Dysautonomia in COVID-19 Patients: A Narrative Review on Clinical Course, Diagnostic and Therapeutic Strategies

IntroductionOn March 11, 2020, the World Health Organization sounded the COVID-19 pandemic alarm. While efforts in the first few months focused on reducing the mortality of infected patients, there is increasing data on the effects of long-term infection (Post-COVID-19 condition). Among the different symptoms described after acute infection, those derived from autonomic dysfunction are especially frequent and limiting. ObjectiveTo conduct a narrative review synthesizing current evidence of the signs and symptoms of dysautonomia in patients diagnosed with COVID-19, together with a compilation of available treatment guidelines. ResultsAutonomic dysfunction associated with SARS-CoV-2 infection occurs at different temporal stages. Some of the proposed pathophysiological mechanisms include direct tissue damage, immune dysregulation, hormonal disturbances, elevated cytokine levels, and persistent low-grade infection. Acute autonomic dysfunction has a direct impact on the mortality risk, given its repercussions on the respiratory, cardiovascular, and neurological systems. Iatrogenic autonomic dysfunction is a side effect caused by the drugs used and/or admission to the intensive care unit. Finally, late dysautonomia occurs in 2.5% of patients with Post-COVID-19 condition. While orthostatic hypotension and neurally-mediated syncope should be considered, postural orthostatic tachycardia syndrome (POTS) appears to be the most common autonomic phenotype among these patients. A review of diagnostic and treatment guidelines focused on each type of dysautonomic condition was done. ConclusionSymptoms deriving from autonomic dysfunction involvement are common in those affected by COVID-19. These symptoms have a great impact on the quality of life both in the short and medium to long term. A better understanding of the pathophysiological mechanisms of Post-COVID manifestations that affect the autonomic nervous system, and targeted therapeutic management could help reduce the sequelae of COVID-19, especially if we act in the earliest phases of the disease

Dysautonomia in COVID-19 patients: a narrative review on clinical course, diagnostic and therapeutic strategies

IntroductionOn March 11, 2020, the World Health Organization sounded the COVID-19 pandemic alarm. While efforts in the first few months focused on reducing the mortality of infected patients, there is increasing data on the effects of long-term infection (Post-COVID-19 condition). Among the different symptoms described after acute infection, those derived from autonomic dysfunction are especially frequent and limiting. ObjectiveTo conduct a narrative review synthesizing current evidence of the signs and symptoms of dysautonomia in patients diagnosed with COVID-19, together with a compilation of available treatment guidelines. ResultsAutonomic dysfunction associated with SARS-CoV-2 infection occurs at different temporal stages. Some of the proposed pathophysiological mechanisms include direct tissue damage, immune dysregulation, hormonal disturbances, elevated cytokine levels, and persistent low-grade infection. Acute autonomic dysfunction has a direct impact on the mortality risk, given its repercussions on the respiratory, cardiovascular, and neurological systems. Iatrogenic autonomic dysfunction is a side effect caused by the drugs used and/or admission to the intensive care unit. Finally, late dysautonomia occurs in 2.5% of patients with Post-COVID-19 condition. While orthostatic hypotension and neurally-mediated syncope should be considered, postural orthostatic tachycardia syndrome (POTS) appears to be the most common autonomic phenotype among these patients. A review of diagnostic and treatment guidelines focused on each type of dysautonomic condition was done. ConclusionSymptoms deriving from autonomic dysfunction involvement are common in those affected by COVID-19. These symptoms have a great impact on the quality of life both in the short and medium to long term. A better understanding of the pathophysiological mechanisms of Post-COVID manifestations that affect the autonomic nervous system, and targeted therapeutic management could help reduce the sequelae of COVID-19, especially if we act in the earliest phases of the disease

Klinisch effektives Konnektivitätsprofil der thalamischen Tiefen Hirnstimulation bei essentiellem Tremor

Die Dissertation ist gesperrt bis zum 06.03.2025 !Der thalamische VIM ist eine etablierte Zielstruktur in der chirurgischen Behandlung des essentiellen Tremors. Das traditionelle, Atlanten-basierte Targeting führt zu großen Schwankungen im klinischen Outcome. Neuerliche Ansätze vergleichen den Effekt der THS-induzierten Tremorsuppression mit einer Konnektivitäts-basierten Segmentation des Zielareals. Entsprechende Studien führen zu widersprüchlichen Ergebnissen, wobei einerseits die Konnektivität zum primär motorischen Kortex und andererseits zum prämotorischen/supplementär motorischen Kortex als therapeutisch relevant angesehen wird. Ziel dieser Arbeit war es, mittels probabilistischer DTI die kortikalen bzw. zerebellären Areale mit der höchsten Konnektivität zum klinisch effektiven thalamischen Stimulationsort zu identifizieren. Hierzu wurden Patienten-spezifische probabilistische DTI-Sequenzen von 20 mit bilateraler thalamischer THS behandelten ET Patienten erstellt. Durchschnittlich 9 Wochen postoperativ erfolgte eine monopolare Überprüfung und optimierte Stimulationsprogrammierung der Elektrodenkontakte. Die aktiven Elektrodenkontakte jeder Hemisphäre wurden mittels einer binären Klassifikation des klinischen Ansprechens (vollständige bzw. unvollständige Tremorsuppression) aufgeteilt. Schließlich wurden Konnektivitätsprofile dieser Kontakte innerhalb des kortikalen und zerebellären Tremornetzwerkes erstellt und zwischen den Gruppen (sowohl auf Patienten- als auch auf Elektrodenebene) verglichen. Wir kamen zu dem Ergebnis, dass die aktiven Elektrodenkontakte in der Gruppe mit vollständiger Tremorsuppression erhöhte Konnektivitäten zu M1, S1, dem Lobus anterior des Zerebellums, SMA und dem Nucleus dentatus aufwiesen. Die Konnektivität zu M1 stellte sich als signifikant höher für die Elektroden/Patienten mit vollständiger Tremorsuppression und als die relevanteste dar. Wichtig ist, dass die klinischen Vorteile nicht mit höheren Stimulationsintensitäten oder auf Kosten von Nebenwirkungen erreicht wurden, was auf ein klinisch wirksames THS-Konnektivitätsmuster hinweist. Bemerkenswert ist, dass die jeweiligen Elektroden der effektiven Stimulation signifikant tiefer gelegen waren. Vollständige Tremorsuppression nach thalamischer THS entsprach einem Konnektivitätsmuster mit abgestufter Relevanz der einzelnen Knoten innerhalb des Tremornetzwerkes. Die Konnektivität zum sensomotorischen Kortex konnte hierbei als die relevanteste identifiziert werden

Dysautonomia in COVID-19 patients: a narrative review on clinical course, diagnostic and therapeutic strategies

IntroductionOn March 11, 2020, the World Health Organization sounded the COVID-19 pandemic alarm. While efforts in the first few months focused on reducing the mortality of infected patients, there is increasing data on the effects of long-term infection (Post-COVID-19 condition). Among the different symptoms described after acute infection, those derived from autonomic dysfunction are especially frequent and limiting. ObjectiveTo conduct a narrative review synthesizing current evidence of the signs and symptoms of dysautonomia in patients diagnosed with COVID-19, together with a compilation of available treatment guidelines. ResultsAutonomic dysfunction associated with SARS-CoV-2 infection occurs at different temporal stages. Some of the proposed pathophysiological mechanisms include direct tissue damage, immune dysregulation, hormonal disturbances, elevated cytokine levels, and persistent low-grade infection. Acute autonomic dysfunction has a direct impact on the mortality risk, given its repercussions on the respiratory, cardiovascular, and neurological systems. Iatrogenic autonomic dysfunction is a side effect caused by the drugs used and/or admission to the intensive care unit. Finally, late dysautonomia occurs in 2.5% of patients with Post-COVID-19 condition. While orthostatic hypotension and neurally-mediated syncope should be considered, postural orthostatic tachycardia syndrome (POTS) appears to be the most common autonomic phenotype among these patients. A review of diagnostic and treatment guidelines focused on each type of dysautonomic condition was done. ConclusionSymptoms deriving from autonomic dysfunction involvement are common in those affected by COVID-19. These symptoms have a great impact on the quality of life both in the short and medium to long term. A better understanding of the pathophysiological mechanisms of Post-COVID manifestations that affect the autonomic nervous system, and targeted therapeutic management could help reduce the sequelae of COVID-19, especially if we act in the earliest phases of the disease