Paris Brain Institute’s Cohort Covid Neuroscience project is studying the neurological and psychiatric consequences of SARS-CoV-2 infection over the course of one year. This unique study focuses on two aspects: the direct effects of Covid-19 on the central nervous system and the impact of the infection on patients suffering from neurological diseases such as Alzheimer’s disease, Parkinson’s disease and multiple sclerosis.
The project’s initial results, six months after the start of the study, have already identified a notable range of impacts of the disease and factors that impact the severity of COVID-19.
Multiple Sclerosis (MS) can increase the risk of severe COVID-19, according to study findings published in JAMA Network. In the way that age and obesity are recognized factors, the severity of neurological disability as a result of MS (the scale of which is known as the EDSS score) is linked to increased COVID-19 risk (requiring at least one hospitalization), although no association was found between disease modifying therapy (DMTs) exposure to treat the neurological condition and COVID-19 severity.
Several types of brain abnormalities have been identified in patients with Covid-19, through brain imaging and the neuroradiology teams of the medical-university Neuroscience Department of the Pitié-Salpêtrière Hospital. Published in Radiology, these findings provide important brain imaging data in patients with COVID-19 and identifies several potential brain targets for CoV-2 SARS infection.
Other publications in the European journal of neurology describe common features of encephalopathy visible on PET-scan, following SARS CoV-2 infection, which may reflect an immune mechanism. Cases of movement disorders were also reported, such as upper limb postural and action tremor, orthostatic tremor and myoclonus. Appearing several weeks after intensive care unit discharge, several hypotheses will be addressed in the future on the mechanisms involved, from direct central nervous system damage by SARS-CoV-2 and immune-mediated mechanism to metabolic origin.
Initial findings are helping researchers and clinicians build a better understanding of the neurological and psychiatric manifestations of Covid-19 and to develop new treatments to help patients in the best possible way. The efforts of researchers and clinicians to better characterize the neurological symptoms of patients have led to the development of a new therapeutic approach in intensive care units.
In the early weeks of the pandemic, neurological symptoms were reported by physicians in patients affected by Covid-19, such as loss of smell or taste, but also more serious conditions such as seizures or stroke. Faced with this challenge, in April 2020, over just a few weeks, the project mobilized the entire forces of the Neuroscience medical-university department of the AP-HP Pitié-Salpêtrière Hospital and the Paris Brain Institute, supported by the International Automobile Federation (FIA), the FIA Foundation and the Institute’s donors. Researchers and clinicians have accomplished the feat of setting up the study programme in a short time-frame, from clinical and ethical authorizations to the establishment of the database and a steering committee.
More than 500 subjects are now enrolled in the study. Data collection, inclusion in a common database and analysis by the Paris Brain Institute’s biostatistics teams can be done in parallel with the entry of patients into the cohort. This is a considerable time saving in order to obtain information on the neurological consequences of Covid-19 and to be able to act almost in “real time” in patients.
Much more work is in the pipeline on stroke, brain tumor patients, and Parkinson’s disease. In addition, there is still much data already acquired to be analyzed, particularly biological data, which will provide a better understanding of the immune response to infection in patients suffering from immune-related pathologies such as multiple sclerosis. At the same time, long-term follow-up of patients on clinical, cognitive, biological and imaging aspects is underway to define the characteristics of the SARS-CoV-2 infection in the long term.
This study, which has mobilized the entire neurology and psychiatry community at the Pitié-Salpêtrière Hospital and many French centers, now goes beyond the national borders with collaborations with prestigious research centers such as Yale or Liverpool University and in international consortiums. They will be key to increasing our knowledge of the infection and its consequences on the central nervous system, always to the primary benefit of patients.
Sources: Publications resulting from research
- Delorme et al. Covid-19-related encephalopathy: a case series with brain FDG-PET/CT findings. Eur J Neurol. 2020. DOI:1111/ene.14478
- Chougar et al. Retrospective observational study of brain MRI findings in patients with acute SARS-CoV-2 infection and neurological manifestations. Radiology. 2020 DOI:1148/radiol.2020202422
- Louapre et al. Clinical characteristics and outcomes in patients with coronavirus disease 2019 and multiple sclerosis. JAMA Neurol. 2020 DOI:1001/jamaneurol.2020.2581
- Altmayer et al. Therapeutic plasma exchange in a critically ill Covid-19 patient. J Clin Apher. 2020DOI:1002/jca.21830
- Cao et al. Severe Covid-19-related encephalitis can respond to immunotherapy. Brain. Accepted. (preprint: hal-02918661)
- Cuhna et al. Movement disorders as a new neurological clinical picture in severe SARS-CoV2 infection. Eur J Neurol. 2020. DOI:1111/ene.14474