Neurology and COVID-19

As the COVID-19 pandemic developed and neurological manifestations were reported, concern grew that SARS-CoV-2 might directly invade neuronal cells. However, research throughout the year to address this concern has revealed a different story with inflammatory processes at its centre.

This year, the COVID-19 pandemic has altered neurological care in many ways. However, evidence indicates that people from marginalized ethnic and socioeconomic groups have been affected by these changes more than others, highlighting and amplifying existing health-care disparities.

The COVID-19 pandemic has posed unique risks to people with Alzheimer disease and dementia. Research from 2020 has shown that these people have a relatively high risk of contracting severe COVID-19, and are also at risk of neuropsychiatric disturbances as a result of lockdown measures and social isolation.

From the interruption of clinical trials by shelter-in-place orders to the challenges involved in safely collecting biofluid samples, drug development for neurological disease was hit hard by the COVID-19 pandemic this year. However, the field has responded with innovative solutions, and 2021 could see the therapeutic pipeline flowing again.

Many neurologists have used telemedicine during the COVID-19 pandemic. Studies have shown that videolinks in acute care can save personal protective equipment and protect staff. Furthermore, the telephone can provide supra-hospital care in Parkinson disease and manage patients with amyotrophic lateral sclerosis well. The primacy of face-to face care has been dented.

Rare neurological complications can occur after COVID-19 vaccination, but recent studies show that such complications are much more common after SARS-CoV-2 infection. Novel approaches to risk–benefit analysis such as Bayesian network models can integrate the latest global evidence with local factors to inform decision-making and support the global vaccination effort.

The neurological deficits caused by COVID-19, which were first reported in the early months of 2020, continue to intrigue neurologists and health-care professionals worldwide. As two new studies highlight, these manifestations are frequent and are expected to increase the burden of morbidity and mortality in the acute and chronic phases of COVID-19.

Detailed immunological analysis in a new study provides insight into the mechanisms of immune responses after SARS-CoV-2 vaccination in people who are receiving B cell-depleting therapy for multiple sclerosis. The findings have implications for clinical practice, but more questions about SARS-CoV-2 vaccination and immunosuppression remain.

In India, the peak of SARS-CoV-2 infections in May 2021 was paralleled by an outbreak of rhino-oculo-cerebral mucormycosis (ROCM) — a fungal infection affecting the nose, eyes and brain. This outbreak provided a unique opportunity to study the neurological manifestations of ROCM and to investigate new treatments for the condition.

The COVID-19 pandemic has added an additional layer of complexity to endovascular treatment (EVT) for acute ischaemic stroke. Drawing on recently published guidelines, this article provides a conceptual framework for EVT in the COVID-19 era, outlining key principles for ensuring safe and timely EVT while minimizing the risk of infectious exposure for health-care workers and patients.

The importance of reported neurological manifestations of coronavirus disease 2019 (COVID-19) is still unclear. Nevertheless, an immediate and ongoing neurological challenge posed by the COVID-19 pandemic is the management of patients who are undergoing immunotherapy for existing neuroimmunological disease.

Acute respiratory distress syndrome is a common occurrence in COVID-19, an infectious disease caused by the coronavirus SARS-CoV-2. In this article, the authors consider how lung innervation might crosstalk with the immune system to modulate lung function and influence outcomes in COVID-19.

In this Perspective, Pezzini and Padovani critique the evidence for neurological manifestations of COVID-19, including epidemiological, neuropathological and neuroimaging data, and highlight the need for further work to establish whether SARS-CoV-2 is responsible for these symptoms.

In this Review, the authors synthesize recommendations on the management of neuroimmunological disease in the context of the COVID-19 pandemic. They consider these recommendations alongside the first available data from patients, and provide an overview of management approaches in the COVID-19 era.