COVID-19 Neuromuscular Involvement in Post-Acute Rehabilitation.

Manfredi Ferraro,Francesca Rubino,Marina Angela Bellavia,Gianluca Battaglia,Caterina Prestandrea,Sergio Bagnato,Tiziana D’Agostino,Cristina Boccagni

doi:10.3390/brainsci11121611

Abstract

Background: Coronavirus disease 2019 (COVID-19) is associated with muscle and nerve injuries as a consequence of prolonged critical illness or the infection itself. In this study, we evaluated neuromuscular involvement in patients who underwent post-acute intensive rehabilitation after COVID-19. Methods: Clinical and neurophysiological evaluations, including nerve conduction studies and electromyography, were performed on 21 consecutive patients admitted for rehabilitation after COVID-19. Results: Clinical signs suggesting muscle or nerve involvement (weakness, reduced deep tendon reflexes, impaired sensitivity, abnormal gait) were found in 19 patients. Neurophysiological examinations confirmed neuromuscular involvement in 17 patients: a likely association of critical illness myopathy (CIM) and critical illness polyneuropathy (CIP) was found in 5 patients; CIM alone was found in 4 patients; axonal sensory-motor polyneuropathy was found in 4 patients (CIP in 2 patients, metabolic polyneuropathy in 2 patients); Guillain-Barré syndrome was found in 2 patients (classical demyelinating sensory-motor polyneuropathy and acute motor axonal neuropathy, respectively); peroneal nerve injury was found in 1 patient; and pre-existing L4 radiculopathy was found in 1 patient. Conclusions: Neuromuscular involvement is a very common finding among patients admitted for rehabilitation after COVID-19, and proper investigation should be conducted when muscle or nerve injury is suspected for adequate rehabilitative strategy planning.

Highlights

Coronavirus disease 2019 (COVID-19) has a wide range of neuromuscular involvement, from neuropathies to different degrees of muscle injury [1]
Guillain-Barré syndrome (GBS) is considered to be the prototype for postinfectious neuropathy, reflecting the ability of some infectious agents to trigger an immune-mediated response against the peripheral nerves
critical illness polyneuropathy (CIP) is an axonal sensory-motor polyneuropathy that occurs in critically ill patients and it is a major cause of intensive care unit-acquired weakness [5]

Summary

Introduction

Coronavirus disease 2019 (COVID-19) has a wide range of neuromuscular involvement, from neuropathies to different degrees of muscle injury [1]. The polyneuropathies reported most commonly after COVID-19 are Guillain-Barré syndrome (GBS) and critical illness polyneuropathy (CIP). GBS is considered to be the prototype for postinfectious neuropathy, reflecting the ability of some infectious agents to trigger an immune-mediated response against the peripheral nerves. Its clinical presentation is similar in patients with and without COVID-19, and the classical form of GBS, characterized by symmetrical weakness of the limbs, sensory symptoms, and reduced or absent tendon reflexes, is the manifestation reported most frequently after COVID-19 [4]. CIP is an axonal sensory-motor polyneuropathy that occurs in critically ill patients and it is a major cause of intensive care unit-acquired weakness [5].

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