COVID-19 primarily affects respiratory system, however, it can affect other systems too, including nervous system. This presentation offers details about neurological symptoms and disorders seen in patients with COVID-19.
Scott Letendre, MD
Professor in Residence
Division of Infectious Diseases & Global Public Health
Departments of Medicine and Psychiatry
University of California, San Diego
TheNeuroSurgeons sponsored the presentation to the Zimbabwe Association of Neurological Surgeons.
we are learning more about the neurological manifestations of the novel coronavirus as we are frantically looking for solution to this formidable pandemic.
Scott Letendre, MD
Professor in Residence
Division of Infectious Diseases & Global Public Health
Departments of Medicine and Psychiatry
University of California, San Diego
TheNeuroSurgeons sponsored the presentation to the Zimbabwe Association of Neurological Surgeons.
we are learning more about the neurological manifestations of the novel coronavirus as we are frantically looking for solution to this formidable pandemic.
This presentation briefly summarizes pathophysiology, clinical features, diagnosis and treatment of different types of tuberculosis of brain and spinal cord.
Multiple sclerosis: Introduction, Risk Factors, Diagnosis and TreatmentEnriqueAlvarez93
Introduction about Multiple Sclerosis.
Risk factors affect to Multiple Sclerosis.
When to Suspect Multiple Sclerosis.
Evaluation and Diagnosis of Multiple Sclerosis.
How to treatment of Multiple Sclerosis.
Treatment of Multiple Sclerosis with Monoclonal Antibody.
Origin of virus??
Transmission of virus??
First case in Wuhan?
Aerosol transmission? Fomites? Re- infection/ reactivation
Vaccine/ safety & efficacy/ antibody test/ community transmission?
Case definition?
Pathophysiology/ pathology
Cardiovascular manifestations/ risk?
ACS
Role of aspirin
Low platelet in covid-19
Anti-coagulants
ACEI/ARB/ARNI
Diuretics
Clinical features
High risk groups
Antibiotics
HCQ& Lopinavir, Ritonavir
Anti viral drugs- remdisivir/ favipiravir
Biological therapy- tocilizumab
Convalescent plasma therapy
Systemic steroids
Ivermectin
NSAIDs
Respiratory failure
Other management in covid 19- fluid/ nebulization
Chemoprophylaxis
Bronchial asthma
Anti diabetics
This presentation briefly summarizes pathophysiology, clinical features, diagnosis and treatment of different types of tuberculosis of brain and spinal cord.
Multiple sclerosis: Introduction, Risk Factors, Diagnosis and TreatmentEnriqueAlvarez93
Introduction about Multiple Sclerosis.
Risk factors affect to Multiple Sclerosis.
When to Suspect Multiple Sclerosis.
Evaluation and Diagnosis of Multiple Sclerosis.
How to treatment of Multiple Sclerosis.
Treatment of Multiple Sclerosis with Monoclonal Antibody.
Origin of virus??
Transmission of virus??
First case in Wuhan?
Aerosol transmission? Fomites? Re- infection/ reactivation
Vaccine/ safety & efficacy/ antibody test/ community transmission?
Case definition?
Pathophysiology/ pathology
Cardiovascular manifestations/ risk?
ACS
Role of aspirin
Low platelet in covid-19
Anti-coagulants
ACEI/ARB/ARNI
Diuretics
Clinical features
High risk groups
Antibiotics
HCQ& Lopinavir, Ritonavir
Anti viral drugs- remdisivir/ favipiravir
Biological therapy- tocilizumab
Convalescent plasma therapy
Systemic steroids
Ivermectin
NSAIDs
Respiratory failure
Other management in covid 19- fluid/ nebulization
Chemoprophylaxis
Bronchial asthma
Anti diabetics
Transverse Myelitis in a Patient with COVID-19: A Case Reportkomalicarol
There has been growing evidence of COVID-19
potentially causing a wide range of neurological abnormalities
from as mild as anosmia to as serious as stroke. It is important to
recognize that amid this pandemic, we have been seeing different
manifestations and associations of COVID-19
Covid 19--EMERGING AND FUTURE CHALLENGES FOR DENTAL SURGEONSOUMENDU KARAK
CORONAVIRUS (COVID-19)-EMERGING AND FUTURE CHALLENGES FOR DENTAL SURGEON.THE SLIDE DESCRIBE BRIEFLY ABOUT VIRUS,ITS CLINICAL MANIFESTATION,FATALITY RATE, MANAGMENT AND HOW WE OVERCOME FROM PRESENT SITUATION.
A cardiologists perspective to current scenario in light of corona pandemic in india and world wide. cardiac procedures , heart disease , aceinhibitors , arni , heart failure , troponin, nt probnp
There are nearly 100 viruses of the herpes group that infect many different animal species.
Official name of herpesviruses that commonly infect human is Humans herpesvirus (HHV)
herpes simplex virus types 1 (HHV 1)
Herpes simplex virus type 2 (HHV 2)
Varicella-zoster virus (HHV 3)
Epstein-Barr virus, (HHV 4)
Cytomegalovirus (HHV 5)
Human herpesvirus 6 (HHV 6)
Human herpesvirus 7 (HHV 7)
Human herpesvirus 8 (HHV 8) (Kaposi's sarcoma-associated herpesvirus).
Herpes B virus of monkeys can also infect humans
hELMINTHS#corona virus#Aspergillosis#BUGANDO#CUHAS#CUHAS#CUHAS
Similar to Neurological Manifestations of COVID-19 Infection (20)
Neurological Evaluation of Acute Ischemic stroke in Emergency RoomSudhir Kumar
Neurological evaluation of acute ischemic stroke in ER should focus on:
1. Exclude stroke mimics
2. Ascertain time of onset of symptoms,
3. Neurological examination
4. NIHSS score
5. Investigations to be done in ER
6. Ascertain eligibility for thrombolysis and exclude any contraindications
7. Informed consent
Lifestyle Measures to Prevent Brain Diseases.pptxSudhir Kumar
Disease prevention is more important in neurology than treatment. This is because treatments are not 100% effective and cure may not be possible. In this presentation, I discuss the evidence-based measures to prevent stroke and dementia. These include adequate sleep, physical activity, eating healthy foods, and reducing stress.
This talk summarizes the definition, diagnosis and management strategies of migraine. It will be useful for general public as well as healthcare professionals.
This is more of a summary of recent evidence available on migraine management. It is easy to read and understand. Please post your queries and comments.
COVID-19 Presenting as stroke- mechanisms, diagnosis and treatmentSudhir Kumar
Covid 19 infection can affect nervous system in many ways, including an increased risk of stroke. This presentation looks at the association of COVID 19 infection and stroke. Mechanisms of stroke in COVID 19 have been elucidated. Approach to diagnosis and management has also been discussed via case studies. Prompt diagnosis and early initiation of treatment ensures a good outcome in covid 19 infected patients presenting with stroke.
CHRONIC PAIN AND DEPRESSION: Cause or Effect or Linked?Sudhir Kumar
Chronic pain and depression are both common conditions, and in many patients, they co-exist. This presentation looks at the link between chronic pain and depression. Various drugs that can be used to treat chronic pain/depression have been discussed, with a special emphasis on tricyclic antidepressants.
Zonisamide is among the newer broad spectrum anti-epileptic drugs, effective against focal and generalized epilepsies. It can be taken once daily and is well tolerated. The current article focuses on clinical efficacy and safety of zonisamide in epilepsy (as add on or as monotherapy). There is long term data as well as comparative studies against carbamazepine.
Multiple sclerosis: fighting the invisibleSudhir Kumar
Multiple sclerosis affects about 100 per 1,00,000 population. Women get affected 3 times more commonly than men. It is a leading cause of disability. This presentation aims at educating people with MS about the symptoms, diagnosis, treatment and prognosis of MS.
Stroke is common. This presentation discusses the broad outlines of acute stroke management, especially in the first 24 hours after onset of symptoms. It would be useful for physicians as well as neurologists.
Stroke is common in pregnancy. All physicians and obstetricians caring for pregnant women should be familiar with symptoms of stroke, as well as its diagnosis and treatment. This presentation gives an overview about the latest management of stroke in pregnant women.
Stroke is a leading cause of death and disability. All doctors should have a basic knowledge about stroke management. This presentation gives a summary of treatment options in acute brain stroke.
Multiple sclerosis is a demyelinating disease affecting brain, optic nerves and spinal cord. It is characterised by frequent relapses. Now, there are a number of effective treatment options for MS. Earlier, only clinical parameters were considered to evaluate the efficacy of MS treatments. However, now, we need to look at disability as well as MRI parameters. All these points are included in NEDA (no evidence of disease activity). This presentation looks at the definition and classification of NEDA. It also looks at NEDA rates with various treatment options.
NEUROLOGICAL DISORDERS DUE TO METABOLIC DERANGEMENTSSudhir Kumar
Metabolic and endocrine disorders can present with neurological signs and symptoms. It is important to recognise them so that can be promptly treated. Majority of symptoms fully reverse if treatment is started on time. This presentation looks at some common metabolic/endocrine disorders with neurological manifestations. The description is in the form of case series.
Management of High Disease Activity in Multiple Sclerosis (MS)Sudhir Kumar
Multiple sclerosis is a common disease affecting the central nervous system. Immunotherapy with interferon is the first line therapy for MS. This presentation discusses the treatment options of high disease activity in patients with MS. Role of natalizumab (tysabri) has been highlighted.
This presentation discusses the revised McDonald's criteria (2017) for the diagnosis of multiple sclerosis. Major changes from the last diagnostic criteria proposed in 2010 have been discussed. Clinical and MRI criteria for dissemination in space and time have been discussed.
Today, everyone needs to market self. Some market their products, and others market their skills. Is marketing difficult? It is difficult, however, it can become easy, if we follow certain protocol. This talk gives you some insights into effective ways of marketing.
Addressing hypertension to reduce the burden of stroke 19 feb2018 (1)Sudhir Kumar
Hypertension is the commonest risk factor for stroke. Management of hypertension is important in ensuring best outcomes for stroke patients. Adequate control of bP is also important to prevent stroke recurrence. This presentation looks at the role of high BP in stroke occurrence and antihypertensive agents that can be used to achieve target BP.
Role of Blood Pressure in Recurrent StrokeSudhir Kumar
Hypertension is a major risk factor for the first stroke as well as recurrent stroke. Therefore, adequate control of BP is necessary to reduce the risk of stroke recurrence. This presentation looks at the ABCD 2 score to predict the exact risk of stroke recurrence after TIA. Target BP that needs to be achieved has been discussed. Various antihypertensive agents based on the scientific evidence have been discussed.
Palmitoylethanolamide in the Treatment of Neuropathic Pain Sudhir Kumar
Neuropathic pain is quite common. It is associated with severe disability and adversely affects the quality of life of sufferers. Current treatment options for neuropathic are not very effective. Moreover, they are associated with significant adverse effects. A new naturally occurring substance- PALMITOYLETHANOLAMIDE (PEA)- has been found to be effective and safe in treating neuropathic pain. The current presentation looks at the efficacy of PEA in neuropathic pain.
Newer drugs for the treatment of motor symptoms of Parkinson's DiseaseSudhir Kumar
Parkinson's disease is a common movement disorder with prominent motor symptoms such as tremors, bradykinesia and rigidity. Many patients suffer from motor fluctuations including on off phenomena, and freezing. This presentation looks at the latest drugs for treating these.
Acute ischemic stroke is an emergency. There are good thrombolytic agents available now. Aspirin or clopidogrel along with statins should be given to all stroke patients. Control of BP and sugar is of paramount importance.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
How to Give Better Lectures: Some Tips for Doctors
Neurological Manifestations of COVID-19 Infection
1. Neurological Manifestations of COVID-19 Infection
Dr. Sudhir Kumar MD DM
Senior Consultant Neurologist
Apollo Hospitals, Hyderabad
2. Introduction
• The novel severe acute respiratory syndrome coronavirus 2 (SARS-
CoV-2) emerged in Wuhan, China and rapidly spread worldwide
• Vast majority of confirmed cases present with respiratory symptoms.
• Neurological manifestations: Case reports, case series, editorials,
reviews, case-control and cohort studies
• The discrimination between causal relationship and incidental
comorbidity is often difficult
3. Neurological manifestations of coronavirus infections
• Upon nasal infection, coronavirus enters the central nervous system (CNS)
through the olfactory bulb causing inflammation and demyelination.
• The virus can reach the whole brain and cerebrospinal fluid (CSF) in less than
seven days.
• The central and peripheral nervous system involvement may be related to hypoxia
and endothelial damage, uncontrollable immune reaction and inflammation,
electrolyte imbalance, hypercoagulable state, DIC, septic shock and/or multiple
organ failure.
European Journal of Epilepsy 79 (2020) 49–52
9. Stroke and COVID19
Acute stroke may complicate or co-exist with COVID-19;
5%, acute ischemic stroke
0.5% cerebral venous sinus thrombosis
and 0.5% of the patients developed cerebral haemorrhage
Li Y, Wang M, Zhou Y, et al. Acute cerebrovascular disease following COVID-19: a
single center, retrospective, observational study,
https://papers.ssrn.com/sol3/papers.cfm?abstract_ id=3550025 (2020, accessed 4 April 2020).
10.
11. (A) Hyperintensity along the wall of inferior horn of right lateral
ventricle on diffusion-weighted imaging, indicating ventriculitis.
(B) Hyperintense signal changes in the right mesial temporal lobe
and hippocampus with slight hippocampal atrophy on FLAIR MRI,
consistent with encephalitis, in a patient with COVID-19.
(C) Hyperintensity within the bilateral medial temporal lobes and
thalami on T2/FLAIR MRI.
(D) Evidence of hemorrhage, indicated by hypointense signal on
susceptibility-weighted images, consistent with acute necrotizing
encephalopathy in a patient with confirmed COVID-19.
(E) CT showing ischemic lesions involving the left occipital lobe.
(F) Right frontal precentral gyrus of the brain in a man aged 64 years
who deteriorated neurologically after admission to hospital with
COVID-19 and was diagnosed with acute stroke.
Brain imaging in patients with neurological disease associated with COVID-19
Lancet Neurol. 2020;S1474-4422(20)30221-0
12. COVID-19 and Guillain-Barre Syndrome
• GBS can occur following COVID-19 infection,
• 5-10 days after the symptom onset of COVID-19,
• Ascending type, LL>UL, with paresthesia and facial weakness
• Axonal or demyelinating type,
• CSF- mild pleocytosis, mildly raised protein
• Treatment- with IVIG/plasma exchange.
• Outcome- is generally good.
13. COVID-19 and Loss of Smell & Taste
• Loss of smell and taste are reported in 55-60% of patients,
• They can occur before (12%), along with (23%) or after the onset
(65%)of typical COVID symptoms,
• These abnormalities persist in >60% even after resolution of typical
COVID symptoms,
14. COVID-19 and BELL’S PALSY
• 65-year old lady in China
• LMN type of facial palsy, without any fever or respiratory symptoms,
• RT-PCR on throat swab positive, and CT showed ground-glass
opacities in right lower lung,
• Resolved with antiviral treatment
15. Are PWE at higher risk of developing COVID-19?
• PWE are not at an increased risk of getting COVID-19
• Epilepsy does not increase the severity of COVID-19
16. SARS and seizures
In a more recent study:
Among 183 hospitalized children with clinically suspected acute encephalitis, 22 (12%) had coronavirus
infection by detection of anti-CoV IgM.
Five of these 22 patients (23%) had seizures.
Cerebrospinal fluid was analysed in all patients with coronavirus-associated encephalitis; 10 patients
(45.5%) had CSF pleocytosis.
Three of the 22 patients with corona virus associated encephalitis underwent electroencephalography
(EEG); all three results were normal.
• SeizureSARS: severe acute respiratory syndrome, CSF: cerebrospinal fluid, CoV IgM: corona immunoglobulin M Seizure; European Journal of Epilepsy 79
18. COVID-19 and seizures contd..
• A growing body of evidence shows that neurotropism is one common feature of coronaviruses.
• Neurological manifestations of COVID-19 could document CNS manifestations in 25% of the patients [headache (13%),
dizziness (17%), impaired consciousness (8%), acute cerebrovascular problems (3%), ataxia (0.5), and seizures (0.5%)].
• Meningitis/encephalitis associated with SARS-CoV2 accompanied by seizures (SARS-CoV2 RNA was detected in the
CSF).
• In patient affected by COVID-the primary presentation was a focal status epilepticus.
• COVID-19 patients develop seizures as a consequence of hypoxia, metabolic derangements, organ failure, or even
cerebral damage
CNS: Central nervous system, RNA: ribo-nucleic acid, SARS-
CoV2: severe acute respiratory syndrome-coronal virus
Seizure, European Journal of Epilepsy 79
(2020) 49–52
19. Management of seizures
• In critically ill patients, untreated seizures can quickly escalate to generalized convulsive status
epilepticus or, more frequently, nonconvulsive status epilepticus (NCSE).
• If a patient with COVID19 develops a clinical or subclinical seizure or status epilepticus, it is very
reasonable to start the treatment with antiseizure medication(ASM) urgently.
• Determine the cause of the seizure and manage the cause [e.g., hypoxia, fever (in children),
metabolic derangements, etc.] immediately.
• When an ASM is initiated, drug factors, such as the onset of action, drug interactions, and adverse
effects, and also patient factors (age, respiratory, renal, hepatic, and cardiac functions) should be
taken into account.
ASM: Anti-seizure medication
Seizure: European Journal of Epilepsy 79
(2020) 49–52
20. Different scenarios of seizure management in critically ill
patients with COVID-19
A single seizure less than 5min long:
Because these patients suffer from severe respiratory and/or cardiac problems, drugs with
significant respiratory/cardiac adverse effects (e.g., Phenytoin, Phenobarbital, etc.) should be
prescribed cautiously.
Drugs with significant drug interactions (e.g., Carbamazepine, Phenytoin, Phenobarbital, and
Valproic acid) should be prescribed cautiously
Lacosamide should be used with caution in patients with cardiac conduction problems (e.g.,
marked first-degree AV block, second-degree or higher AV block),
Brivaracetam is a safe treatment option in these patients.
Similarly, levetiracetam is an optimal ASM in critically ill patients with a reasonable adverse effect
profile and minimal interactions with other drugs
ASM: Anti-seizure medication Seizure, European Journal of Epilepsy 79 (2020)
49–52
22. Different scenarios of seizure management in critically ill
patients with COVID-19 contd..
More than one seizures (either shorter or longer than 5min) or status epilepticus
(convulsive or nonconvulsive):
General management principals of serial seizures and status epilepticus should be applied.
New-onset seizures in these patients could be considered as acute symptomatic seizures.
Patients with acute symptomatic seizures do not need long-term ASM therapy after the period of acute
illness, unless a subsequent seizure occurs.
Since the period from the onset of COVID-19 symptoms to death may range from 6 to 41 days, it is reasonable
to continue the ASM for about 6 weeks and then tapper and discontinue the drug rapidly in 1–2 weeks.
ASM: Anti-seizure medication European Journal of Epilepsy 79 (2020) 49–52
23. COVID-19 in people with epilepsy: An altered management approach
• The International League Against Epilepsy (ILAE) has provided valuable resources to tackle some of the
important issues on this topic.
• Drug-drug interactions between ASMs and anti-COVID therapies may pose significant challenges.
• Furthermore, cardiac, hepatic or renal impairments, which may happen in patients with severe COVID-19,
may require adjustment to ASMs.
• Adverse effects of both groups of therapies (ASMs and anti-COVID therapies) should be considered.
• Administering hydroxychloroquine to a patient with epilepsy, who is already taking Lacosamide, may carry an
added risk and should be done with precaution and ECG monitoring.
• Also, QT prolongations may occur with azithromycin and chloroquine and some ASMs (e.g., Carbamazepine,
Lacosamide, Phenytoin, and Rufinamide) may cause cardiac conduction abnormalities.
ASM: Anti-seizure medication European Journal of Epilepsy 79 (2020) 49–52
24. Clinically relevant DDI between AEDs and medications used in the
treatment of COVID-19 patients
DDI, drug-drug interaction; ATV, atazanavir; DRV/c, darunavir/cobicistat LPV/r, lopinavir/ritonavir; RDV, remdesivir/GS-5734;
FAVI, favipiravir; CLQ, chloroquine; HCLQ, hydroxychloroquine; NITA, nitazoxanide; RBV, ribavirin; TCZ, tocilizumab; IFN-β-
1a; interferon β-1a; OSV, oseltamivir https://www.ilae.org/files/dmfile/Antiepileptic-drugs-interactions_in_COVID-19.pdf
25. Issues with access to ASMs during the COVID-19
pandemic and utility of telemedicine
SARS outbreak in 2003 in Taiwan, showed that 22% of the people did not receive their medications; 12% of
the patients suffered seizure worsening during the outbreak.
In the context of a pandemic, telemedicine, particularly video consultations, should be promoted and scaled up.
Should have a regulatory framework to authorize, integrate, and reimburse telemedicine services.
In the COVID-19 pandemic, integrated telemedicine in national healthcare system, is a call to adopt.
ASM: Anti-seizure medication European Journal of Epilepsy 79 (2020) 49–52
26. Summary
• Neurologic findings vary from non-specific to specific symptoms in
COVID-19 patients.
• Some severe symptoms or diseases can present in the later stage of the
disease.
• Should be aware of the presence of neurologic signs & symptoms as a
chief complaint of COVID-19
27. References
[1] Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun 2020;26(Febuary):102433https://doi. org/10.1016/j.jaut.2020.102433.
[Epub ahead of print].
[2] Bohmwald K, Gálvez NMS, Ríos M, Kalergis AM. Neurologic alterations due to respiratory virus infections. Front Cell Neurosci 2018;12:386.
[3] Hung Ec, Chim Ss, Chan Pk, Tong Yk, Ng Ek, Chiu Rw, et al. Detection of SARS coronavirusRNAinthecerebrospinal fluidofapatientwithsevereacuterespiratory syndrome. Clin Chem
2003;49:2108–9.
[4] Lau KK, Yu WC Chu CM, Lau ST, Sheng B, Yuen KY. Possible central nervous system infection by SARS coronavirus. Emerg Infect Dis 2004;10:342–4.
[5] Li Y, Li H, Fan R, Wen B, Zhang J, Cao X, et al. Coronavirus infections in the central nervous system and respiratory tract show distinct features in hospitalized children. Intervirology
2016;59:163–9.
[6] Saad M, Omrani AS, Baig K, Bahloul A, Elzein F, Matin MA, et al. Clinical aspects and outcomes of 70 patients with Middle East respiratory syndrome coronavirus infection:asingle-
centerexperienceinSaudiArabia.IntJInfectDis2014;29:301–6.
[7] Algahtani H, Subahi A, Shirah B. Neurological complications of middle east respiratory syndrome coronavirus: a report of two cases and review of the literature. Case Rep Neurol Med
2016;2016:3502683.
[8] Dominguez SR, Robinson CC, Holmes KV. Detection of four human coronaviruses in respiratory infections in children: a one-year study in Colorado. J Med Virol 2009;81:1597–604.
[9] Carman KB, Calik M, Karal Y, Isikay S, Kocak O, Ozcelik A, et al. Viral etiological causes of febrile seizures for respiratory pathogens (EFES Study). Hum Vaccin Immunother 2019;15:496–502.
[10] Woo PC, Yuen KY, Lau SK. Epidemiology of coronavirus-associated respiratory tract infections and the role of rapid diagnostic tests: a prospective study. Hong Kong Med J 2012;18(Suppl
2):22–4.
[11] Li YC, Bai WZ, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may be at least partially responsible for the respiratory failure of COVID-19 patients. J Med Virol 2020;27(Febuary).
https://doi.org/10.1002/jmv.25728. [Epub ahead of print].
[12] Mao L, Wang M, Chen S, et al. Neurological Manifestations of hospitalized Patients with COVID-19 in Wuhan, China: a retrospective case series study. JAMA Neurol 2020;10(April):e201127.
[13] MoriguchiT,HariiN,GotoJ,etal.A firstcaseofMeningitis/Encephalitisassociated with SARS-Coronavirus-2. Int J Infect Dis 2020(20 April):30195–8. https://doi.org/ 10.1016/j.ijid.2020.03.062.
[Epub ahead of print]. 3. pii: S1201-S9712.