammation of the peripheral nerves”. Out of almost 53 thousand patients hospitalized for Covid-19, about 2 thousand were affected by neuro-Covid disorders and were followed up for at least 6 months after diagnosis, in order to analyze the evolution of the disorders.
Cognitive problems the most persistent, from memory deficit to decreased attention
“A first important figure”, highlights Simone Beretta, neurologist at IRCCS San Gerardo and first author of the study, indicates that “neuro-Covid disorders have gradually become less frequent with each subsequent pandemic wave, going from about 8% of the first wave to about 3% of the third. This is regardless of the respiratory severity of the virus and before the arrival of vaccines. The most probable reason for this reduction therefore seems to be linked to the variants of the virus itself, which passing from the original Wuhan to the Delta made the virus less dangerous for the nervous system. With the Omicron variant and the use of vaccines, the situation has further improved and neuro-Covid disorders have now become very rare”.
The second figure that emerged from the work concerns neurological recovery in the months following the infection. “In over 60% of patients – reports Ferrarese – there has been a complete resolution of neurological symptoms or the persistence of mild symptoms, which do not prevent the activities of daily life. This percentage reaches over 70% for patients of working age, between 18 and 64 years of age. However, we must not forget – he specifies – that in about 30% of patients the neurological symptoms lasted more than 6 months after infection. This is especially true for patients with stroke associated with the infection from Covid, which in the first waves were also burdened by a high intra-hospital mortality”.
“But also for cognitive, concentration and memory disorders – the specialists remark – the resolution of symptoms was much slower than for other neurological conditions, so much so that it fell into what has been called long-Covid syndrome” and which many of the neurological centers involved in the project are monitoring.
Experts warn, ‘monitoring disease progress over the years, the numbers could be important’
“If, when and to what extent Sars-CoV-2 infection can lead to an increase in the risk of neurological diseases related to it over the years, obviously remains to be studied”, Priori points out. “Given the data of the pandemic that has just ended – he warns – the numbers could hypothetically be important. This implies that European health systems, as well as scientific societies, will have to carefully monitor the neuro-epidemiological picture and dedicate specific resources to this observation over time”.
“The Neuro Covid Italy study makes us proud – comments Silani – for having early intuition of the involvement of the nervous system in the pandemic linked to Covid and thus having determined the collection of data in the Peninsula, tracing a first assessment of the acute and long-term neurological impact of the pandemic”.
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