Long COVID (Post Acute Sequelae of SARS-CoV-2 infection [PASC]) Research

Objective(s): To assess and report current effective treatments on clinical outcomes for adults with Long-COVID.

Data Sources: We searched PubMed (NLM) from January 1 2021 to February 2023 using the following key words (including MESH) Post-Acute COVID-19 Syndrome AND brain OR neurolog* AND treat*.

Study Selection: Following a predefined protocol, one reviewer included experimental and observational human studies of Long-Covid therapeutic interventions published in English.

Data Extraction: One reviewer extracted data into a standardized form, recorded clinical outcomes and effects on the brain.

Data Synthesis: Twelve studies (total number of patients=2340, avg age=57.4, 62.1% male, with follow-up 2 weeks to 18 months) out of 91 screened studies were evaluated in this review. Three out of 12 were randomized controlled trials (RCT), all other studies were pre-experimental. Initial therapeutic interventions used, including Stellate ganglia block, Hyperbaric Oxygen Therapy, Non-Invasive Brain Stimulation, oral palmitoylethanolamide/luteolin and oral Ginkgo biloba leaf special extract EGb 761 show good potential to ameliorate Long-COVID type sequelae, through various mechanistic approaches. Clinical improvements of various symptomatology including olfactory, cognitive and memory dysfunction, fatigue, visual field, and quality of life were noted in all 12 studies; outcome measurements included neurophysiologic measures (MRI, DTI, EEG, TMS), cardiopulmonary/exercise function tests, and questionaries/scales (including VAS, Clinical Global Impression Severity and Fibromyalgia Impact Questionnaire). Cognitive measures included MoCA, interview/questionnaires (symptom severity, parosmia) and symptom report.

Conclusions: Results are based on limited RCTs. More research warranted to 1) establish all possible and most common neurologic sequelae, 2) determine causative mechanisms and 3) develop effective treatment strategies.

Author(s) Disclosures: None.