what a warm welcome to today's talk it's just Tuesday the 27th of September now I'm becoming more concerned about neurological complications or sequelae following covered infection now I'm studying I'm going to look at today it's from nature medicine and it shows that people that have had covered are 42 more likely to get neurological complications compared to that uninfected uh counterparts now of course these days not many people are uninfected so this is taken from fairly early on in the pandemic that could affect things of course it's not going to be exactly the same now but it's the best day to have gotten it is interesting and and somewhat concerning especially following on from yesterday's video when we looked at the increased risk of Alzheimer's disease and not only is the 42 percent more likely to get a neurological sequelae um it actually turns out that seven percent a whole seven percent of people that are infected are getting a neurological Sequoia line and I know recently personally I've been meeting quite a lot of people complaining of brain fog memory loss and sometimes they can relate it to an infection other times they can't but it is becoming more prevalent and I'm sure many of you watching have this problem and or certainly know people who have this problem and at least 40 million people worldwide and and probably significantly more than that have been affected now this is from this paper here so it's it's nature medicine fully peer-reviewed article actually quite readable um very well written uh quite long uh but uh but a very well written article if you wanted to read this um you know the average intelligent person could could work through this article now give the first word here to um to DrAli who's the main author overall covid-19 has contributed to more than 40 million new cases new cases of neurological disorders worldwide and and it's going to be many more than that actually um so long-term neurological outcomes of coverage sequeline nature medicine so all peer-reviewed stuff um based at the uh Washington University School of Medicine St Louis so all all very well conducted study now um comprehensive evaluation of the uh post-acute neurological sequelae at one year has not really been undertaken yet so that was the aim of this topic to take that up national Healthcare databases U. S Veterans Affairs now they've come up with a cohort of 154 000 people who had covered so that's the group now of course this sounds very small because virtually everyone's had covered now but this was early on in the pandemic so um they compared that with uh 5. 6 million people who are in controls contemporary controls and this is I like this about this study as well I'm not going to give full details on it but they also compared data from 2017.
well before pre-pandemic time so we can see that they had a good experimental group 154 000 and also a pretty good control group now this study looked at non-hospitalized hospitalized and patients admitted to intensive care and one of the things that's concerning about this was they did find quite a lot of neurological neurological sequel like even in people that had not been hospitalized and people that had relatively minor illness were still developing these complications now um one reason it could be a bit pessimistic the average age in this study was 61. um but there again there's a lot of people over 61 in the population as well this is going to be a big burden of morbidity into the future I am afraid um estimated risk and burdens of uh incident neurological disorders at 12 months following sarcoida virus 2 infection so this is 12 months after longitudinal observation or study so good the following it up longer term they're going to carry on following this up as well um started March 20 as we said through to January 2021 so early on in the pandemic so this predates Delta and Omicron and the other covert variants now this is going to affect things of course and how much we don't know because it hasn't happened yet or at least the data for that hasn't been collected yet now straight on to the results of this study um in the post-acute phase of covid-19 there was an increased risk of an array of instant neurological sequelae so there's quite a few things now some of the things we can mention ischemic and hemorrhagic stroke now a stroke is where there's a lack of blood supply to part of the brain ischemia means it's a lack of blood supply that's damaged part of the brain hemorrhagic stroke means there's a a blood vessel is ruptured within the brain so that's bleeding within the brain both core Strokes typically the ischemic ones are much more common this is called transient ischemic attack where there's a lack of blood supply to the brain for a period of time cognition and memory disorders this is this is probably the most common memory disorders I've met so many people who say you know German memory is just not what it was a couple of years ago and of course virtually all of these people have had I've had covered um this is going to be an issue and of course the vast majority of people in the UK have been vaccinated as well um peripheral nervous system disorders so that's the nerves in the anything that's not the brain in the Central and anything it's not the brain and the spinal cord episodic disorders migraine and fitting again fitting um seizures fairly common especially more so in younger people distressingly extra pyramidal and movement disorders so there's two ways that the messages get from the brain to the body one is the pyramidal system and one is the extra biometal system basically the extra Prime needle system means symptoms which are a bit like Parkinson's disease mental health disorders anxiety depression even psychosis this one surprised me a bit um triggering of psychosis definitely seems to be happening psychotic disorders musculoskeletal sensory disorders guillong barrier syndrome is is a is a reactive polyneuritis where many peripheral nerves become inflamed and can start working causing paralysis um other conditions mentioned um in kephalitosaur and kephalopathy so Encephalitis in inflammation of the brain and kephalopathy damage to the tissue of the brain pathology in the brain headaches also right now um Hazard ratio of any neurological sequelae as we say the hazard ratio is 1. 42 so that's a 42 increased chance of getting a neurological sequelae in people that had the infection as opposed to people that hadn't this is a significant increase but they also looked at the burden how common this is and they worked out it was 70.
69 uh persons per thousand at 12 months which of course is 7. 069 percent so this is affecting not only is there an increased risk it's also very common there's a high burden seven percent of people that had covered in this age group early on in the pandemic went on to develop some neurological sequelite the global implications for this are pretty big um I'm still wrestling with the implications of the size of these numbers actually um but but becoming consistent with what I am seeing around about me um the risk and burdens were evaluated even in people who did not require hospitalizations so more risk and more burden in people who were not hospitalized but the risks of owned burdens did increase according to severity of infection so in other words people that um had minor illness had increased risk and there was an increased burden of disease in those people but the people that were hospitalized had even more and the people that were intensive care had even more but the differences weren't often that great um from non-hospitalized hospitalized to intensive care now I'm just going to give you a relative example here that now the paper does give you huge amounts of data on all of this so do check on the paper if you're interested in a particular condition but um this was the hazard ratio here uh for people that were um these people were not hospitalized these people were hospitalized and these people were in intensive care but we see that the burden that they were non-hospitalized up to here these were hospitalized and these are intensive care so we see even people that had minor illness are getting a lot of sequeline um as I say full details of the art in the paper quite intelligible um direct quote from the authors taken together our results provide evidence of increased risk of long-term neurological disorders in people who had covert um it's this is a definite finding now I'm just going to give a couple of examples a few examples here um cerebrovascular disorders at 12 months ischemic stroke lack of blood supply Hazard ratio 1. 5 50 increase chance three point um 3.
40 per thousand was the burden um transient ischemic attacks Hazard ratio 1. 62 62 increase chance 2. 3 per thousand uh affected have a ragic stroke Hazard ratio 2.
19 so that's pretty pretty high really there more more than uh more more than double the chance um quite High more than double a burden thankfully relatively low 0. 21 per thousand silver Venous Thrombosis um we'd have talked about this in the context of the um adenovirus Vector vaccines in the past but this is in context of post covert infection again increa more than double the risk but thankfully the burden relatively low composite of these cerebrovascular outcomes Hazard ratio 1. 56 so 56 in chance of getting one of them burden for 0.
29 per thousand which of course is getting them for half a percent uh cognitive and memory um risk of memory problems quite High 1. 777 77 percent 77 increased chance burden there also basically one percent isn't it 10. 07 per thousand Alzheimer's disease double the chance we believe this is a triggering not an initiating but it's nevertheless it's a finding composite of these outcomes Hazard ratio were 80 increased chance 1.
8 and the burden was um over one percent 10. 35 per thousand disorders are peripheral nerves Hazard ratio 1. 34 34 increased chance a 5.
64 per thousand uh parasthesia things like pins and needles abnormal feeling again 32 increased chance burden 2. 89 per thousand so this is disorders of the autonomic nervous system of course controls things like blood pressure and well basically the the autonomic nervous system controls everything all the neurological functions you don't have to think about um I've seen something similar in the past called shy Drger syndrome where the person loses control of their autonomic nervous system very distressing the patient I looked after was always going dizzy and couldn't maintain his blood pressure properly um Bell's Palsy the paralysis of one side of the face and again composite of these disorders 34 increased chance but getting on for one percent um a 8. 64 per thousand episodic disorders migraine epilepsy seizures concerning that the uh the seizures the fitting was more common in the younger age groups uh composite again 1.
32 and 4. 75 not going to go for the numbers of course but just looking at some extra pyramidal movement disorders so extra pine needle basically gives you rigidity and tremors um abnormal involuntary movements Tremor parkinson-like disease dystonia this dystonia is a loss of tone we sort of go floppy uh myoclonuses is like uh sudden jerks um muscle jerks uh composite of these extra pine needle and movement disorders Hazard ratio 1. 42 3.
98 per thousand mental health disorders and again for the figures they're all in the paper here all day ever told you them all major depressive disorders this really is very very concerning stuff um actually stress and adjustment disorders so stress we all know what stress is where people can't adjust the new situations without excessive stress anxiety disorder and psychotic disorders now this surprised me it's concerning so so like um if you feel you know if something bad happens in your life you lose your job or something and you become depressed that's not surprising but if you become depressed and there's not an external cause for it that could be a psychotic depression or if you develop these mood swings this cyclophthalmia this manic depression that that's a psychosis as well and of course the classic psychosis like schizophrenia paranoia uh basically Detachment from reality a very concerning severe mental illnesses composite of these 43 increased risk Hazard ratio but the burden was 25 per thousand so that is uh that is 2. 5 isn't it that is a big common problem so from this covert is going to be giving us more mental health problems into the future now with all of these disorders there's been a limited amount of time we don't know how long they're going to last a minority are do seem to be getting better but a lot don't seem to be getting better they seem to be persisting for a long period of time so there's no question we've got an extra burden of disease now how long this is going to last we don't know but some could be indefinitely as far as we know at the moment musculoskeletal joint pain muscle pain myopathy that's disorder disease of the muscles um composite of these Hazard ratio 45 increased chance burden but very high burden 40 per thousandths four percent very high sensory disorders hearing abnormalities tinnitus Vision abnormalities loss of smell loss of taste and again uh Hazard ratio 1. 25 25 increase chance but burdens 17 uh per thousand that's 1.
7 percent of course uh and and then briefly um other neurological Related Disorders dizziness or falling asleep all the time and feeling sleepy Guillain-Barre syndrome Encephalitis or encephalopathy transverse myelitis is where transverse myelitis if you imagine the the spinal cord going up and down here if there's a lesion that goes across the spinal cord that is a transverse lesion and um that can cause paralysis below that level of the lesion very alarming thankfully uh very low burden on that one composite of these and other neurological disorders Hazard ratio 1. 46 burden as we say 7.
