COVID-19’s Impact on Neurological Disorder Pathology

As the 2020 calendar year concludes, NeurologyLive took the time to look back and reflect on how COVID-19 and the pandemic have impacted clinical care across a range of different conditions and treatment strategies. The third segment of “Reflections on the Impact of COVID-19: A Short Expert Series,” covers how the virus influenced changes to neurological disorders and their pathologies.

A main concern for clinicians, especially towards the beginning of the COVID-19 pandemic, was whether a patient with a neurologic disorder would be more severely impacted if they contracted the virus.

In July, the first dataset on patients with Parkinson disease (PD) and COVID-19 was released, which identified a number of consequences as a result of the virus for those with chronic neurologic disorder. The dataset, compounded by the Michael J. Fox Foundation for Parkinson’s Research, demonstrated that 55% of patients with PD who were infected reported a worsening of present motor symptoms, such as tremor, slowness, or balance issues, as well as more than half of the patients reporting worsening of nonmotor symptoms such as mood issues, gastrointestinal challenges, pain, and fatigue.

Months later, a study presented at the 2020 MDS Virtual Congress, September 12–16, 2020, showed that patients with PD or who were post-stroke struggled to maintain routine activities due to lockdown procedures, leading to a major negative impact on health, function, and well-being.

A large amount of discussion surrounding the virus was about its associations with stroke and an increased incidence. Recently published research confirmed these thoughts in a subset population and found that COVID-19-positive patients who have hypertension and type 2 diabetes are more likely to experience neurological complications such as intracranial hemorrhage and stroke. Episode 11 of the Mind Moments podcast included a conversation with Shadi Yaghi, MD, associate professor of neurology at NYU Grossman School of Medicine, who offered his perspective on a recent study he and his colleagues conducted of patients with stroke and COVID-19 and the difficulties in understanding their relationship.

Having COVID-19 at onset of stroke was also associated with more than twice the mortality rate of other patients with stroke and worse outcomes, according to a study from English and Scottish stroke centers.

Questions were also raised whether a patient with a more severe neurologic condition may be more prone to worse infection. A look back at our conversation with Asaff Harel, MD, neurologist, Lenox Hill Hospital, who found associations between Expanded Disability Status Scale (EDSS) score ≥6 in patients with multiple sclerosis (MS) with COVID-19 led to an increased rate of hospitalization.

Clinicians have been able to establish associations between the virus and neurologic disorders and their potential worsening, but the data varies from each condition. Click the links below to read more about those associations.

• WATCH MORE: Jennifer Frontera, MD: Neurologic Implications of COVID-19 Infection
• READ MORE: EEG Abnormalities in Acutely Ill Patients With COVID-19
• READ MORE: Severe COVID-19 in Multiple Sclerosis Linked to Disability Status, Age, Obesity
• READ MORE: Higher Rates of Stroke Observed With COVID-19 Than Influenza