key: cord-1042587-0bty528l
authors: Winkler, Andrea Sylvia; Knauss, Samuel; Schmutzhard, Erich; Leonardi, Matilde; Padovani, Alessandro; Abd-Allah, Foad; Charway-Felli, Augustina; Emmerich, Julius Valentin; Umapathi, Thirugnanam; Satishchandra, Parthasarthy; Hoo, Fan Kee; Dalmau, Josep; Oreja-Guevara, Celia; Ferreira, Lúcia Brito; Pfausler, Bettina; Michael, Benedict; Tagliavini, Fabrizio; Höglinger, Günter; Endres, Matthias; Klein, Christine; Hemmer, Bernhard; Correll, William; Sejvar, James; Solomon, Tom
title: A call for a global COVID-19 Neuro Research Coalition
date: 2020-05-26
journal: Lancet Neurol
DOI: 10.1016/s1474-4422(20)30150-2
sha: e1005d5fd672f17fa6508adf2eee75181b6f70df
doc_id: 1042587
cord_uid: 0bty528l

nan

admission to an intensive-care unit or intubation) might be difficult.

The European Academy of Neurology (EAN) aims to gather evidence about the neurological impact of COVID-19. Encompassing 45 000 European neurologists, 47 European National Neurological Societies, and ten associate National Societies from Africa and Asia, the EAN has created a multidisciplinary task force, the EANcore COVID-19, to develop: diagnostic and treatment recommendations for patients with COVID-19 with all subgroups of neurological condition; an online Neuro COVID-19 survey on neurological complications of COVID-19 (for which more than 4200 responses have been already received as of April 30, 2020); and the EAN Neuro COVID-19 registry, which arises from a collaboration with the Italian, Spanish, and Portuguese neuro logical societies and aims to collect stand ardised information about demographics, comorbidities, general and neurological manifestations, and course and outcome of COVID-19. This registry, launched on April 29, 2020, will be offered by the EAN to all interested neurologists, neurology departments, and National Societies, together with the necessary ethical, methodological, and technical support. EAN will also provide a platform for rapid COVID-19related literature alerts and information.

Difficult times ask for innovative and courageous solutions. Neurologists are called on to play their part. The EAN is ready to support and join inter na tional efforts to alleviate the medi cal consequences and also the burden associated with the COVID-19 pandemic. 

The frequency, determinants, and evolution of neurological manifestations associated with coronavirus disease 2019 (COVID-19) remain unknown, because of few available data and the retrospective nature of most reports. 1-4 Furthermore, the possible neuro tropic nature of the virus (leading to dyspnoea and respiratory failure) is yet to be confirmed. 5 Neurologists are facing many other challenges in the current pandemic, including the management of older patients and those with pre-existing neurological disorders for whom ethical decisions about escalation of care (eg, asymptomatic. Asymptomatic children might still harbour the virus, with so far unknown effects on their health status later in life, including brain development. Additionally, once a vaccine becomes available, careful monitoring across age groups and disease spectra will be required to identify adverse effects and any deterioration of signs and symptoms in patients with neurological diseases. Overall, understanding is needed of whether susceptible groups exist who are at increased risk of deterioration after SARS-CoV-2 infection, how to detect them by use of biomarkers, and whether treatment needs to be specifically targeted in case of neurological signs and symptoms. Systems for clinical surveillance, epidemiological and clinical research, and post-mortem studies will be needed to achieve this aim. The COVID-19 pandemic necessitates close collaboration on a global scale, with a special emphasis on inclusion of colleagues and partner institutions from low-income and middle-income countries. Inspired by the COVID-19 Clinical Research Coalition described recently in The Lancet, 5 our proposal is to build on and link existing international neurology partnerships, such as the Brain Infections Global COVID-Neuro Network, that provides a network for interested clinicians, a daily update of all publications relating to neurological COVID-19 disease, and freely accessible downloads of case-record forms; the European Academy of Neurology COVID-19 registry; the Lean European Open Survey on SARS-CoV-2 Infected Patients endorsed by the German Neurological Society; and the activities of the World Federation of Neurology around COVID-19. Additionally, WHO can play an important part in building this coalition through identifying priorities and developing harmonised systems for neurological research. We are therefore launching a call for an inclusive and collaborative global COVID-19 Neuro Research Coalition cocreated by the research communities around the world (panel). In a first step, we will create a platform of exchange and communication. If you are interested in becoming part of this community, please register at the Center for Global Health, Department of Neurology, Technical University of Munich, Germany, by sending an email to covid19.neuro@med.tum.de. ME reports grants from Bayer and fees paid to their institution from Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Pfizer, Daiichi Sankyo, Amgen, GlaxoSmithKline, Sanofi, Covidien, and Novartis, all outside of the submitted work. TS reports fees paid to their institution from GlaxoSmithKline Ebola tissue directly, although it has been isolated from the CSF of some patients. 3 The hypothesis of neurotropism with subsequent neuronal injury, either directly or indirectly (through immune mechanisms), is supported by previous findings from other infections with severe acute respiratory syn drome CoV and Middle East respiratory syndrome CoV. 3 Pre-existing cardiovascular or pulmonary disease and old age increase the chances of contracting SARS-CoV-2 infection and those risk factors are often present in patients with neurological disorders. Individuals with autoimmune diseases, such as multiple sclerosis, who require immunotherapy, might be at increased risk of SARS-CoV-2 infection and neurologists are in need of tailored recommendations for immunotherapy, relapse management, and delivery of care. Patients with Parkinson's disease have an increased risk for cardiovascular complications and can have multiple comorbidities, including cognitive impairment, depression, and psychosis, which can deteriorate during isolation. 4 Also, many patients with cognitive impairment might not be able to follow infection prevention and control recommendations, thereby putting themselves and their caregivers at risk of contracting SARS-CoV-2. Additionally, very little is known about potential interaction between various medications for chronic neurological diseases and drug treatment for COVID-19.

Because the effects of SARS-CoV-2 on the nervous system are largely unknown, estimating the neurological morbidity that might occur from the acute phase of the pandemic is difficult. Also, whether patients might have long-term neurological or cognitive sequelae, or whether pre-existing neuro logical disease might deteriorate (eg, patients with mild cognitive impairment might have little cognitive reserve and develop dementia early) is unknown. Effects of coronavirus in children seem less severe and often the virus is present but children are reported on 214 patients who were admitted to hospital in Wuhan, China, with acute COVID-19. Symptoms were severe in 59% (mean age 58·7 years) of these patients, and non-severe in 41% (mean age 49·9 years). In total, 78 (36%) of 214 patients had neurological compromise, which was more common in severe (46%) than in non-severe (30%) cases and included stroke, impaired consciousness, myopathy, and neu ralgic pain. Viral meningo encephalitis with presence of SARS-CoV-2 in CSF by viral genome sequencing has been reported in patients in China 3 and Japan. 4 In the USA, a woman aged between 50 and 60 years developed COVID-19 and altered mental status. Brain MRI on this patient showed bilateral haemorrhagic rim-enhancing lesions within thalami, medial tem poral lobes, and subinsular regions char acteristic of acute haemorrhagic necrotis ing encephalopathy. 5 This con dition also, but rarely, occurs in influenza and other encephali tides in association with cytokine storm syndrome.

Amid confronting a severe out break of COVID-19, the Spanish Neurological Society (Sociedad Española de Neurología) implemented a registry of neuro logical manifestations in patients with confirmed COVID-19. We applaud this initiative and propose to expand these efforts globally to define the nervous system involvement in COVID-19. The Environmental Neurology Specialty Group of the World Federation of Neurology (ENSG-WFN) is encouraging neurological soci eties around the world to develop national or regional neuroepidemiological data banks to report all cases of new-onset, acute, delayed, and any long-latency neurological disorders associ ated with SARS-CoV-2 infection during the COVID-19 pandemic. Late parkinsonism occurred among survivors of the 1918-20 influenza pandemic. Therefore, neurologists must be prepared for the occurrence of delayed neurological manifestations of COVID-19.

The pandemic of coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has already affected more than 2·7 million people and caused more than 192 000 deaths worldwide. Respiratory symptoms are the most common, and neurogenic breathing failure is suspected to be involved. 1 Symptoms such as anosmia, dysgeusia, headache, and muscle pain have been noted, along with reports of central and peri pheral nervous system involvement. Mao 

Neurologic manifestations of hospitalized patients with coronavirus disease

Neurologic features in severe SARS-CoV-2 infection

Nervous system involvement after infection with COVID-19 and other coronaviruses

The impact of COVID-19 on Parkinson's disease: hidden sorrows and emerging opportunities

COVID-19 Clinical Research Coalition. Global coalition to accelerate COVID-19 clinical research in resource-limited settings