Lead Marketing Strategist, Allegheny Health Network

Dana Allwein

As more people receive the COVID-19 vaccine, a sense of normalcy is emerging for the general population. But others are burdened by neurological complications after having the virus, and they’re looking for help.

Kevin M. Kelly, MD, PhD, an Allegheny Health Network (AHN) neurologist, is answering that call with a research study to determine which parts of the brain are causing these problems. Even people who had the virus and only experienced mild symptoms tell doctors they’re dealing with issues as frustrating as having “brain fog” or as alarming as losing their memory.

As many as 1 in 3 infected with COVID-19 have longer-term neurological or mental health symptoms.

“We want to validate what these patients are feeling and living with by assessing which parts of their brains are affected and then making a plan to help them,” Kelly said. “We don’t have enough information yet, so we can’t tell patients when they’ll get better. This is a way to get to the source of the problem.”

Experts speculate that these neurological issues come about after COVID-19 triggers an inflammatory response in the brain.

A recent study found that as many as 1 in 3 people infected with COVID-19 have longer-term neurological or mental health symptoms. It involved the electronic health records of more than 236,000 COVID-19 patients. Results showed that 34% of COVID-19 survivors received a diagnosis for a neurological or psychological condition within six months of their infection.

Kelly’s study involves using the Neurolign Dx 100™, a high-tech goggle that assesses brain function using eye-tracking technology. He said the data will provide information about which pathways of each patient’s brain has been compromised.

“The eyes are the window to the soul, as well as the brain,” Kelly said. “Using 22 different metrics, we can get some answers.”

Patients in the study put the Neurolign goggles over their eyes. A computerized voice asks them to follow an illuminated dot as it moves and jumps across the screen. For 20 minutes, the device delivers a comprehensive set of oculomotor, vestibular, and reaction time (OVRT) tests while capturing eye and motor reflexes and responses.

Eye movement irregularities are captured as images, analyzed against algorithms, and consolidated into reports that may provide valuable insight into a patient’s neurological health. Kelly used a similar device in past studies to successfully gather information about concussions in high school athletes.

The study’s enrolling patients 18 to 45 who had COVID-19 and experienced no, mild, or severe symptoms and now have neurological complications. Patients’ symptoms can vary — from headaches, dizziness, confusion, memory loss, and reduced alertness to ataxia, stroke, and seizures.

Kelly discussed a 39-year-old patient who recovered from COVID-19 late last year and, months later, says, “I just don’t feel right.” He’s having memory lapses, struggling with multitasking, and oftentimes has to deliberately think of what he needs to do next at work.

“It can be scary and frustrating for these patients,” Kelly said. “They may have employers who don’t believe them, family and friends who think they’re being lazy, and physicians who may doubt the patient.”

“The goal is to provide patients with the help they need,” Kelly said. Results of the study will show if a patient would benefit from services, such as physical therapy, nutrition counseling, a sleep specialist, and cognitive behavior therapy.

AHN recently opened a specialized clinic to address all of these unique health needs of patients recovering from COVID-19 and experiencing its longer-term effects. The myriad of issues that doctors are seeing patients deal with range from neurological and pulmonary, to heart and vascular problems, to chronic fatigue, headaches, and post-traumatic stress disorder.

The AHN Post-COVID-19 Recovery Clinic is led by AHN’s Division of Pulmonary and Critical Care and is based at AHN Wexford Health + Wellness Pavilion. Participating physicians, like Kelly, are located at hospitals throughout the network, and they offer both telemedicine and in-person appointments.

“We want to put a story together as to what is causing each patient’s symptoms, monitor them for improvement, and provide multifaceted care to those who don’t progress,” Kelly said.

For more information about the project, contact Dr. Kelly at 412-359-8850.

REFERENCES
1.Taquet M, Geddes JR, Husain M, Lucian S, Harrison PJ. 6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19: a retrospective cohort study using electronic health records. 

. 2021;8(5):416-427. doi:10.1016/S2215-0366(21)00084-5
2. Kelly KM, Kiderman A, Akhavan S, et al. Oculomotor, Vestibular, and Reaction Time Effects of Sports-Related Concussion: Video-Oculography in Assessing Sports-Related Concussion. 

. 2019;34(3):176-188. doi:10.1097/HTR.0000000000000437

Neurolign Dx 100 is a trademark of Neurolign Technologies Inc., and is used with permission.

Articles

COVID-19’s Effect on the Brain

Talking on the phone with her husband, all of a sudden, Gwen Prokovich couldn’t speak. The words were stuck in her head. She couldn’t translate them from her brain to her voice.

“I lost my speech for about two minutes, so it was definitely frightening,” said Gwen, 53, and a first grade teacher in the Riverside Beaver County School District.

The minutes felt like hours to Gwen, but her speech eventually returned. Wanting to know the cause, she made an appointment with her primary care physician. For years, Gwen had suffered with migraines, so doctors suspected they caused her temporary speech loss.

But after Gwen met with AHN specialists, her scans painted a different picture.

She had an aneurysm on the right front side of her brain, a middle cerebral artery bifurcation aneurysm. If the bulging artery bursts, Gwen could have a disabling stroke or even die.

“No one can predict a stroke, so prevention is always better,” said Dr. Russell Cerejo, AHN interventional neurologist, who met with Gwen and explained her treatment options.

The standard for minimally invasive brain aneurysm treatment is coil placement. But many patients need multiple coils to fill the aneurysm and sometimes additional devices are needed to support the coils. And the more devices used to treat an aneurysm, the higher the risk for complications.

“This aneurysm had an irregular shape, which made it a higher risk for rupture,” Dr. Cerejo said. “And Gwen preferred to have something done and didn’t want to take the watchful waiting approach.”

Flow diversion is another endovascular option. Instead of placing a coil inside the aneurysm sac, a stent is placed in the parent blood vessel to divert blood flow away from the aneurysm. But in Dr. Cerejo’s experience, some patients’ anatomy don’t match the device seamlessly, making it ineffective.

Other complex brain aneurysms, like Gwen’s, can be treated safely with traditional open surgery if they’re in a shallow enough location. But recently, the U.S. Food and Drug Administration (FDA) approved a new device for challenging aneurysms — the Woven EndoBridge® (WEB).

Shaped like a tiny marshmallow surrounded by woven wires, the WEB device is inserted into a patient’s groin or wrist through a catheter. Threaded into the aneurysm sac, the WEB conforms to the shape of the aneurysm, stopping blood flow and creating a scaffold for long-lasting treatment.

Unlike traditional coil devices, only one WEB device is necessary to treat an aneurysm. In fact, in a study called the WEB-IT pivotal trial,1 the WEB device demonstrated 84.6% adequate sealing. It also proved safe for aneurysms that are difficult to treat with standard coils and adjunct devices. eurologist, who met with Gwen and explained her treatment options.

In the last few years, more than 10,000 WEB devices have been used worldwide to treat aneurysms.

And although it had just recently been approved in the U.S., Gwen didn’t hesitate to choose the WEB.

“For me, watching and waiting was not an option because every time I had a headache and any little twinge, I would worry it was rupturing,” Gwen said. “And the clip and coil had risks, so I said if we’re doing this new device, let’s get it going.”

Gwen had the one-hour procedure in March and returned home the next day. She said the only pain she dealt with was bruising in her groin where the catheter was inserted.

“I didn’t even have a headache. It really worked out perfectly.”

Dr. Cerejo explained how the device has made a complex procedure much simpler. “We deploy the device into the aneurysm, detach it, pull the catheters out, the patient wakes up from anesthesia, spends a night in the hospital, and can leave as soon as the next day.”

“What makes the WEB device so unique and promising for many patients is that it is a single implant that serves a dual role — it seals the aneurysm and diverts blood flow away from it, all without an open cranial procedure.”

Six months after the procedure, Gwen is preparing for the start of the school year. Her follow-up angiogram confirmed the device was still doing its job, and she’s feeling confident about her health.

“I’m anxious to be back with the kids. I feel like I was extremely well cared for, and now it’s time to return to the classroom and get started.”

REFERENCE
The WEB-IT Clinical Study (WEB-IT). Updated May 5, 2021. Accessed January 18, 2022. clinicaltrials.gov/ct2/show/NCT02191618

The WEB™ Aneurysm Embolization System is manufactured by MicroVention Inc. and device images are used with permission. WEB™ Aneurysm Embolization System is a trademark of MicroVention Inc. and is used with permission.

Recently, the U.S. Food and Drug Administration approved a new device for challenging aneurysms — the Woven EndoBridge®, or WEB.

Double Duty: Groundbreaking Device Seals and Diverts Blood From Brain Aneurysms

For many patients, obesity doesn’t just affect their lifestyle, it affects their health. Conditions related to obesity include heart disease, stroke, and diabetes. And in some cases, death.

“Their day is ruled by questions like, ‘What am I going to eat next?’” said Neurosurgeon Donald Whiting, MD, system chair, Allegheny Health Network Neuroscience Institute. “Despite trying virtually every weight loss approach, they are still hungry, they can’t lose weight, or they lose it but can’t keep it off.”

That’s why Dr. Whiting is studying whether deep brain stimulation (DBS) could be a solution for these patients. Working in the same way that a pacemaker does for the heart, the treatment sends electrical signals directly to the brain.

“The ideal candidate for this procedure is someone who has met all the criteria for gastric bypass, had surgery, but still didn’t lose enough weight,” said Dr. Whiting. “We want to target the part of the brain that controls metabolism as well as hunger and cravings so we can help people change the pattern of weight gain. In effect, their metabolic balance will be modified.”

Electrical Signals to Regulate Metabolism and Hunger

To perform deep brain stimulation surgery for obesity, Dr. Whiting places an electrode into each side of the brain. The electrode is just deep enough to reach the lateral hypothalamus, which is responsible for feeding behavior.

“Deep brain stimulation has been hugely successful for movement disorders like Parkinson’s,” said Dr. Whiting. “The electrodes help to regulate brain activity—sort of like how a thermostat regulates a furnace—by supplying a low-level electrical current to the part of the brain that needs to be regulated.”

Initially, Dr. Whiting and his fellow surgeons found that a small area of the brain, the lateral hypothalamus, just a couple of millimeters in size, was reactive at higher frequencies than is needed to correct movement disorders. The next step was to find the right amount of electrical current.

Dr. Whiting thinks of the DBS electrodes like an old transistor-style radio. If you’re not on a station at the right frequency, you get static—or no signal at all. With that, part of their research focused on identifying which electrical settings would most likely change the metabolic rate enough to start weight loss.

“Once we found the right setting—which we found could dramatically boost metabolism—we were able to set it at that setting and let it go in the patients in our study,” said Dr. Whiting. “And some lost weight.”

The electrodes placed in the brain are on continuously, keeping that portion of the brain at a consistent set-point for weight loss. Dr. Whiting said the electrodes can be put in and removed without consequence. “The procedure is reversible and adjustable.”

Dr. Whiting and his neuroscience team have been leaders in using DBS to successfully treat patients with movement disorders, such as Parkinson’s disease, and psychiatric disorders, including obsessive-compulsive disorder. Obesity is another possible clinical application for DBS.

“We’re currently moving into the second phase of researching DBS for weight loss,” said Dr. Whiting. “We suspect everyone is born with a set point for weight, and that we think we may be resetting patients’ weight thermostats with DBS. Continuing our study will help us know if that is true, and that the associated weight loss is permanent.”

Deep brain stimulation has been used to successfully treat patients with movement disorders and psychiatric disorders, and obesity has emerged as another possible clinical application.

Dana Allwein

Articles

COVID-19’s Effect on the Brain

Double Duty: Groundbreaking Device Seals and Diverts Blood From Brain Aneurysms

Mind Control: Battling Obesity with Brain Stimulation

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