Neuropsychiatric Manifestations of Mast Cell Activation Syndrome and Response to Mast-Cell-Directed Treatment: A Case Series

Mast cell activation syndrome (MCAS) is an immune disease with an estimated prevalence of 17%. Mast cell chemical mediators lead to heterogeneous multisystemic inflammatory and allergic manifestations. This syndrome is associated with various neurologic and psychiatric disorders, including headache, dysautonomia, depression, generalized anxiety disorder, and many others. Although MCAS is common, it is rarely recognized, and thus, patients can suffer for decades. The syndrome is caused by aberrant mast cell reactivity due to the mutation of the controller gene. A case series is presented herein including eight patients with significant neuropsychiatric disorders that were often refractory to standard medical therapeutics. Five patients had depression, five had generalized anxiety disorder, and four had panic disorder. Other psychiatric disorders included attention-deficit hyperactivity disorder, obsessive compulsive disorder, phobias, and bipolar disorder. All eight patients were subsequently diagnosed with mast cell activation syndrome; six had comorbid autonomic disorders, the most common being postural orthostatic tachycardia syndrome; and four had hypermobile Ehlers-Danlos syndrome. All patients experienced significant improvements regarding neuropsychiatric and multisystemic symptoms after mast-cell-directed therapy. In neuropsychiatric patients who have systemic symptoms and syndromes, it is important to consider the presence of an underlying or comorbid MCAS

A response to call for “A New Paradigm” for Long Covid in Lancet Respiratory Medicine: Long COVID is not a functional disorder

A Response to Call for “A New Paradigm” for Long COVID in Lancet Respiratory Medicin

COVID-19 in Patients With Pre-existing Neurologic Disorders: Clinical Course and Outcomes (2608)

Objective: To assess the clinical course and outcomes of COVID-19 in patients with pre-existing neurologic disorders and the impact of COVID-19 on neurologic disorder during and after COVID-19. Background: In March of 2020, as COVID-19 increased in the United States, several risk factors for severe COVID-19 emerged, including age, hypertension, diabetes, and immunocompromised state. Neurologic disorders were not among these risk factors, and no information existed on the course and outcomes of COVID-19 in patients with various neurologic disorders. Design/Methods: After receiving IRB approval, a structured questionnaire was distributed via various media platforms between April–October 2020 to the US neurologists and neurology trainees with questions pertaining to their patients with pre-existing neurologic disorders who had COVID-19 infection confirmed either by SARS-Co-V2 PCR or IgG test. Results: Over a 6-month period, 66 patients, (age range 1–94, mean 49.2 years, 39 females, 27 males) were submitted, with most frequent neurologic disorders being chronic migraine (23%), epilepsy (12%) and multiple sclerosis (MS) (11%). Of these, 58% had a mild-to-moderate course of COVID-19 requiring no hospitalization, 41% required hospitalization or intensive care unit admission, and 5 patients died (2 were in their 90s with a history of stroke, 2 in their 60s with malignancy, and one 31-year-old male with MS.) COVID-19 resulted in exacerbation of the underlying neurologic disorder during or after COVID-19 in 57% of patients. Common persistent symptoms after COVID-19 included fatigue, exercise intolerance and headache. Conclusions: In this cohort, majority of patients with pre-existing neurologic disorders had a mild-to-moderate course of COVID-19 requiring no hospitalization, but many experienced exacerbation of their pre-existing neurologic disorder during or after COVID-19 and had persistent symptoms of fatigue, exercise intolerance and headache. Large prospective studies are needed to determine which neurologic disorders present a significant risk in order to protect the most vulnerable patient population

Die Übersicht zur aktuellen Evidenz ignoriert die aktuelle Evidenz : Leserbrief

Leserbrief zu Ludwig B et al (2022) Myalgische Enzephalo- myelitis/chronisches Fatigue-Syndrom: eine Übersicht zur aktuellen Evidenz. Nervenarzt. https://doi.org/10.1007/s00115-022-01431-