Disorders of Consciousness Associated With COVID-19: A Prospective, Multimodal Study of Recovery and Brain Connectivity
Neurology (12/03/21) DOI: 10.1212/WNL.0000000000013067
Fischer, David; Snider, Samuel B.; Barra, Megan E.; et al.
A prospective, longitudinal study aimed to describe the natural history of COVID-19 disorders of consciousness (COVID-DoC). The condition, for which the prognosis and pathophysiology are still unclear, can affect decisions regarding life-sustaining therapies. The study enrolled 12 critically ill adults with a median age of 63.5 years and a DoC that could not be explained by sedation or structural brain injury. To assess functional and structural connectivity, resting state functional MRI and diffusion MRI were conducted, while the recovery of consciousness and functional outcomes were measured at hospital discharge and at three- and six-months' post-discharge. One patient died soon after enrollment; however, the remaining 11 patients recovered consciousness after a median 7 days following the discontinuation of continuous intravenous sedation. The patients remained dependent at discharge, with a median Glasgow Outcome Scale Extended (GOSE) of 3 and median Disability Rating Scale (DRS) of 23. Aside from two patients with severe polyneuropathy, the patients went home with normal cognition and minimal disability, with median GOSE and DRS scores of 3 and 7 at three months and 4 and 3 at six months, respectively. Advanced neuroimaging for 10 patients demonstrated reduced functional and structural brain connectivity in COVID-DoC compared with healthy controls and structural connectivity that was comparable to that for patients with severe traumatic brain injury. Further research is needed, the researchers report, but the findings provide greater information about COVID-DoC.