Welcome to the WCN 2021 Interactive Program

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    Please note that all sessions will run at their scheduled time and be followed by a LIVE Q&A/Discussion at the end

     The viewing of sessions, cannot be accessed from this conference calendar. All sessions are accessible via the Virtual Platform

Displaying One Session

Free Communication
Session Time
11:30 - 13:00
Room
Free Communication A
Chair(s)
  • Chandrashekhar M. Meshram (India)
Free Communication

THE QUEEN SQUARE BRAIN INFCETION AND ENCEPHALITIS MULTIDISCIPLINARY MEETING: PRE AND POST COVID-19 EXPERIENCE (2018 – 2021)

Session Type
Free Communication
Date
06.10.2021, Wednesday
Session Time
11:30 - 13:00
Room
Free Communication A
Lecture Time
11:30 - 11:40
Presenter
  • Rachel Brown (United Kingdom)

Abstract

Background and Aims:

Patients with suspected encephalitis represent diagnostic challenges. Many potential aetiologies and presentations exist, crossing a wide range of disciplines, and often involving intensive care management. Outcomes can be devastating and are associated with ascertaining an early diagnosis and appropriate treatment. Acknowledging these challenges, in February 2018 we established a monthly encephalitis multidisciplinary team meeting (MDT). Input involved Neurology, Infectious Diseases, Microbiology, Virology, Immunology, Neuroradiology, Neuropathology, Neuropsychiatry and NeuroICU physicians. By necessity, the MDT expanded following the onset of the COVID-19 pandemic to a weekly virtual meeting accepting national referrals. We retrospectively reviewed our service to determine its impact over a 3-year period.

Methods:

MDTs are conducted in a standard format. Electronic referral proformas are pre-completed by referring teams, updated at the meeting and uploaded to patient records. We reviewed referral data, case records, and attendance registers, and gained feedback from referring/attending clinicians.

Results:

307 referrals (235 patients) were presented, with a rise in cases following the pandemic onset. Cases were broadly classified under neuroinflammatory, antibody-associated, neuro-infection, neuro-COVID, and mimics. Outcomes included diagnostic clarification, recommendations for specialised (often novel) diagnostics or treatment, and transfer of cases to specialist centres. Strong positive feedback from attendees confirmed the high clinical and educational benefit.

Conclusions:

Patients with suspected encephalitis need specialised multidisciplinary input, to ensure all possible differential diagnoses are considered. This facility is invaluable to physicians managing complex, unwell patients, including providing access and suggestions to novel diagnostics and therapies, and should be made available more widely. International cooperation by virtual technology should be encouraged.

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Free Communication

ANTI-BRAIN PROTEIN AUTOANTIBODIES IN EXTRAPARENCHYMAL NEUROCYSTICERCOSIS *

Session Type
Free Communication
Date
06.10.2021, Wednesday
Session Time
11:30 - 13:00
Room
Free Communication A
Lecture Time
11:40 - 11:50
Presenter
  • Arturo Carpio (Ecuador)

Abstract

Background and Aims:

Neurocysticercosis (NC) is the most common parasite infection of the CNS worldwide, and a main cause of seizures and epilepsy in endemic countries. The objective of this work has been to screen for the presence of autoantibodies to brain proteins in the cerebrospinal fluid (CSF) of clinically defined NC patients, representative of the two main clinical forms of NC, extraparenchymal (EP-NC) and parenchymal (P-NC) invasion.

Methods:

Cerebrospinal fluid (CSF) samples were taken from 21 patients with NC and from 15 control neurological patients diagnosed as NC negative, were collected from January 2015 to February 2016. Both control and experimental CSF were assayed in the HP10 Ag which detects a secreted glycoprotein of viable metacestodes.

Results:

Using quantitative immunoblot methodology, we demonstrate the presence of autoantibodies to brain proteins in CSF from EP-NC, but not P-NC, patients. Nine corresponding proteins autoantigens were additionally identified by mass spectroscopy.

Conclusions:

There was striking correlation between the level of autoantibodies and the levels of the secreted metacestode glycoprotein HP-10, suggesting that the level of stimulation of the autoantibody response may be a function of the number of viable parasites.

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Free Communication

ENCEPHALITIS DURING FIRST YEAR OF SARS-COV-2 PANDEMIC– FIRST RESULTS OF THE EUROPEAN ENCOVID REGISTRY

Session Type
Free Communication
Date
06.10.2021, Wednesday
Session Time
11:30 - 13:00
Room
Free Communication A
Lecture Time
11:50 - 12:00
Presenter
  • Andrea Pilotto (Italy)

Abstract

Background and Aims:

Objective: Several preclinical and clinical investigations have argued for nervous system involvement in SARS-CoV-2 infection. No data about clinical, imaging and biomarkers presentations as well as long-term outcomes are available for SARS-CoV-2 encephalitis in comparison with infectious and autoimmune encephalitis.

Methods:

Methods: The ENCOVID European registry included patients with probable or definite diagnosis of encephalitis with and without SARS-CoV-2 infection admitted for hospitalization in the European recruiting centers between February 1st 2020 and March 30th, 2021. Each patient underwent a standardized assessment including full infectious screening, CSF, EEG, MRI data. Clinical presentation and laboratory markers, severity of COVID-19 disease, response to treatment and outcomes were recorded.

Results:

Results – Out of 155 cases screened, forty-five cases of encephalitis positive for SARS-CoV-2 infection and 63 without COVID-19 with full available data were included. SARS-CoV-2 encephalitis exhibited common presentation with aphasia and dysarthria compared to non-COVID- encephalitis and exhibited higher prevalence of patients with normal MRI but mild hyperproteinorracchia/pleocytosis. Most SARS-CoV-2 cases appeared during the onset of COVID-19 and exhibited different response to treatment and long-term outcomes compared to non COVID encephalitis.

Conclusions:

Conclusions –The registry identified a wide spectrum of encephalitis associated with COVID19 infection, with clinical characteristics and course different from classical infectious and autoimmune encephalitis. Biomarkers studies are warranted in order to evaluate the specific inflammatory pathways associated with SARS-Cov-2 encephalitis.

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Free Communication

NEUROLOGICAL DISORDERS ASSOCIATED WITH COVID-19 INFECTION: AN ITALIAN MULTI-CENTER COHORT STUDY (NEURO-COVID)

Session Type
Free Communication
Date
06.10.2021, Wednesday
Session Time
11:30 - 13:00
Room
Free Communication A
Lecture Time
12:00 - 12:10
Presenter
  • Simone Beretta (Italy)

Abstract

Background and Aims:

A variety of neurological disorders has been reported as presentations or complications of COVID-19 infection. The NEURO-COVID study is a multi-center cohort study of neurological disorders associated with COVID-19 conducted in 51 centers in Italy, sponsored by the Italian Society of Neurology (SIN).

Methods:

We present an interim analysis of hospitalized adult patients with COVID-19 infection, defined by a positive SARS-CoV-2 test independently from clinical severity, and concomitant newly diagnosed neurological disorders. Patients were recruited from March 1, 2020 to March 26, 2021 from 18 centers and followed-up prospectively for 6 months. Follow-up data at 6 months are currently ongoing and will be available for the WCN 2021 congress.

Results:

904 patients with confirmed COVID-19 infection and concomitant newly diagnosed neurological disorders were recruited. The median age was 68 years (IQR 56-78) and 57.5% were males. Severe acute respiratory syndrome occurred in 35.9%. The most common new neurological diagnoses were hypogeusia (21.1%), hyposmia (20.5%), acute ischemic stroke (19.6%), delirium (14.4%), headache (12.3%), cognitive impairment (11.3%), abnormal behaviour or psychosis (8.9%), seizures (5.9%), Guillain-Barrè syndrome (5.1%), severe encephalopathy with stupor or coma (3.7%), dizziness (3.0%), encephalitis (2.3%) and haemorrhagic stroke (2.3%). Overall, the onset of neurological disorders occurred during the presymptomatic-asymptomatic phase in 45.9%, during the acute respiratory illness in 37.5% and after recovery in 16.6%. In-hospital mortality was 12.2% and was mostly due to COVID-related respiratory failure (9.1%).

Conclusions:

A wide spectrum of treatable neurological disorders are associated with COVID-19 infection. Most cases occur in late middle-aged adults with mild or severe respiratory syndrome.

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Free Communication

BRAINSTEM INVOLVEMENT IN COVID-19: A NEUROPATHOLOGICAL AND NEUROPHYSIOLOGICAL STUDY

Session Type
Free Communication
Date
06.10.2021, Wednesday
Session Time
11:30 - 13:00
Room
Free Communication A
Lecture Time
12:10 - 12:20
Presenter
  • Tommaso Bocci (Italy)

Abstract

Background and Aims:

Whilst respiratory failure in COVID-19 arises from severe interstitial lung involvement, SARS-CoV-2 likely spreads also through the nervous system in a prion-like way, possibly reaching respiratory centers in the brainstem. Here, we evaluated neuropathologically, neurophysiologically and clinically the brainstem involvement in COVID-19.

Methods:

Neuropathological data were acquired from two patients died for COVID-19 and two patients COVID-19 negative; neuronal damage and the number of corpora amylacea (CA)/mm2 were assessed. The expression of the “nuclear protein” of SARS-Cov-2 was also evaluated. To clarify whether neuropathological findings had a functional correlate, we studied the blink reflex (BR) in 11 COVID-19 patients, admitted to our Intensive Care Unit (ICU), and compared data both with healthy subjects and non COVID-19 ICU patients. BR assesses a ponto-medullary circuitry partly involving the reticular formation (RF) close to the respiratory nuclei; RF itself modulates the activity of the respiratory centers. An extensive neurological examination, comprising the corneal and glabellar reflexes, was also performed.

Results:

Autopsies showed a high percentage of neuronal damage and a higher number of CA in the medulla oblongata of COVID-19 patients; immunohistochemistry revealed the presence of SARS-Cov-2 virus in the brainstem (Figure 1). Neurophysiologically, the medullary RII component of the BR was selectively impaired in COVID-19 and, clinically, the glabellar reflex severely impaired or absent.

figure 1_histopathology.jpg

Conclusions:

Our findings provide the neuropathological, neurophysiological and clinical evidence of SARS-Cov-2-related brainstem involvement, suggesting a neurogenic component of respiratory failure.

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Free Communication

NEUROLOGIC DISEASE AND COVID-19: A COMPARATIVE STUDY BETWEEN FIRST AND SECOND WAVE HOSPITALIZED PATIENTS IN BRESCIA, LOMBARDIA, ITALY.

Session Type
Free Communication
Date
06.10.2021, Wednesday
Session Time
11:30 - 13:00
Room
Free Communication A
Lecture Time
12:20 - 12:30
Presenter
  • Viviana Cristillo (Italy)

Abstract

Background and Aims:

Neurological disorders have been variably associated with SARS-CoV- 2 infection. The aim of this study is to compare clinical and laboratory characteristics and outcomes of neurological patients admitted during the first and second waves of COVID-19 pandemic in a neuro-COVID unit.

Methods:

In this retrospective study, we included all adult inpatients with confirmed COVID-19, admitted to a Neuro-COVID Unit during the first (February 21- May 31, 2020) and the second (February 21- May 31, 2020) pandemic wave. Demographic, clinical and laboratory data were extracted from medical records and compared by Mann-Whitney U test, χ2 test or Fisher’s exact test where appropriate.

Results:

191 patients were included in this study, 112 admitted during the first wave and 79 throughout the second spreading. Second wave patients exhibited a lower qSOFA score on admission (0.59+0.7 vs0.88+0.7, p=0.010), resulting in a less oxygen support needed. Steroid treatment was adopted in about 4% of patients admitted during the first wave, but in 53% of second outbreak, adjusted for disease severity (p=0.001).The incidence of cerebrovascular diseases was significative lower in the second outbreak (n=28, 34.6% vs n=73, 65.2%, p=0.001) with a less severity outcome (mean NIHSS score 1.8+4.4 vs 9.36+7.3, p<0.000) and a lower in-hospital mortality rates (n=12, 14.8% vs n=35, 31.3%, p=0.009).

Conclusions:

Second wave COVID-19 patients admitted with neurological diseases exhibited a lower incidence and a reduced severity of cerebrovascular disease compared to those of the first outbreak, with less systemic inflammatory response and in-hospital mortality. Longitudinal studies are warranted in order to understand the impact of early immunomodulator treatments in neurological COVID19 patients.

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Free Communication

SPECTRUM, RISK FACTORS AND OUTCOMES OF NEUROLOGICAL COMPLICATIONS OF COVID-19

Session Type
Free Communication
Date
06.10.2021, Wednesday
Session Time
11:30 - 13:00
Room
Free Communication A
Lecture Time
12:30 - 12:40
Presenter
  • 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.

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Free Communication

GUILLAIN-BARRÉ SYNDROME AND COVID-19: AN OBSERVATIONAL MULTICENTER STUDY

Session Type
Free Communication
Date
06.10.2021, Wednesday
Session Time
11:30 - 13:00
Room
Free Communication A
Lecture Time
12:40 - 12:50
Presenter
  • Stefano Cotti Piccinelli (Italy)

Abstract

Background and Aims:

Single cases and series of Guillain-Barré syndrome (GBS) were reported during the SARS-CoV-2 outbreak worldwide. We aimed to evaluate the incidence and clinical features of GBS in a cohort of patients from two regions of northern Italy with the highest number of COVID-19 patients.

Methods:

GBS cases diagnosed in 12 referral hospitals in March and April 2020 were retrospectively collected. As a control population, GBS patients diagnosed in March and April 2019 in the same hospitals were considered.

Results:

Incidence of GBS in March and April 2020 was 0.202/100,000 per month (estimated rate 2.43/100.000 per year; C.I. 0.140-0.282) versus 0.077/100.000 per month (estimated rate 0.93/100.000 per year; C.I.: 0.041-0.132) in March and April 2019 with a 2.6-fold increase. Estimated incidence of GBS in COVID-19 positive patients was 47.9/100,000 and in the COVID-19 positive hospitalized patients was 236/100,000.

COVID-positive GBS were compared with COVID-negative patients and a higher frequency of demyelinating subtype (AIDP) (76.6% vs 35.3%; p. 0.005), a lower MRC sum score (26.33 +/- 18.31 vs 41.41 +/- 14.85; p 0.006) and more frequent admission to ICU (66.6% vs 17.6%; p 0.002) were observed.

Conclusions:

This study shows an increased incidence of GBS during the first COVID-19 wave in northern Italy. This might not be unexpected considering that GBS is unanimously considered a post-infectious disease with several new infectious agents even recently added as possible trigger for GBS, including Zika and Hepatitis E viruses. We suggested that a correlation might exist between the COVID-19 and the increase in GBS incidence.

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Free Communication

LIVE Q&A

Session Type
Free Communication
Date
06.10.2021, Wednesday
Session Time
11:30 - 13:00
Room
Free Communication A
Lecture Time
12:50 - 13:00