tetano
Editor, Senior Moderator
Clin Neurophysiol
. 2021 Mar 13;132(5):1138-1143.
doi: 10.1016/j.clinph.2021.03.001. Online ahead of print.
Intracortical GABAergic dysfunction in patients with fatigue and dysexecutive syndrome after COVID-19
Viviana Versace[SUP] 1 [/SUP], Luca Sebastianelli[SUP] 2 [/SUP], Davide Ferrazzoli[SUP] 2 [/SUP], Roberto Romanello[SUP] 2 [/SUP], Paola Ortelli[SUP] 2 [/SUP], Leopold Saltuari[SUP] 2 [/SUP], Alessia D'Acunto[SUP] 3 [/SUP], Francesco Porrazzini[SUP] 3 [/SUP], Valentina Ajello[SUP] 4 [/SUP], Antonio Oliviero[SUP] 5 [/SUP], Markus Kofler[SUP] 6 [/SUP], Giacomo Koch[SUP] 7 [/SUP]
Affiliations
Abstract
Objective: 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.
Methods: 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[SUB]A[/SUB]-mediated inhibition, long-interval intracortical inhibition (LICI), a marker of GABA[SUB]B[/SUB] 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.
Results: 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.
Conclusions: 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.
Significance: TMS may serve as diagnostic tool in cognitive disturbances and fatigue in post-COVID-19 patients.
Keywords: COVID-19; Executive functions; Fatigue; GABA; TMS.
. 2021 Mar 13;132(5):1138-1143.
doi: 10.1016/j.clinph.2021.03.001. Online ahead of print.
Intracortical GABAergic dysfunction in patients with fatigue and dysexecutive syndrome after COVID-19
Viviana Versace[SUP] 1 [/SUP], Luca Sebastianelli[SUP] 2 [/SUP], Davide Ferrazzoli[SUP] 2 [/SUP], Roberto Romanello[SUP] 2 [/SUP], Paola Ortelli[SUP] 2 [/SUP], Leopold Saltuari[SUP] 2 [/SUP], Alessia D'Acunto[SUP] 3 [/SUP], Francesco Porrazzini[SUP] 3 [/SUP], Valentina Ajello[SUP] 4 [/SUP], Antonio Oliviero[SUP] 5 [/SUP], Markus Kofler[SUP] 6 [/SUP], Giacomo Koch[SUP] 7 [/SUP]
Affiliations
- PMID: 33774378
- DOI: 10.1016/j.clinph.2021.03.001
Abstract
Objective: 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.
Methods: 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[SUB]A[/SUB]-mediated inhibition, long-interval intracortical inhibition (LICI), a marker of GABA[SUB]B[/SUB] 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.
Results: 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.
Conclusions: 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.
Significance: TMS may serve as diagnostic tool in cognitive disturbances and fatigue in post-COVID-19 patients.
Keywords: COVID-19; Executive functions; Fatigue; GABA; TMS.