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Neurology

Neurology and COVID-19

Educational Objective
To understand how COVID-19 is affecting the field of neurology

1 Credit CME

JAMA

Published Online: September 22/29, 2020

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Article Information and Disclosures

S. Andrew Josephson, MD^1,2;

Hooman Kamel, MD^3,4

Author Affiliations

¹Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco
²Editor, JAMA Neurology
³Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York
⁴Deputy Editor, JAMA Neurology

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Dimitri A. Christakis, MD, MPH
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Robert O. Bonow, MD, MS; Patrick T. O’Gara, MD; Clyde W. Yancy, MD, MSc
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Rita F. Redberg, MD, MSc; Mitchell Katz, MD; Robert Steinbrook, MD
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In the early days of the coronavirus disease 2019 (COVID-19) pandemic, involvement by neurologists seemed unnecessary. The virus was thought to lead to a respiratory illness, largely sparing the brain and the rest of the nervous system. However, early reports from large outbreaks in China quickly changed this view. A study of more than 200 patients hospitalized in 3 COVID-19–focused hospitals in Wuhan demonstrated that more than one-third experienced a variety of neurologic manifestations, including altered mental status and acute cerebrovascular diseases, most commonly in those with severe respiratory illness.¹ These findings quickly changed the perspective of neurologists worldwide and focused efforts toward both understanding the mechanisms responsible for this neurologic involvement and devising systems of care to identify and effectively treat these increasingly recognized complications.

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Article Information

Corresponding Author: S. Andrew Josephson, MD, UCSF Department of Neurology, 505 Parnassus Ave, Box 0114, San Francisco, CA 94143 (andrew.josephson@ucsf.edu).

Conflict of Interest Disclosures: Dr Josephson reported serving as associate editor for Continuum Audio. Dr Kamel reported serving as co–principal investigator for the National Institutes of Health–funded ARCADIA trial (NINDS U01NS095869), which receives in-kind study drug from the BMS-Pfizer Alliance for Eliquis and ancillary study support from Roche Diagnostics, serving as a steering committee member for Medtronic’s Stroke AF trial (uncompensated), serving on an end-point adjudication committee for a trial of empagliflozin for Boehringer Ingelheim, and having served on an advisory board for Roivant Sciences related to factor XI inhibition.

References

Mao L , Jin H , Wang M , et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020;77(6):683-690. doi:10.1001/jamaneurol.2020.1127 PubMed Google Scholar Crossref

Merkler AE , Parikh NS , Mir S , et al. Risk of ischemic stroke in patients with coronavirus disease 2019 (COVID-19) vs patients with influenza. JAMA Neurol. Published online July 2, 2020. doi:10.1001/jamaneurol.2020.2730 PubMed Google Scholar

Kansagra AP , Goyal MS , Hamilton S , Albers GW . Collateral effect of Covid-19 on stroke evaluation in the United States. N Engl J Med. 2020;383(4):400-401. doi:10.1056/NEJMc2014816 PubMed Google Scholar Crossref

Solomon IH , Normandin E , Bhattacharyya S , et al. Neuropathological features of Covid-19. N Engl J Med. Published online June 12, 2020. doi:10.1056/NEJMc2019373 PubMed Google Scholar

Politi LS , Salsano E , Grimaldi M . Magnetic resonance imaging alteration of the brain in a patient with coronavirus disease 2019 (COVID-19) and anosmia. JAMA Neurol. 2020;77(8):1028-1029. doi:10.1001/jamaneurol.2020.2125 PubMed Google Scholar Crossref

Zubair AS , McAlpine LS , Gardin T , Farhadian S , Kuruvilla DE , Spudich S . Neuropathogenesis and neurologic manifestations of the coronaviruses in the age of coronavirus disease 2019: a review. JAMA Neurol. 2020;77(8):1018-1027. doi:10.1001/jamaneurol.2020.2065 PubMed Google Scholar Crossref

Louapre C , Collongues N , Stankoff B , et al; Covisep Investigators. Clinical characteristics and outcomes in patients with coronavirus disease 2019 and multiple sclerosis. JAMA Neurol. Published online June 26, 2020. doi:10.1001/jamaneurol.2020.2581 PubMed Google Scholar

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.