Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy.
Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy.
Clin Neurophysiol. 2021 May;132(5):1138-1143. doi: 10.1016/j.clinph.2021.03.001. Epub 2021 Mar 13.
A high proportion of patients experience fatigue and impairment of cognitive functions after coronavirus disease 2019 (COVID-19). Here we applied transcranial magnetic stimulation (TMS) to explore the activity of the main inhibitory intracortical circuits within the primary motor cortex (M1) in a sample of patients complaining of fatigue and presenting executive dysfunction after resolution of COVID-19 with neurological manifestations.
Twelve patients who recovered from typical COVID-19 pneumonia with neurological complications and complained of profound physical and mental fatigue underwent, 9 to 13 weeks from disease onset, a psychometric evaluation including a self-reported fatigue numeric-rating scale (FRS, Fatigue Rating Scale) and the Frontal Assessment Battery (FAB). Intracortical activity was evaluated by means of well-established TMS protocols including short-interval intracortical inhibition (SICI), reflecting GABA-mediated inhibition, long-interval intracortical inhibition (LICI), a marker of GABA receptor activity, and short-latency afferent inhibition (SAI) that indexes central cholinergic transmission. TMS data were compared to those obtained in a control group of ten healthy subjects (HS) matched by age, sex and education level.
Post-COVID-19 patients reported marked fatigue according to FRS score (8.1 ± 1.7) and presented pathological scores at the FAB based on Italian normative data (12.2 ± 0.7). TMS revealed marked reduction of SICI, and disruption of LICI as compared to HS. SAI was also slightly diminished.
The present study documents for the first time reduced GABAergic inhibition in the M1 in patients who recovered from COVID-19 with neurological complications and manifested fatigue and dysexecutive syndrome.
TMS may serve as diagnostic tool in cognitive disturbances and fatigue in post-COVID-19 patients.
相当比例的 COVID-19 患者在疾病康复后会出现疲劳和认知功能障碍。在此，我们应用经颅磁刺激（TMS）技术，来探索主要抑制性皮质内回路在出现 COVID-19 神经系统并发症并伴有疲劳和执行功能障碍的患者大脑运动皮质（M1）中的活动。
12 名患者患有典型 COVID-19 肺炎合并神经系统并发症，自述存在严重的身心疲劳，在疾病发病后 9-13 周进行了心理测量评估，包括自我报告的疲劳数字评定量表（FRS）和额叶评估量表（FAB）。通过既定的 TMS 方案评估皮质内活动，包括短潜伏期皮质内抑制（SICI），反映 GABA 介导的抑制；长潜伏期皮质内抑制（LICI），是 GABA 受体活性的标志物；短潜伏期传入抑制（SAI），反映中枢胆碱能传递。将 TMS 数据与 10 名健康对照者（HS）进行比较，这些 HS 按年龄、性别和教育程度匹配。
COVID-19 后患者根据 FRS 评分（8.1±1.7）报告有明显疲劳，且根据意大利参考数据，在 FAB 上出现病理性评分（12.2±0.7）。与 HS 相比，COVID-19 后患者的 SICI 明显降低，LICI 紊乱，SAI 也略有下降。
本研究首次证明，患有 COVID-19 神经系统并发症且出现疲劳和执行功能障碍的患者 M1 中的 GABA 能抑制减少。
TMS 可能成为 COVID-19 后患者认知障碍和疲劳的诊断工具。
