Eileen Joyce (United Kingdom)
UCL Queen Square Institute of Neurology Clinical and Movement NeurosciencesAuthor Of 2 Presentations
SPECTRUM, RISK FACTORS AND OUTCOMES OF NEUROLOGICAL COMPLICATIONS OF COVID-19
- Marc Hardwick (United Kingdom)
Abstract
Background and Aims:
SARS-CoV2 is associated with neurological and psychiatric complications including cerebrovascular events, encephalopathy and peripheral nerve disease. Detailed clinical data is lacking, hampering prediction modelling and targeted therapeutic interventions.
Methods:
We conducted a UK-wide cross-sectional surveillance study of 267 adult hospitalised patients with SARS-CoV2 infection and neurological and psychiatric complications. Detailed demographic and clinical data was provided by reporting physicians from multiple specialities. A priori clinical case definitions were used, with cross-specialty adjudication for discrepant cases.
Results:
Cerebrovascular events were most frequent (n=131), followed by delirium (n=28), central inflammatory (n=25), psychiatric (n=25), and other encephalopathies (n=17), including a severe encephalopathy (n=13) not meeting delirium criteria; and peripheral nerve disease (n=41). COVID-19 associated strokes were younger and had more conventional risk factors compared to pre-pandemic normative data. 27% of strokes occurred in patients under 60 years old: these had delayed onset from respiratory symptoms, higher rates of multi-vessel occlusion (31%) and systemic thrombotic events. Cases with severe encephalopathy were younger and had a greater usage of intensive care compared to delirium. In a multivariable model, increasing age, pre-admission frailty and admission white cell count were more predictive of negative outcomes than diagnostic group.
Conclusions:
COVID-19-associated stroke is more likely to affect younger patients with conventional risk factors, and with a distinct phenotype suggestive of systemic coagulopathy. There is consensus recognition of severe encephalopathy atypical for delirium occuring in patients with severe COVID-19. Overall, pre-morbid factors have the greatest effect on outcome. These findings will inform mechanistic studies and patient stratification in future clinical trials.
CONTROVERSIES IN NEUROPSYCHIATRY: DEEP BRAIN STIMULATION FOR SEVERE MENTAL ILLNESS
- Eileen Joyce (United Kingdom)
Abstract
Abstract Body
Deep brain stimulation (DBS) has been available for neurological conditions such as Parkinson’s disease and dystonia for over 20 years and is an approved treatment in many countries. DBS for severe mental illness was also first described decades ago, for OCD in 1999 and depression in 2005. However, it is not widely available for these indications as a health-service treatment and remains largely experimental. The reasons include: debate about the best target; acceptability of neurosurgery to psychiatrists and patients; and failures of randomised controlled trials off DBS for depression. This presentation will provide an overview of the controversies in DBS for mental illness, an update of recent evidence concerning brain targets and a discussion of future directions.
Presenter of 1 Presentation
CONTROVERSIES IN NEUROPSYCHIATRY: DEEP BRAIN STIMULATION FOR SEVERE MENTAL ILLNESS
- Eileen Joyce (United Kingdom)
Abstract
Abstract Body
Deep brain stimulation (DBS) has been available for neurological conditions such as Parkinson’s disease and dystonia for over 20 years and is an approved treatment in many countries. DBS for severe mental illness was also first described decades ago, for OCD in 1999 and depression in 2005. However, it is not widely available for these indications as a health-service treatment and remains largely experimental. The reasons include: debate about the best target; acceptability of neurosurgery to psychiatrists and patients; and failures of randomised controlled trials off DBS for depression. This presentation will provide an overview of the controversies in DBS for mental illness, an update of recent evidence concerning brain targets and a discussion of future directions.
Moderator of 1 Session
- Eileen Joyce (United Kingdom)