Department of Rehabilitation Medicine, Xijing Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, 710032, PR China.
Lintong Rehabilitation and Convalescent Centre, Xi'an, 710600, PR China.
J Transl Med. 2024 Aug 5;22(1):720. doi: 10.1186/s12967-024-05319-z.
Fatigue is one of the most common neurological symptoms reported post coronavirus disease 2019 (COVID-19) infection. In order to establish effective early intervention strategies, more emphasis should be placed on the correlation between fatigue and cortical neurophysiological changes, especially in healthcare workers, who are at a heightened risk of COVID-19 infection.
A prospective cohort study was conducted involving 29 COVID-19 medical workers and 24 healthy controls. The assessment included fatigue, sleep and health quality, psychological status, and physical capacity. Functional near-infrared spectroscopy (fNIRS) was employed to detect activation of brain regions. Bilateral primary motor cortex (M1) excitabilities were measured using single- and paired-pulse transcranial magnetic stimulation. Outcomes were assessed at 1, 3, and 6 months into the disease course.
At 1-month post-COVID-19 infection, 37.9% of patients experienced severe fatigue symptoms, dropping to 10.3% at 3 months. Interestingly, the remarkable decreased activation/excitability of bilateral prefrontal lobe (PFC) and M1 were closely linked to fatigue symptoms after COVID-19. Notably, greater increase in M1 region excitability correlated with more significant fatigue improvement. Re-infected patients exhibited lower levels of brain activation and excitability compared to single-infection patients.
Both single infection and reinfection of COVID-19 lead to decreased activation and excitability of the PFC and M1. The degree of excitability improvement in the M1 region correlates with a greater recovery in fatigue. Based on these findings, targeted interventions to enhance and regulate the excitability of M1 may represent a novel strategy for COVID-19 early rehabilitation.
The Ethics Review Committee of Xijing Hospital, No. KY20232051-F-1; www.chictr.org.cn , ChiCTR2300068444.
疲劳是新冠病毒病（COVID-19）感染后最常见的神经症状之一。为了建立有效的早期干预策略，应更加重视疲劳与皮质神经生理变化之间的相关性，尤其是在医护人员中，他们感染 COVID-19 的风险更高。
进行了一项前瞻性队列研究，纳入了 29 名 COVID-19 医务人员和 24 名健康对照者。评估包括疲劳、睡眠和健康质量、心理状态和身体能力。采用功能近红外光谱（fNIRS）检测脑区激活。使用单脉冲和双脉冲经颅磁刺激测量双侧初级运动皮层（M1）兴奋性。在疾病病程的 1、3 和 6 个月时评估结局。
在 COVID-19 感染后 1 个月时，37.9%的患者出现严重疲劳症状，3 个月时降至 10.3%。有趣的是，双侧前额叶（PFC）和 M1 的显著降低的激活/兴奋性与 COVID-19 后疲劳症状密切相关。值得注意的是，M1 区兴奋性增加越大，疲劳改善越显著。再感染患者的脑区激活和兴奋性水平低于单次感染患者。
COVID-19 的单次感染和再感染均导致 PFC 和 M1 的激活和兴奋性降低。M1 区兴奋性的改善程度与疲劳恢复程度呈正相关。基于这些发现，增强和调节 M1 兴奋性可能成为 COVID-19 早期康复的一种新策略。
西京医院伦理审查委员会，编号 KY20232051-F-1；www.chictr.org.cn ，ChiCTR2300068444。
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