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. 2022 Aug 15:439:120315.
doi: 10.1016/j.jns.2022.120315. Epub 2022 Jun 3.

Neurological long-COVID in the outpatient clinic: Two subtypes, two courses

Stefano Giuseppe Grisanti  1 , Sara Garbarino  2 , Emanuela Barisione  3 , Teresita Aloè  3 , Marco Grosso  3 , Cristina Schenone  1 , Matteo Pardini  4 , Erica Biassoni  1 , Federico Zaottini  3 , Riccardo Picasso  3 , Silvia Morbelli  3 , Cristina Campi  5 , Giampaola Pesce  3 , Federico Massa  1 , Nicola Girtler  4 , Denise Battaglini  6 , Corrado Cabona  3 , Matteo Bassetti  3 , Antonio Uccelli  4 , Angelo Schenone  4 , Michele Piana  5 , Luana Benedetti  7
Affiliations

Neurological long-COVID in the outpatient clinic: Two subtypes, two courses

Stefano Giuseppe Grisanti et al. J Neurol Sci. .

Abstract

Introduction: Symptoms referable to central and peripheral nervous system involvement are often evident both during the acute phase of COVID-19 infection and during long-COVID. In this study, we evaluated a population of patients with prior COVID-19 infection who showed signs and symptoms consistent with neurological long-COVID.

Methods: We prospectively collected demographic and acute phase course data from patients with prior COVID-19 infection who showed symptoms related to neurological involvement in the long-COVID phase. Firstly, we performed a multivariate logistic linear regression analysis to investigate the impact of demographic and clinical data, the severity of the acute COVID-19 infection and hospitalization course, on the post-COVID neurological symptoms at three months follow-up. Secondly, we performed an unsupervised clustering analysis to investigate whether there was evidence of different subtypes of neurological long COVID-19.

Results: One hundred and nine patients referred to the neurological post-COVID outpatient clinic. Clustering analysis on the most common neurological symptoms returned two well-separated and well-balanced clusters: long-COVID type 1 contains the subjects with memory disturbances, psychological impairment, headache, anosmia and ageusia, while long-COVID type 2 contains all the subjects with reported symptoms related to PNS involvement. The analysis of potential risk-factors among the demographic, clinical presentation, COVID 19 severity and hospitalization course variables showed that the number of comorbidities at onset, the BMI, the number of COVID-19 symptoms, the number of non-neurological complications and a more severe course of the acute infection were all, on average, higher for the cluster of subjects with reported symptoms related to PNS involvement.

Conclusion: We analyzed the characteristics of neurological long-COVID and presented a method to identify well-defined patient groups with distinct symptoms and risk factors. The proposed method could potentially enable treatment deployment by identifying the optimal interventions and services for well-defined patient groups, so alleviating long-COVID and easing recovery.

Keywords: Long-COVID; Post-COVID neurological symptoms.

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Figures

Fig. 1
Fig. 1
Percentage of neurological symptoms.
Fig. 2
Fig. 2
Subtypes of disorders related to PNS involvement.
Fig. 3
Fig. 3
Results of cluster analysis. Top panel, clusters on the set of five neurological symptoms. Blue cluster (long-COVID type 2) = symptoms of PNS involvement; red cluster (long-COVID type 1) = memory disturbances, psychological impairment, headache, anosmia and ageusia. Bottom panel, centroid profiles of the two clusters. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
See this image and copyright information in PMC

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