Clinicians need to evaluate new or worsening neurologic symptoms of post-acute sequelae of SARS-CoV-2 infection (PASC) and treat or refer them to specialists when appropriate, according to new guidance from the American Academy of Physical Medicine & Rehabilitation (AAPM&R).
Neurologic symptoms related to PASC — commonly known as long COVID — include headache, weakness, muscular numbness, pain, tremors, and palsy, according to Leslie Rydberg, MD, of the Northwestern University Feinberg School of Medicine and the Shirley Ryan AbilityLab in Chicago, and Sarah Sampsel, MPH, of SL Sampsel Consulting in Albuquerque, and co-authors.
Clinicians should pursue appropriate diagnostic workup and collaborate with multidisciplinary clinical teams to address specific neurologic symptoms for long COVID patients, while aiming to reduce polypharmacy and avoiding a rapid escalation of activities that might trigger symptom worsening, the authors said in PM&R.
“What we know is that many people with mild or moderate COVID infections end up with neurologic sequelae that lasts longer than 4 weeks, and we see a very wide variety of neurologic symptoms,” Rydberg said in a press briefing. “Whether these patients were hospitalized or not, they continue to have these neurologic symptoms that are persistent and prevalent.”
In collaboration with primary care providers or appropriate specialists, clinicians also should look to treat underlying medical conditions — including psychiatric, pain, renal, endocrine, cardiovascular, neurological, respiratory, and other conditions — which may be contributing to neurologic symptoms, the guidance authors wrote.