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. 2023 Feb;30(2):413-433.
doi: 10.1111/ene.15617. Epub 2022 Dec 7.

Comparative features and outcomes of major neurological complications of COVID-19

Ettore Beghi  1 , Elena Moro  2 , Eugenia Irene Davidescu  3 , Bogdan Ovidiu Popescu  3 , Oxana Grosu  4 , Franco Valzania  5 , Maria Sofia Cotelli  6 , Gordana Kiteva-Trenchevska  7 , Maria Zakharova  8 , Tibor Kovács  9 , Carmel Armon  10 , Waldemar Brola  11 , Clarissa Lin Yasuda  12 , Luís F Maia  13 , Arijana Lovrencic-Huzjan  14 , Mafalda Maria Laracho de Seabra  15   16 , Rafael Avalos-Pavon  17 , Anne Hege Aamodt  18 , Sara Meoni  2 , Victoria Gryb  19 , Serefnur Ozturk  20 , Omer Karadas  21 , Ingomar Krehan  22 , Maurizio A Leone  1 , Maria Lolich  23 , Elisa Bianchi  1 , Verena Rass  24 , Raimund Helbok  24 , Claudio L A Bassetti  25 ; ENERGY Study Group
Collaborators, Affiliations

Comparative features and outcomes of major neurological complications of COVID-19

Ettore Beghi et al. Eur J Neurol. 2023 Feb.

Abstract

Background and purpose: The aim of this study was to assess the neurological complications of SARS-CoV-2 infection and compare phenotypes and outcomes in infected patients with and without selected neurological manifestations.

Methods: The data source was a registry established by the European Academy of Neurology during the first wave of the COVID-19 pandemic. Neurologists collected data on patients with COVID-19 seen as in- and outpatients and in emergency rooms in 23 European and seven non-European countries. Prospective and retrospective data included patient demographics, lifestyle habits, comorbidities, main COVID-19 complications, hospital and intensive care unit admissions, diagnostic tests, and outcome. Acute/subacute selected neurological manifestations in patients with COVID-19 were analysed, comparing individuals with and without each condition for several risk factors.

Results: By July 31, 2021, 1523 patients (758 men, 756 women, and nine intersex/unknown, aged 16-101 years) were registered. Neurological manifestations were diagnosed in 1213 infected patients (79.6%). At study entry, 978 patients (64.2%) had one or more chronic general or neurological comorbidities. Predominant acute/subacute neurological manifestations were cognitive dysfunction (N = 449, 29.5%), stroke (N = 392, 25.7%), sleep-wake disturbances (N = 250, 16.4%), dysautonomia (N = 224, 14.7%), peripheral neuropathy (N = 145, 9.5%), movement disorders (N = 142, 9.3%), ataxia (N = 134, 8.8%), and seizures (N = 126, 8.3%). These manifestations tended to differ with regard to age, general and neurological comorbidities, infection severity and non-neurological manifestations, extent of association with other acute/subacute neurological manifestations, and outcome.

Conclusions: Patients with COVID-19 and neurological manifestations present with distinct phenotypes. Differences in age, general and neurological comorbidities, and infection severity characterize the various neurological manifestations of COVID-19.

Keywords: COVID-19; coronavirus; neurological complications; neurology.

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Conflict of interest statement

Ettore Beghi reports grants from the Italian Ministry of Health, grants from SOBI, personal fees from Arvelle Therapeutics, and grants from American ALS Association, outside the submitted work. Elena Krehan, Eugenia Bianchi, Maria Lolichand, Victoria Gryb, Verena Rass, Rafael Avalos‐Pavon, Oxana Grosu, M. Meoni, Mafalda Maria Laracho de Seabra, Maria Sofia, Cotelli, Raimund Helbok, Claudio Bassetti, Eugenia Irene Davidescu, Bogdan Ovidiu Popescu, Maurizio Leone, Franco Valzania, Anne Hege Aamodt and Gordana Kiteva‐Trenchevska have nothing to report. Maria Zakharova reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Johnson and Johnson (Janssen), and has supported webinars/lections dedicated to the COVID‐19 pandemic: February 26, 2021 – webinar – “COVID‐19 pandemic: new challenges for MS therapy” (taught in Russian); May 28, 2021 ‐ conference, “Management of MS patients in the COVID‐19 era” (taught in Russian); and December 3, 2021 – webinar “СOVID‐19: updated data from multiple sclerosis patient registries” (taught in Russian). Tibor Kovács reports consulting fees from Richter Ltd, Pfizer Hungary, Biogen Hungary and Ipsen, payment or honoraria for lectures, presentations, speaker bureaus, manuscript writing or educational events from Richter Ltd, Pfizer Hungary, Biogen Hungary and Ipsen, support for attending meetings and/or travel from Richter Ltd, Pfizer Hungary and Medis Hungary, and participation on a Data Safety Monitoring Board or Advisory Board for Novo Nordisk and Biogen. Arijana Lovrencic‐Huzjan reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from TEVA, Krka and Novartis, and is President of the Ethics Committee of UHC Sestre milosrdnice. Due to the conflict of interest, she did not participate in the discussion or decision‐making on the proposed research. Elena Moro reports grants or contracts from any entity (if not indicated in item #1 above) as follows: research grant from Ipsen; honoraria for consulting from Medtronic, Abbott and Kyowa; and participation on a data safety monitoring board or advisory board for Newronika. Clarissa Lin Yasuda reports support for the present manuscript from FAPESP2013/07559–3; FAPESP 2019/11457–8, and payment or honoraria for lectures, presentations, speaker bureaus, manuscript writing or educational events from UCB, ZODIAC and TORRENT. Carmel Armon reports royalties or licenses: UpToDate co‐author on two chapters, payment for expert testimony as a neurology consultant to Inbal, Inc. and the Israeli government insurance company. Luís Maia reports support for the present manuscript from Research4COVID – FCT grant n°229 Project grant for institution, and Bial Foundation Grant Project grant for institution. Waldemar Brola reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Biogen, Merck, Novartis, Sanofi Genzyme and Roche, and support for attending meetings and/or travel from Biogen, Sanofi and Roche.

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