Abstract
Encephalopathy, a common condition among patients hospitalized with COVID-19, can be a challenge to manage and negatively affect prognosis. While encephalopathy may present clinically as delirium, subsyndromal delirium, or coma and may be a result of systemic causes such as hypoxia, COVID-19 has also been associated with more prolonged encephalopathy due to less common but nevertheless severe complications, such as inflammation of the brain parenchyma (with or without cerebrovascular involvement), demyelination, or seizures, which may be disproportionate to COVID-19 severity and require specific management. Given the large number of patients hospitalized with severe acute respiratory syndrome coronavirus–2 infection, even these relatively unlikely complications are increasingly recognized and are particularly important because they require specific management. Therefore, the aim of this review is to provide pragmatic guidance on the management of COVID-19 encephalopathy through consensus agreement of the Global COVID-19 Neuro Research Coalition. A systematic literature search of MEDLINE, medRxiv, and bioRxiv was conducted between January 1, 2020, and June 21, 2021, with additional review of references cited within the identified bibliographies. A modified Delphi approach was then undertaken to develop recommendations, along with a parallel approach to score the strength of both the recommendations and the supporting evidence. This review presents analysis of contemporaneous evidence for the definition, epidemiology, and pathophysiology of COVID-19 encephalopathy and practical guidance for clinical assessment, investigation, and both acute and long-term management.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 12-27 |
| Number of pages | 16 |
| Journal | Journal of Neuropsychiatry and Clinical Neurosciences |
| Volume | 35 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 2023 |
Funding
Dr. Michael is supported by the Medical Research Council (MRC)/United Kingdom Research and Innovation (UKRI) (grants MR/V007181//1 and MR/T028750/1) and Wellcome Trust (grant ISSF201902/3) for neurological inflammation research. Drs. Michael, Breen, and Solomon are supported by UKRI/MRC (grant MR/V03605X/1) to conduct COVID-19 neuroscience research. Dr. Singh is supported by the MRC Global Effort on COVID-19 Programme (grant MR/V033441/1) to study COVIDassociated neurological disease and the U.K. National Institute for Health Research (NIHR)-funded Global Health Research Group on Acute Brain Infections (number 17/63/110). Dr. Chou is supported by the National Institute of Neurological Disorders and Stroke (grant R21NS113037) and a Neurocritical Care Society award (Investing in Clinical Neurocritical Care Research). Dr. Thakur is supported by the Centers for Disease Control and Prevention and NIH. Dr. Solomon is supported by the NIHR Health Protection Research Unit in Emerging and Zoonotic Infections (grant NIHR200907), the NIHR Global Health Research Group on Brain Infections (grant 17/63/110), the MRC Global Effort on COVID-19 Programme (grant MR/V033441/1), and the COVID19 Clinical Neuroscience Study (grant MR/V03605X/1).The Global COVID-19 Neuro Research Coalition is supported by the School of Medicine, Technical University of Munich, Germany (grant H.40001.1.708). Dr. Breen has served on the advisory board for COMPASS Pathways. Dr. Chou has served as a scientific advisor and consultant for BioVie and CSL Behring. Dr. Menon has received collaborative grant funding, consultant fees, or educational grants from Calico, GlaxoSmithKline, Integra Neurosciences, Lantmännen, NeuroTrauma Sciences, and PresSura Neuro. All other authors report no financial relationships with commercial interests. Dr. Michael is supported by the Medical Research Council (MRC)/United Kingdom Research and Innovation (UKRI) (grants MR/V007181//1 and MR/T028750/1) and Wellcome Trust (grant ISSF201902/3) for neurological inflammation research. Drs. Michael, Breen, and Solomon are supported by UKRI/MRC (grant MR/V03605X/1) to conduct COVID-19 neuroscience research. Dr. Singh is supported by the MRC Global Effort on COVID-19 Programme (grant MR/V033441/1) to study COVID-associated neurological disease and the U.K. National Institute for Health Research (NIHR)-funded Global Health Research Group on Acute Brain Infections (number 17/63/110). Dr. Chou is supported by the National Institute of Neurological Disorders and Stroke (grant R21NS113037) and a Neurocritical Care Society award (Investing in Clinical Neurocritical Care Research). Dr. Thakur is supported by the Centers for Disease Control and Prevention and NIH. Dr. Solomon is supported by the NIHR Health Protection Research Unit in Emerging and Zoonotic Infections (grant NIHR200907), the NIHR Global Health Research Group on Brain Infections (grant 17/63/110), the MRC Global Effort on COVID-19 Programme (grant MR/V033441/1), and the COVID-19 Clinical Neuroscience Study (grant MR/V03605X/1).The Global COVID-19 Neuro Research Coalition is supported by the School of Medicine, Technical University of Munich, Germany (grant H.40001.1.7-08). Dr. Breen has served on the advisory board for COMPASS Pathways. Dr. Chou has served as a scientific advisor and consultant for BioVie and CSL Behring. Dr. Menon has received collaborative grant funding, consultant fees, or educational grants from Calico, GlaxoSmithKline, Integra Neurosciences, Lantmännen, NeuroTrauma Sciences, and PresSura Neuro. All other authors report no financial relationships with commercial interests.
ASJC Scopus subject areas
- General Medicine