Volume 03 Issue 05-2023
100
International Journal of Medical Sciences And Clinical Research
(ISSN
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2771-2265)
VOLUME
03
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OCLC
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1121105677
Publisher:
Oscar Publishing Services
Servi
ABSTRACT
The article presents a review of scientific literature, clinical observations, containing data on the features of
neurological manifestations and mental disorders, complications from the nervous system in a new coronavirus
infection, illustrated with clinical examples. Neurological manifestations are not leading in the clinic for diseases
caused by coronaviruses. However, the development of the nervous system is also possible with respiratory, sensory,
motor, autonomic and other disorders of the central and peripheral nervous system. In addition, COVID-19 can worsen
the course of already existing neurological diseases, therefore, this article provides basic recommendations for the
management of certain groups of patients with nervous diseases. Given the earlier epidemics of other coronavirus
infections, neurologists most often face cognitive and psycho-emotional disorders and other pathologies in the
subsequent period. Therefore, it is important to choose the appropriate treatment and monitor the development of
early and long-term consequences of neurological manifestations and complications of COVID-19 and then evaluate
the effectiveness of effective individual rehabilitation programs for patients.
KEYWORDS
Research Article
NEUROLOGICAL AND PSYCHONEUROLOGICAL MANIFESTATIONS IN
COVID 19 PATIENTS
Submission Date:
May 21, 2023,
Accepted Date:
May 26, 2023,
Published Date:
May 31, 2023
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume03Issue05-15
Nilufar Kh. Muminova
Assistant, Department Of Traditional Medicine, Rehabilitation And Physical Education, Tashkent Medical
Academy, Uzbekistan
Sukhrob K. Boisov
Assistant, Department Of Traditional Medicine, Rehabilitation And Physical Education, Tashkent Medical
Academy, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 03 Issue 05-2023
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International Journal of Medical Sciences And Clinical Research
(ISSN
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VOLUME
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ISSUE
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SJIF
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(2021:
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OCLC
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1121105677
Publisher:
Oscar Publishing Services
Servi
Covid 19, nervous system, neurological symptoms, disease, coronavirus, rehabilitation, complicated by
neuropsychiatric disorders, program, traditional oriental (Korean) medicine.
INTRODUCTION
The realities of the last months of the coronavirus
pandemic forced us to re-evaluate the features of
neurological pathology, the degree of detection of
new and decompensation of existing diseases, when
this comorbidity becomes sharply threatening to
health, including leading to tragic outcomes. COVID-19
(Coronavirus Disease 2019) is a new viral infection that
has a number of features, such as a fast spread rate, a
high mortality rate, significant social and economic
consequences that destroy the usual way of life [1, 2].
The virus is capable of mutating, and all forms of it can
be potentially dangerous to humans. Bats serve as a
natural reservoir of SARS-CoV, camels and Himalayan
civets are intermediate hosts. Confirmation of COVID-
19 infection is a positive laboratory test for the
presence of SARS-CoV-2 RNA by the polymerase chain
reaction (PCR) method, regardless of clinical
manifestations. In 97.5% of people, the incubation
period is 11.5 days, ranging from 2 to 14 days, on
average 5
–
7 days. COVID-19 is characterized by the
presence of clinical symptoms of acute respiratory viral
infection: increased div temperature (> 90%); cough
(dry or with a small amount of phlegm) in 80% of cases;
shortness of breath (55%); fatigue (44%); a feeling of
congestion in the chest (> 20%), sore throat, rhinitis.
There may also be a decrease in smell and taste, signs
of conjunctivitis [3]. A triad of symptoms characterizes
the clinical picture: fever, cough, shortness of breath.
In addition to systemic and respiratory symptoms, the
virus causes neurological disorders, as it is neurotropic.
Neurological disorders occur in approximately 36.4% of
patients with COVID-19 [4]. Recently, severe viral
hemorrhagic encephalitis, toxic encephalopathy, acute
demyelinating lesions, acute cerebrovascular accidents
(ACVA) and other complications have been described.
The direct effect of coronavirus on the nervous system,
the likelihood of its penetration through the olfactory
and trigeminal nerves and through the hematogenous
pathway through the endothelial cells of the blood-
brain barrier (BBB) is discussed [5]. The SARS-CoV-2
virus, like SARS-CoV-1, enters human cells through the
receptor for angiotensin converting enzyme 2 (ACE2)
[6]. The outbreak of coronavirus infection around the
world will remind of itself with various kinds of
consequences for a long time. In addition, mainly
complications in patients who have undergone COVID-
19, up to neurological and psychiatric ones. This
phenomenon has received the name "pandemic"
(from the Greek. Πανδημία
- "the whole people") - an
unusually strong epidemic that spread over the
territory of countries and continents. Most people who
are personally affected by the coronavirus will
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Servi
experience acute stress disorder, many will experience
post-traumatic stress disorder (PTSD), but some
people will have a deeper trauma in the form of
lingering anxiety disorders, depressive episodes,
neurotic disorders and personality deformities. Thus,
touching upon the topic of mental disorders triggered
by the COVID-19 pandemic, we can talk about the
"coronavirus syndrome." [8]. In humans, ACE2 is
expressed by most organs and tissues, and, according
to H. Zou et al. (2020), the most vulnerable to the SARS-
CoV-2 virus are the lungs and lower parts of the
respiratory tract, heart, kidneys, intestines, as well as
smooth muscle cells of the vascular wall (mainly the
microvasculature). It is necessary to evaluate the
damaging effect of the virus on the brain and other
parts of the central and peripheral nervous system,
taking into account the fact that neurons, glial cells,
and endothelial cells [9] express ACE2. Considering
previous publications on neurological disorders in
SARS-CoV-1 and MERS-CoV infections, the neurological
disorders due to SARS-CoV-2 virus can be divided into
two groups. The first group of disorders is direct
damage to the central and peripheral nervous system
by the SARS-CoV-2 virus. The second is a change in the
course of neurological diseases against the
background of an infection caused by the SARS-CoV-2
virus, especially with the development of pneumonia
and SARS. Neurological disorders caused by human
coronaviruses, including SARS-CoV-2, are attracting the
attention of researchers [10].
Experimental models have shown that the SARS-CoV-2
virus related to the SARS-CoV-1 virus is able to enter the
brain and cause serious neurological disorders [11]. The
pathophysiology of neurological disorders in infection
with the SARS-CoV-2 virus is probably similar to that in
SARS-CoV-1, and penetration into the brain can occur
by the hematogenous and / or perineural route.
To date, works have been published that consider the
issues of damage to the nervous system by the SARS-
CoV-2 virus. The first review of neurological
manifestations was carried out by L. Mao et al. (2020)
in patients with a confirmed diagnosis of COVID-19 who
were in a hospital in Wuhan. According to the materials
presented by L. Mao et al., (2020) of 214 patients, 88
(41.1%) patients had a severe course of the disease, 126
(58.9%) had mild or moderate severity. The group with
a severe course was characterized by an older age
(58.7 ± 15.0 and 48.9 ± 14.7 years) and more frequent
concomitant pathology (47.7 and 32.5%). Neurological
symptoms were detected in 78 (36.4%) of 214 patients
and were more often observed in severe cases (45.5
and 30.2%). In the same group, cerebral strokes (5.7 and
0.8%), impaired consciousness (14.8 and 2.4%) and
muscle damage (19.3 and 4.8%) developed more often.
In general, if we summarize the publications available
now, we can distinguish three variants of damage to
the nervous system in COVID-19: damage to the central
nervous system; damage to the peripheral nervous
system and damage to the muscular system. One of
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Publisher:
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Servi
the variants of damage to the peripheral nervous
system with the subsequent possible penetration of
infection into the brain is damage to the olfactory
nerves. Previously, it was experimentally established
that the SARS-CoV-1 virus, related to the SARS-CoV-2
virus, from the nasal cavity through the olfactory
nerves penetrated into the cranial cavity and further
into the brain, causing its severe damage [12]. L. Mao
et al. (2020) diagnosed olfactory disorders in patients
with COVID-19 in 5.1% of cases, and somewhat more
often in patients with a mild form of the disease. The
latter may be due to difficulties in identifying olfactory
disorders in patients with a severe form. According to
S. Gane et al. (2020), loss of smell may not only precede
infectious symptoms, but also be the only clinical
manifestation of COVID-19. This is confirmed by the
publication of M. Eliezer et al. (2020) that a significant
decrease or loss of smell in the absence of other clinical
and CT / MRI changes in the nasal cavity and nasal
passages may be the only early sign of COVID-19.
According
to
the
British
Association
of
Otorhinolaryngologists [ETN UK], in the current
situation, the acute decrease / loss of smell should be
considered as a marker of COVID-19. It is important to
note that the impairment of smell in COVID-19 differs
to some extent from changes in the sense of smell in
other viral diseases in which nasal congestion is
present. In cases of the development of hypo / anosmia
in COVID-19, the question of the possibility of further
penetration of the virus through the olfactory
pathways into the brain remains open and important.
The data on taste changes are also interesting. L. Mao
et al. (2020) revealed changes in taste in 5.6% of cases,
while they were somewhat more common in mild than
in severe cases of the disease (7.1 and 3.4%).
Differences in frequency, as well as changes in the
sense of smell, probably need to be interpreted taking
into account the complexity of their determination in
patients with severe form. In 1.5% of cases, taste
changes preceded infectious symptoms; their
frequency did not differ between patients with mild
and severe forms of the disease. The question of the
localization of the process and the pathogenetic
mechanisms of taste disturbance in COVID-19 remains
open. Given that, ACE2 receptors are abundantly
present on the taste surface of the tongue, the direct
effect of the virus on taste buds and / or on nerve fibers
cannot be ruled out.
METHODS
Our survey included 125 percent who had a
coronavirus infection and showed signs of damage to
the nervous system. They were on outpatient
treatment at the COYCA Oriental Medicine Center at
the RCH # 2, polyclinic # 2. Of these - 57 men (45.6%), 68
women (54.4%), aged 20 to 60 years. The examination
program included patients who underwent COVID 19
from 3 to 8 months (average 5.5) which, Covid 19 was
confirmed by laboratory and instrumental data.
Depending on the ongoing rehabilitation program, the
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patients were divided into 4 groups. In the first group,
the methods of traditional oriental medicine were used
to restore patients. In the second group, patients
received physiotherapy procedures. In the third group
- the complex application of physical factors and
methods of traditional oriental (Korean) medicine. The
fourth group is the control group, in which patients
received only drug therapy.
To take into account the results of treatment, we used:
-
neurological status;
-
assessment of exercise tolerance according to the
Borg Scale,
-
assessment of muscle strength on the MRC scale
(muscles),
-
assessment of the intensity of anxiety and
depression according to the Hospital Anxiety and
Depression Scale (HADS).
RESULTS OF INVESTIGATION
In this study, 78 (62.4%) of 125 patients with COVID 19
had neurological manifestations with damage to the
central and peripheral nervous system and skeletal
muscles. In most cases, these neurological symptoms
were observed early in the disease before the typical
symptoms of COVID 19 developed. The presence of
neurological general cerebral symptoms during the
manifestation of COVID-19 infection was described in
36.4% of patients in the form of confusion, headache
(13.1%), nausea, vomiting, seizures, dizziness (16.8%),
impaired sense of smell (5.1%), taste (5.6%), epileptic
seizures (20%), "musculoskeletal syndromes" (10.7%),
changes in mental status (15%), as well as in the form of
ataxia and acute cerebrovascular syndrome. A study
involving 125 patients showed that more than half
(50.7%) had depressive symptoms, 44.7% had anxiety
symptoms and 36.1% had sleep disorders. The clinical
manifestations of PTSD were: fear, anticipation of a
threat, nightmares, irritability, anger, impulsive
decisions to flee quarantined communities, feelings of
loneliness, decreased memory and attention,
frustration and hopelessness. Associations with the
deterioration of the mental health of the population
have been formed. Neurological disorders associated
with COVID 19 had clinical manifestations of damage to
various structures of the nervous system - the central
nervous system, peripheral nervous system and cranial
nerves, as well as mental disorders. Undoubtedly,
further in-depth studies of the lesions of the nervous
system in COVID-19 are needed, which will greatly
complement the information available today. For the
first time, the experience of using physical factors and
methods of traditional oriental (Korean) medicine in
the rehabilitation of patients who have undergone
coronavirus infection complicated by neuropsychiatric
disorders will be analyzed, and an approach to the
differentiated prescription of the most optimal
method of rehabilitation therapy will be developed.
CONCLUSION
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Because of the study, the data available to date
suggest the possibility of damage in COVID-19 and the
central and peripheral nervous systems. The defeat of
the nervous system is realized through the direct
action of the virus.
All data presented and summarized in this article are
preliminary. We will study the features of rehabilitation
programs for patients who have undergone COVID19,
complicated
by
neuropsychiatric
disorders.
A
neurorehabilitation program will be developed using
the methods of traditional oriental (Korean) medicine
Evaluated the effectiveness of various rehabilitation
programs in a comparative aspect.
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