Academy of Science and Medicine Issues Guidance on Prolonged Novel Coronavirus Neurological Symptoms


According to new guidance from the American Association of Physical Therapy and Rehabilitation (AAPM&R), clinicians should assess new or worsening neurological symptoms of post-SARS-CoV-2 acute sequelae (PASC) and treat as needed. or refer you to a professional. .

According to Leslie Rydeberg, M.D., Ph.D., of Northwestern University Feinberg School of Medicine and Shirley Ryan Ability Lab, neurological symptoms associated with PASC (commonly known as long coronavirus) include headaches, weakness, muscle numbness, These include pain, tremors, and paralysis. Sarah Sampsel, MPH, and co-author of her SL Sampsel Consulting in Chicago, Albuquerque.

Clinicians should pursue appropriate diagnostic work-ups and work with multidisciplinary clinical teams to address specific neurological symptoms in long-standing COVID-19 patients, while reducing polypharmacy and exacerbating symptoms. The rapid escalation of activity that can cause it should be avoided, the authors said in their paper. PM&R.

“What we do know is that many patients with mild or moderate COVID-19 have neurological sequelae lasting more than 4 weeks and have a wide variety of neurological symptoms. That’s it,” Rydberg said at a press conference. “These patients continue to have persistent and pervasive neurological symptoms, whether or not they have been hospitalized.”

Clinicians should work with primary care providers and appropriate professionals to identify psychiatric, pain, renal, endocrine, cardiovascular, neurological, and respiratory disorders that may contribute to neurological symptoms. We should also try to treat underlying conditions, including diseases and other diseases. Written by the author of the guidance.

For patients with neurological sequelae that affect gait, mobility, cognitive status, or activities of daily living, referral to a physical therapist, rehabilitation physician, or physical therapist, occupational therapist, speech-language pathologist, social worker, etc. Referrals to other health care professionals may help improve function and improve rehabilitation. Independence, they added.

This statement was produced by the PASC Collaborative of AAPM&R, a multidisciplinary group of physicians, clinicians, and patient advocacy groups. The authors outline that clinicians should identify and intervene immediately to address the following red flags:

  • Sudden or progressive weakness or sensory changes
  • Unexplained Upper Motor Neuron Signs in Debilitation
  • bowel or bladder incontinence or urinary retention
  • fainting or temporary loss of consciousness
  • Acute neuropsychiatric symptoms or psychosis
  • Positional headache, headache associated with focal neurologic signs, or rapid-onset “thunderclap” headache
  • Cranial nerve abnormalities in medical examination

Rydberg et al. emphasized that many of these neurological red flags may require referral to the emergency department rather than neurology or cardiology, depending on the time course and urgency.

Rydberg also said it’s important to know if patients are experiencing other symptoms such as sleep problems, cardiopulmonary symptoms, mood problems and functional limitations.

“When we’re talking about people with the long-term neurological sequelae of COVID-19, we really take a step back and put history in perspective and really think about everything that’s impacting these patients. is very important,” Rydberg said. “Neurologic symptoms lasting more than 4 weeks should always be evaluated.”

“Most importantly, we would like to emphasize that neurological sequelae are common in long-term COVID-19, and this is what we really need to be aware of and be prepared to treat. To emphasize that it is an ongoing problem. [and] We need resources to treat it,” she added.

The AAPM&R has published multiple consensus guidance statements on long-term coronaviruses, including papers on fatigue, cardiovascular problems, autonomic dysfunction, and long-term coronaviruses in children, followed by a paper on mental health symptoms of long-term coronaviruses. will be announced.

“For Doctors Who See Less” [long] COVID-19…these statements are a great resource with all the data and all the information in one place, hopefully giving you a big picture idea on how to manage this group ‘ said Rydberg.

The organization is also preparing a master guidance statement to address the full spectrum of known long-term COVID-19 symptoms, according to co-author Monica Verdusco Gutierrez, M.D., Ph.D., of the University of Texas San Antonio Health Science Center. It says.

“Patients don’t come in with just one symptom,” she says. She “will cover all the different statements that have been made regarding pulmonary, cardiac and neurological symptoms.” [and] cognition. “

The best approach may be to focus first on the symptoms that most affect a patient’s quality of life, using relevant guidance statements, before moving on to milder symptoms, said Verdusco Gutierrez. said.

“We understand that there is a lot of pressure on clinicians to see patients in a short period of time, so they may be focused on one thing,” she said. says. “Okay, this week we’ll focus on neurological symptoms and address those symptoms. Come back at your next appointment and we’ll talk about your heart symptoms.”

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    Michael DePeau-Wilson is a reporter on MedPage Today’s corporate and research team. He covers psychiatry, long-term COVID-19, and infectious diseases, among other relevant US clinical news. follow

Disclosure

The writing committee’s work is supported solely by the American Academy of Physical Therapy and Rehabilitation without commercial endorsement.

Rydberg made no disclosures. Sampsel has contracted with AAPM&R to support the development and submission of each PASC Collaborative Consensus Guidance Statement. Verduzco-Gutierrez and other authors report receiving grants, contracts, or honoraria from a variety of sources, some of which went to their institutions, some of which were paid to his PASC and more broadly. personal reimbursement for activities related to relevant research and professional fields.

Primary information

PM&R

Source reference: Melamed E, et al., “Interdisciplinary Consensus Guidance Statement on the Evaluation and Treatment of Hospitalized Patients with Neurological Consequences with Post-SARS-CoV-2 Acute Sequelae (PASC).” PM&R Year 2023; DOI: 10.1002/pmrj.12976.





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