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ORIJINAL ARAŞTIRMA

COVID-19 Enfeksiyonu Sonrası Elektronörofizyoloji Laboratuvarına Yönlendirilen Hastaların Klinik Özellikleri: Retrospektif Analiz
Clinical Features of Patients Referred to an Electroneurophysiology Laboratory After COVID-19 Infection: Retrospective Analysis
Received Date : 16 Oct 2021
Accepted Date : 21 Jan 2022
Available Online : 26 Jan 2022
Doi: 10.31609/jpmrs.2021-86658 - Makale Dili: EN
J PMR Sci. 2022;25(2):220-25
ÖZET
Amaç: Bu çalışmanın amacı, koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)] enfeksiyonu sonrası elektronöromiyografi (ENMG) laboratuvarına refere edilen hastaların klinik özelliklerinin değerlendirilmesidir. Gereç ve Yöntemler: 11 Mart 2020-11 Mart 2021 tarihleri arasında şiddetli akut solunum sendromu- CoV-2 [severe acute respiratory syndrome-CoV-2 (SARS-CoV-2)] tanısı alan ve sonrasında nöromusküler semptom ve bulguları olan, ENMG laboratuvarına refere edilen hastaların, hastane dosyaları retrospektif olarak tarandı. Hastaların demografik bilgileri, komorbiditeleri, şikâyetleri, SARS-CoV-2 enfeksiyon tarihi, istenen elektrofizyolojik tetkik ve ENMG sonuçları kaydedildi. Bulgular: Bin iki yüz yetmiş dört hasta dosyası tarandı ve 62 hasta çalışmaya dâhil edildi [ortalama yaş: 50,39±17,2, %58,1 (n=36) erkek]. Hastalar, COVID-19 tanısını pandemi başlangıcından itibaren ortalama 7,29±1,59 ay sonra almış olup, çoğu yoğun bakımda tedavi edilmemişti (%95,2). Hastaların nöromusküler şikâyetleri, COVID-19 enfeksiyonundan ortalama 2,65±1,86 ay sonra başlamıştı. Sık görülen semptomlar, parestezi (%41,9) ve ekstremitelerde ağrı (%17,7) idi. En sık görülen komorbiditeler arasında ise hipertansiyon (%22,6) ve diabetes mellitus (%17,7) yer almaktaydı. Hastaların %30,6’sında duyu bozukluğu, azalmış kas kuvveti ve derin tendon refleks değişikliği saptandı. En sık ENMG tanısı, polinöropati idi (%22,5). Hastaların %42,1’inde ise ENMG bulguları normal sınırlarda saptandı. Sonuç: COVID-19, periferik sinir sistemi (PSS) dâhil birçok nörolojik komplikasyona yol açabilmektedir. İlk elektrofizyolojik değerlendirmeler normal saptansa bile devam eden PSS şikâyetleri olan hastalarda, ENMG tekrarlanmalı ve daha duyarlı elektrofizyolojik testlerin de gerekliliği dikkate alınmalıdır. Gelecekteki çalışmalarda, PSS patolojilerinin oluşumunda SARS-CoV-2 enfeksiyonunun gerçek bir etkisi olup olmadığı araştırılmalıdır.
ABSTRACT
Objective: The aim of this study was to determine the clinical features and electrophysiological diagnoses of patients referred to the electroneuromyography (ENMG) laboratory after coronavirus disease-2019 (COVID-19) infection. Material and Methods: Medical records of patients referred to the ENMG laboratory between March 11, 2020 and March 11, 2021 with neuromuscular signs and symptoms, preceded by a diagnosis of severe acute respiratory syndrome-CoV-2 (SARS-CoV-2), were reviewed retrospectively. Patient demographics, comorbidities, presenting complaints, date of SARS-CoV-2 infection, nature of electrophysiological investigation and ENMG outcomes were recorded. Results: 1,274 medical records were reviewed, 62 patients were included in the study. Mean age was 50.39±17.2 years, 36 (58.1%) were male. The diagnosis of COVID-19 was made 7.29±1.59 months after the onset of the pandemic and 95.2% did not require treatment in the intensive care unit of the hospital. Patients presented with neuromuscular complaints 2.65±1.86 months after COVID-19 diagnosis. Common symptoms were paraesthesia (41.9%) and pain in the extremities (17.7%). Hypertension (22.6%) and diabetes mellitus (17.7%) were the most commonly reported comorbidities. Changes in sensation and deep tendon reflexes and reduced muscle power were detected in 30.6%. Most common ENMG diagnosis was polyneuropathy (22.5%). ENMG findings were normal in 42.1%. Conclusion: COVID-19 gives rise to many neurological complications, including those involving the peripheral nervous system (PNS). Repeat ENMG and further, more sensitive electrophysiological testing should be considered in those with continued PNS complaints, despite initially normal electrophysiological findings. Further studies should establish whether SARS-CoV-2 infection is causal or coincidental in the development of PNS pathologies and related ENMG findings.
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