Movement Disorders Associated with COVID-19.

Mehri Salari,Nahad Sedaghat,Hosein Nouri,Masoud Etemadifar,Bahareh Zaker Harofteh

doi:10.1155/2021/3227753

Abstract

As neurological complications associated with COVID-19 keep unfolding, the number of cases with COVID-19-associated de novo movement disorders is rising. Although no clear pathomechanistic explanation is provided yet, the growing number of these cases is somewhat alarming. This review gathers information from 64 reports of de novo movement disorders developing after/during infection with SARS-CoV-2. Three new cases with myoclonus occurring shortly after a COVID-19 infection are also presented. Treatment resulted in partial to complete recovery in all three cases. Although the overall percentage of COVID-19 patients who develop movement disorders is marginal, explanations on a probable causal link have been suggested by numerous reports; most commonly involving immune-mediated and postinfectious and less frequently hypoxic-associated and ischemic-related pathways. The current body of evidence points myoclonus and ataxia out as the most frequent movement disorders occurring in COVID-19 patients. Some cases of tremor, chorea, and hypokinetic-rigid syndrome have also been observed in association with COVID-19. In particular, parkinsonism may be of dual concern in the setting of COVID-19; some have linked viral infections with Parkinson's disease (PD) based on results from cerebrospinal fluid analyses, and PD is speculated to impact the outcome of COVID-19 in patients negatively. In conclusion, the present paper reviewed the demographic, clinical, and treatment-associated information on de novo movement disorders in COVID-19 patients in detail; it also underlined the higher incidence of myoclonus and ataxia associated with COVID-19 than other movement disorders.

Highlights

Coronavirus disease 2019 (COVID-19), a lower respiratory infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is associated with a wide range of neurological manifestations
Low to very-low concentrations of viral RNA have been detected by reverse transcription-polymerase chain reaction (RT-PCR) in some autopsied brain samples—especially those from the olfactory bulb and medulla; lack of correlation with microglial activation and nodules in those specimens is against the speculated CNS tropism [8, 9]
We conducted a comprehensive systematic literature search in PubMed and Scopus databases using the following terms: “coronavirus disease 2019,” “COVID,” “COVID-19,” “SARS-CoV-2,” “Neurologic,” “Movement disorders,” “Tremor,” “Myoclonus,” “Parkinsonism,” “ataxia,” “dystonia,” and “chorea”. e Mendeley application was used to detect, scan, and remove duplicates. e remaining studies were scanned for relevant titles/abstracts

Summary

Introduction

Coronavirus disease 2019 (COVID-19), a lower respiratory infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is associated with a wide range of neurological manifestations. Among the less common yet more severe complications are cerebrovascular diseases, encephalitis, encephalopathy, and inflammatory central and peripheral nervous systems (CNS and PNS) disorders [3]. Movement abnormalities such as ataxia and opsoclonusmyoclonus have been observed in COVID-19 patients [4, 5]. The expression of angiotensin-converting enzyme 2 (ACE2) in the human brain parenchyma and whether SARS-CoV-2 infects the CNS neuronal cells is not established yet [7]. We review all published reports on COVID-19-associated movement disorders and present three new patients with myoclonus after contracting COVID-19

Literature Search Strategy and Inclusion Criteria

Results

Discussion

Hypokinesia and Parkinsonism