A call for a global COVID-19 Neuro Research Coalition
Authors: Andrea Sylvia Winkler, Samuel Knauss, Erich Schmutzhard, Matilde Leonardi, Alessandro Padovani, Foad Abd-Allah, Augustina Charway-Felli, Julius Valentin Emmrich, Thirugnanam Umapathi, Parthasarthy Satishchandra, Fan Kee Hoo, Josep Dalmau, Celia Oreja-Guevara, Maria Lúcia Brito Ferreira, Bettina Pfausler, Benedict D Michael, Fabrizio Tagliavini, Günter Höglinger, Matthias Endres, Christine Klein, Bernhard Hemmer, William Carroll, James Sejvar, Tom Solomon
Journal: The Lancet Neurology (2020)

Reports are emerging at a rapid pace that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) affects the nervous system in various ways. Preliminary data from Wuhan, China, suggest that neurological manifestations are present in more than 30% of patients presenting with coronavirus disease 2019 (COVID-19).1Mao L Jin H Wang M et al.Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China.DOI:10.1001/jamaneurol.2020.1127Google Scholar Neurological features range from quite diffuse neurological signs and symptoms like headache, dizziness, reduced level of consciousness, confusion, diffuse corticospinal tract signs, and paraesthesia, to more specific manifestations, such as seizures, stroke, encephalitis, or meningoencephalitis, and myopathy.1Mao L Jin H Wang M et al.Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China.DOI:10.1001/jamaneurol.2020.1127Google Scholar, 2Helms J Kremer S Merdji H et al.Neurologic features in severe SARS-CoV-2 infection.N Engl J Med. 2020; (published online April 15.)DOI:10.1056/NEJMc2008597Crossref PubMed Scopus (1817) Google Scholar To date, SARS-CoV-2 has not been detected in the neural tissue directly, although it has been isolated from the CSF of some patients.3Wu Y Xu X Chen Z et al.Nervous system involvement after infection with COVID-19 and other coronaviruses.Brain Behav Immun. 2020; (published online March 30.)DOI:10.1016/j.bbi.2020.03.031Google Scholar The hypothesis of neurotropism with subsequent neuronal injury, either directly or indirectly (through immune mechanisms), is supported by previous findings from other infections with severe acute respiratory syndrome CoV and Middle East respiratory syndrome CoV.3Wu Y Xu X Chen Z et al.Nervous system involvement after infection with COVID-19 and other coronaviruses.Brain Behav Immun. 2020; (published online March 30.)DOI:10.1016/j.bbi.2020.03.031Google Scholar Pre-existing cardiovascular or pulmonary disease and old age increase the chances of contracting SARS-CoV-2 infection and those risk factors are often present in patients with neurological disorders. Individuals with autoimmune diseases, such as multiple sclerosis, who require immunotherapy, might be at increased risk of SARS-CoV-2 infection and neurologists are in need of tailored recommendations for immunotherapy, relapse management, and delivery of care. Patients with Parkinson's disease have an increased risk for cardiovascular complications and can have multiple comorbidities, including cognitive impairment, depression, and psychosis, which can deteriorate during isolation.4Helmich RC Bloem BR The impact of COVID-19 on Parkinson's disease: hidden sorrows and emerging opportunities.J Parkinsons Dis. 2020; 10: 351-354Crossref PubMed Scopus (235) Google Scholar Also, many patients with cognitive impairment might not be able to follow infection prevention and control recommendations, thereby putting themselves and their caregivers at risk of contracting SARS-CoV-2. Additionally, very little is known about potential interaction between various medications for chronic neurological diseases and drug treatment for COVID-19. Because the effects of SARS-CoV-2 on the nervous system are largely unknown, estimating the neurological morbidity that might occur from the acute phase of the pandemic is difficult. Also, whether patients might have long-term neurological or cognitive sequelae, or whether pre-existing neurological disease might deteriorate (eg, patients with mild cognitive impairment might have little cognitive reserve and develop dementia early) is unknown. Effects of coronavirus in children seem less severe and often the virus is present but children are asymptomatic. Asymptomatic children might still harbour the virus, with so far unknown effects on their health status later in life, including brain development. Additionally, once a vaccine becomes available, careful monitoring across age groups and disease spectra will be required to identify adverse effects and any deterioration of signs and symptoms in patients with neurological diseases. Overall, understanding is needed of whether susceptible groups exist who are at increased risk of deterioration after SARS-CoV-2 infection, how to detect them by use of biomarkers, and whether treatment needs to be specifically targeted in case of neurological signs and symptoms. Systems for clinical surveillance, epidemiological and clinical research, and post-mortem studies will be needed to achieve this aim. The COVID-19 pandemic necessitates close collaboration on a global scale, with a special emphasis on inclusion of colleagues and partner institutions from low-income and middle-income countries. Inspired by the COVID-19 Clinical Research Coalition described recently in The Lancet,5COVID-19 Clinical Research CoalitionGlobal coalition to accelerate COVID-19 clinical research in resource-limited settings.Lancet. 2020; 395 (published online April 2.): 1322-1325Summary Full Text Full Text PDF PubMed Scopus (103) Google Scholar our proposal is to build on and link existing international neurology partnerships, such as the Brain Infections Global COVID-Neuro Network, that provides a network for interested clinicians, a daily update of all publications relating to neurological COVID-19 disease, and freely accessible downloads of case-record forms; the European Academy of Neurology COVID-19 registry; the Lean European Open Survey on SARS-CoV-2 Infected Patients endorsed by the German Neurological Society; and the activities of the World Federation of Neurology around COVID-19. Additionally, WHO can play an important part in building this coalition through identifying priorities and developing harmonised systems for neurological research. We are therefore launching a call for an inclusive and collaborative global COVID-19 Neuro Research Coalition co-created by the research communities around the world (panel). In a first step, we will create a platform of exchange and communication. If you are interested in becoming part of this community, please register at the Center for Global Health, Department of Neurology, Technical University of Munich, Germany, by sending an email to [email protected].PanelPotential aims for a global COVID-19 Neuro Research Coalition•To create a platform for global scientific exchange and networking•To collaborate and partner with our colleagues in low-income and middle-income countries•To harmonise methods and research tools•To design joint studies, mobilise research funds, and publish together•To establish, if appropriate, and to collaborate with existing registries•To pursue new research translation into policies•To join forces with national neurological research societies, the European, African, and American Academies of Neurology, the International Child Neurology Association, and the World Federation of Neurology•To collaborate in a multidisciplinary way with other medical and allied disciplines and their respective societies and networks•To team up with the brain health unit and COVID-19-related activities of the WHO•To pursue in all activities a One Health, gender-based and equity-based approach, promoting the vision of Universal Health Coverage and the aims of the Sustainable Development GoalsCOVID-19=coronavirus disease 2019. •To create a platform for global scientific exchange and networking•To collaborate and partner with our colleagues in low-income and middle-income countries•To harmonise methods and research tools•To design joint studies, mobilise research funds, and publish together•To establish, if appropriate, and to collaborate with existing registries•To pursue new research translation into policies•To join forces with national neurological research societies, the European, African, and American Academies of Neurology, the International Child Neurology Association, and the World Federation of Neurology•To collaborate in a multidisciplinary way with other medical and allied disciplines and their respective societies and networks•To team up with the brain health unit and COVID-19-related activities of the WHO•To pursue in all activities a One Health, gender-based and equity-based approach, promoting the vision of Universal Health Coverage and the aims of the Sustainable Development Goals COVID-19=coronavirus disease 2019. This online publication has been corrected. The corrected version first appeared at thelancet.com/neurology on July 20, 2020 This online publication has been corrected. The corrected version first appeared at thelancet.com/neurology on July 20, 2020 ME reports grants from Bayer and fees paid to their institution from Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Pfizer, Daiichi Sankyo, Amgen, GlaxoSmithKline, Sanofi, Covidien, and Novartis, all outside of the submitted work. TS reports fees paid to their institution from GlaxoSmithKline Ebola Vaccine programme, Siemens Diagnostics Clinical Advisory Board, Siemens Healthineers Clinical Advisory Board, Data Safety Monitoring Committee of the GlaxoSmithKline Study to Evaluate the Safety and Immunogenicity of a Candidate Ebola Vaccine in Children GSK3390107A (ChAd3 EBO-Z) vaccine, during the conduct of the study. TS has a patent test for bacterial meningitis based on a blood test, filed for patent pending (GB 1606537.7). All other authors declare no competing interests. ASW and SK contributed equally. Correction to Lancet Neurol 2020; 19: 482–84Winkler AS, Knauss S, Schmutzhard E, et al. A call for a global COVID-19 Neuro Research Coalition. Lancet Neurol 2020; 19: 482–84—In this Correspondence, the spelling of author names Julius Valentin Emmrich, Maria Lúcia Brito Ferreira, Benedict D Michael, and William Carroll were incorrect, and the affiliations for Fan Kee Hoo, Parthasarthy Satishchandra, Thirugnanam Umapathi, Josep Dalmau, Benedict D Michael, and Tom Solomon were incorrect. These corrections have been made to the online version as of July 20, 2020. Full-Text PDF The neurological impact of COVID-19Since WHO declared COVID-19 as a "Public Health Emergency of International Concern" on January 30, 2020, neurologists' lives have changed in many ways. Now—almost 4 months later—the impact of COVID-19 on neurological services and patients is profound. COVID-19 and mandatory social distancing have forced neurology practices worldwide to dramatically reshape their delivery of care. Simultaneously, non-urgent surgical procedures and medical appointments have been cancelled to increase bed capacity and care for patients with the infection, while many neurologists have had to leave their clinics to help other physicians on the frontlines. Full-Text PDF