Neurological conditions and long COVID combined… What is the impact?

Whilst the coronavirus pandemic has already brought a great deal of anxiety and concern regarding the safety of individuals, overwhelm of our NHS, delays in routine healthcare appointments, a spike in mental health difficulties, and an unprecedented number of changes to daily living, another concern is rapidly arising. Will I get long-COVID?

Post-COVID syndrome, or 'Long-COVID' includes a range of symptoms which many people living with a neurological condition will find strangely familiar: fatigue, cognitive impairment, dizziness, heart palpitations, joint pain, depression and anxiety, tingling and numbness - and more, in addition to respiratory and cardiovascular complications. The NHS state that one in five people with coronavirus go on to develop long-term symptoms.

Maintaining or improving health as a means of experiencing as mild symptoms as possible from COVID-19 in the event of developing it, has been advised, and MS Academy provided a webinar on this for people with multiple sclerosis (MS) in April last year. However, there is no apparent correlation between the severity of COVID virus experienced and the likelihood of developing long-COVID. Indeed, anecdotal evidence suggests individuals having such mild symptoms as for the disease to go unnoticed, until they develop long-COVID.

The most common continuing symptoms documented are fatigue and breathlessness. However, pain, difficulty sleeping, heart palpitations and sensory disruptions have also been well-documented. A six-month review of patients in Wuhan found that 76% of individuals discharged from hospitalisation with COVID retaining at least one lingering symptom (Huang: 2021).

Image taken fromThe Economist online reporting on Huang: 2021

Recent studies have found that COVID may exacerbate existing neurological conditions and others have suggested that the neurological weakness or inflammation in the brain may lead to susceptibility for other neurological conditions in the future, such as Parkinson's (Beauchamp, 2020) and stroke (Paterson, 2020).

Indeed, the anecdotal evidence for this has resulted in a new database being launched by the National Institutes of Health (US), which will collect information from clinicians about COVID-19-related neurological symptoms, complications, and outcomes, as well as COVID-19 effects on pre-existing neurological conditions.

Impact on health services

Although the NHS have announced £10 million in funds to support a network of new long-COVID clinics, over 60 of which are already open, it seems likely that our mainstream neurological services are set to receive an influx of new patients. This may be due to long-COVID itself or because of neurological conditions developing as a result of a weakened or impaired central nervous system (Achar, 2020) - both are becoming apparent consequences of the infection.

Combining this with the difficulties of providing effective support and treatment to people with neurological conditions during the coronavirus pandemic (Lancet: 2020; Neurological Alliance: 2020), this presents a considerable challenge.

Practical implications

For some, long-COVID's neurological symptoms compound, or are additional to, pre-existing neurological disorders, as neurologist Dr Agne Straukiene noted in her recent LinkedIn post.

Agne feels that it is essential we support these individuals to understand and manage their symptoms effectively. This is important both to minimise the further impact on their mental and emotional health, and to enable them to gain control over their lives again for as long as their symptoms last.

'The NHS has put out some useful guidance around living a healthy life which is really helpful. We need to encourage people to take care of themselves, to be kind to themselves, and to work towards living as well as they can,' Agne explained.

The comprehensive information is designed for anyone who has experienced COVID symptoms of any severity, and encourages individuals to both accept how they feel currently and to work towards feeling the best they can. The advice is tailored thematically, and includes eating and sleeping well, getting moving, emotional connections and grief and bereavement.

References and further information

• The neurological impact of COVID-19 - The Lancet Neurology
• 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study - The Lancet
  
• 20200703-Final-Restarting-Services-for-People-with-Neurological-conditions-v3.pdf (neural.org.uk)
• NHS England » Long COVID patients to get help at more than 60 clinics
• Parkinsonism as a Third Wave of the COVID-19 Pandemic? - IOS Press
• emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings | Brain | Oxford Academic (oup.com)
• Cells | Free Full-Text | COVID-19-Associated Neurological Disorders: The Potential Route of CNS Invasion and Blood-Brain Barrier Relevance (mdpi.com)
• NHS COVID Recovery: https://www.yourcovidrecovery.nhs.uk