COVID-19 - neurologists stay aware!

In December 2019, an epidemic outbreak of a new virus disease was reported in the Chinese area of Wuhan. The new disease primarily caused symptoms of a respiratory tract infection with cough, shortness of breath and viral pneumonia. The clinical spectrum showed mostly mild symptoms with some patients developing bilateral pneumonia that needed intensive care treatment and caused death [1]. It became apparent that this new disease was highly contagious and patient numbers were rapidly increasing, overwhelming the capacity of local healthcare facilities. Parts of the clinical picture were reminiscent of previous viral outbreaks of severe acute respiratory syndrome (SARS). The new virus was identified as SARS‐coronavirus 2 (SARS‐CoV2) and the new disease described as coronavirus disease 2019 (COVID‐19). The disease started to spread in China and to other countries. On 11 March 2020, the World Health Organization reported more than 118 000 cases in 114 countries with 4291 deaths and officially declared the COVID‐19 pandemic [2]. As of today (19thMay 2020), official numbers report more than 4.7 million cases worldwide, more than 315 000 deaths and approximately 1.7 million patients who have recovered from the disease. These numbers reflect only those who are being tested for SARS‐CoV2 and, for many reasons, the number of people affected worldwide is thought be much higher.

Although the disease was initially regarded as mainly a respiratory disease, according to the most prevalent symptoms, it quickly became apparent that other organs were also affected. First reports emerged about neurological symptoms [3]. In this issue, Vonck et al. provide an excellent review of the current literature regarding the impact of COVID‐19 on the nervous system [4]. Ranging from early neurological signs of ageusia and anosmia, also indicating a mild form of the disease, increased rates of cerebrovascular events and reports of brainstem encephalitis and Guillain–Barre syndrome, the virus affects the peripheral and central nervous system at different locations, through different mechanisms and at different stages of the disease. Furthermore, possible underlying mechanisms, according to current knowledge, and basic science data on SARS‐CoV2, SARS, Middle East respiratory syndrome and other viruses are discussed.

COVID‐19 emerged 6 months ago. We are currently in the first outbreak and the world has come to a halt, with lockdowns in approximately 114 countries. Scientific knowledge of the disease mechanisms, symptoms and therapeutic options is growing on a daily base. Case reports, case series, reviews and surveys have been published, which have been tremendously helpful in this first phase of the pandemic. The term ‘neuro covid’ in the LitCovid search tool of the National Library of Medicine ‐ National Institutes of Health [5] found 1172 out of 11 711 publications today, illustrating that 10% of the literature covers neurological involvement. Identifying the symptoms of neuro‐COVID and understanding the effects on the nervous system will open new avenues in the diagnosis and treatment of COVID‐19 in particularly severely affected cases. Prospective data collection of large international multicenter cohorts will be necessary to fully understand the disease and its neurological involvement. We neurologists need to stay vigilant and aware of neuro‐COVID‐19, taking a joint effort to characterize the disease on scientific grounds. To facilitate this, the European Academy of Neurology has developed the Ean NEuro‐covid ReGistrY (ENERGY) for prospective data collection (ean.org).

Disclosure of conflicts of interest

The author is web‐editor in chief of the European Academy of Neurology.