1/š§µYour brain āon COVIDāš§
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Letās integrate >20 studies on #LongCOVID neuropathology
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My 24 y/o patient explained: āI donāt have a future because I canāt think anymore.ā
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Letās talk:
Autopsy Studies
Viral persistence
Brain Size & Disability
Recovery & Hope
H/T pic šļø tw 13
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Letās integrate >20 studies on #LongCOVID neuropathology
Ā
My 24 y/o patient explained: āI donāt have a future because I canāt think anymore.ā
Ā
Letās talk:
Autopsy Studies
Viral persistence
Brain Size & Disability
Recovery & Hope
H/T pic šļø tw 13
4/ This autopsy study (N=44) showed COVID virus throughout the body persisted for months in some people w viral evidence in the hypothalamus, infected neurons of cervical spine, spinal ganglia, cerebellum
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go.nature.com
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go.nature.com
6/ Whatās Tropism?
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Tropism is when a organism (eg plant, cell, organ tissue) is involuntarily directed by a stimulus (eg, COVID) to turn & march in a new direction
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Instead of healing, in #LongCOVID patients this tropism is a response toward aging & entropy:
ie, Senescence
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Tropism is when a organism (eg plant, cell, organ tissue) is involuntarily directed by a stimulus (eg, COVID) to turn & march in a new direction
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Instead of healing, in #LongCOVID patients this tropism is a response toward aging & entropy:
ie, Senescence
7/ The exact cause of brain disease in #LongCOVID is unknown.
Damaged executive function occurs in many. Why?
This small study found much less Cortical Gray Matter š§ than expected on MRI, which complements large, controlled UK Biobank data (next tweet)
bit.ly
Damaged executive function occurs in many. Why?
This small study found much less Cortical Gray Matter š§ than expected on MRI, which complements large, controlled UK Biobank data (next tweet)
bit.ly
8/ It turns out that āSize Does Matterā when it comes to brain function.
Loss of actual brain tissue is found in #LongCOVID pts & helps explain newly-acquired cognitive dysfunction.š
Loss of actual brain tissue is found in #LongCOVID pts & helps explain newly-acquired cognitive dysfunction.š
10/ Other Long COVID PET studies correlate this hypometabolism w numerous functional complaints & symptoms of ongoing problems with smell, memory & cognitive disabilities, chronic pain & sleep disruption that halts recoveryš
11/ Whatās āhurtā in our brains in LC?
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Clues: think Glial Cell injury
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Biomarkers of disease (eg, CCL11) are popping up in animals & humans. TY @michelle_monje & @VirusesImmunity
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White Matter injury (axons) can indirectly hurt Gray Matter (neurons)
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bit.ly
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Clues: think Glial Cell injury
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Biomarkers of disease (eg, CCL11) are popping up in animals & humans. TY @michelle_monje & @VirusesImmunity
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White Matter injury (axons) can indirectly hurt Gray Matter (neurons)
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bit.ly
12/ GENES: Why do some get Long COVID & others donāt?
Weāre learning that different patterns of gene expression in acute COVID predict symptom patterns 1-yr later
This study establishes a connection between acute & long COVID based on gene responses
go.nature.com
Weāre learning that different patterns of gene expression in acute COVID predict symptom patterns 1-yr later
This study establishes a connection between acute & long COVID based on gene responses
go.nature.com
13/ Does Severe COVID accelerate agingāļø
Authors: āgenes associated w inflammation & stress were ā¬ļø active in brains of people after COVID than controls
Conversely, genes linked to cognition & formation of connections between brain cells were ā¬ļø activeā
go.nature.com
Authors: āgenes associated w inflammation & stress were ā¬ļø active in brains of people after COVID than controls
Conversely, genes linked to cognition & formation of connections between brain cells were ā¬ļø activeā
go.nature.com
14/ Persistent Immunity can be a Double-Edged Sword
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In some it means #Recovery
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In others?
These authors conclude that in some kids, activated cells in tonsillectomy tissue after COVID may lead to long-COVID & multisystem inflammatory syndrome
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go.nature.com
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In some it means #Recovery
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In others?
These authors conclude that in some kids, activated cells in tonsillectomy tissue after COVID may lead to long-COVID & multisystem inflammatory syndrome
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go.nature.com
16/ The family of autoimmune diseases found in COVID survivors most often involved blood vessels
Fitting since COVID is a disease of blood vessels
Others are finding that persistent anti-nuclear antibodies (think Lupus) predict #LongCOVID
bit.ly
Fitting since COVID is a disease of blood vessels
Others are finding that persistent anti-nuclear antibodies (think Lupus) predict #LongCOVID
bit.ly
17/ Reinfection with COVID matters
This study of 440k w 1 infection vs 40k with >=2 infections vs 5M controls found 2X death, 3X hospitalization, and more #LongCOVID after reinfections.
This was true regardless of Vaxx status
go.nature.com
This study of 440k w 1 infection vs 40k with >=2 infections vs 5M controls found 2X death, 3X hospitalization, and more #LongCOVID after reinfections.
This was true regardless of Vaxx status
go.nature.com
18/ These two figures explain our emerging insights into the bleeding & vascularš©øconsequences of COVID.
The authors discuss potential therapeutic options for #LongCOVID
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Mitra bit.ly
The authors discuss potential therapeutic options for #LongCOVID
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Mitra bit.ly
20/ What do we about acquired brain problems after COVID?
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š¹Validate & be present
š¹Believe patients as the experts of their own illness
š¹Take steps to prevent re-infection (mask & vaxx)
š¹Rest & seek personalized care in LC clinics
š¹Enroll in Trials
@EricTopol Dignity š„š
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š¹Validate & be present
š¹Believe patients as the experts of their own illness
š¹Take steps to prevent re-infection (mask & vaxx)
š¹Rest & seek personalized care in LC clinics
š¹Enroll in Trials
@EricTopol Dignity š„š
21/ Avoid stigmatizing Long COVID patients
Researchers @NisreenAlwan found 95% of sufferers experience stigma & 76% experience it āoftenā or āalwaysā ā even more often w formal diagnosis.
Instead of denial & frustration, letās explore ideas & solutions?
bit.ly
Researchers @NisreenAlwan found 95% of sufferers experience stigma & 76% experience it āoftenā or āalwaysā ā even more often w formal diagnosis.
Instead of denial & frustration, letās explore ideas & solutions?
bit.ly
24/ Extrapolating to Long COVID:
šItās early & we need more data of course
šPacing would be required to avoid PEM
šCognitive training can give pts & families a feeling of efficacy & empowerment
šWe need non-invasive non-pharma treatmentsā¦
Patience & understanding
šItās early & we need more data of course
šPacing would be required to avoid PEM
šCognitive training can give pts & families a feeling of efficacy & empowerment
šWe need non-invasive non-pharma treatmentsā¦
Patience & understanding
25/ fin
Read the most well-researched review on Long COVID to date
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@ahandvanish & @erictopol legitimize brain š§ signaling dysfunction & offer pacing & post-concussion syndrome protocols
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Science + Empathy = Step 1 in our Long COVID path
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go.nature.com
Read the most well-researched review on Long COVID to date
Ā
@ahandvanish & @erictopol legitimize brain š§ signaling dysfunction & offer pacing & post-concussion syndrome protocols
Ā
Science + Empathy = Step 1 in our Long COVID path
Ā
go.nature.com
āI can't cope with multiple inputs': a qualitative study of the lived experience of 'brain fog' after COVID-19
@trishgreenhalgh et al help us learn to invoke the personal, social & occupational context plus specialist services
bit.ly
@trishgreenhalgh et al help us learn to invoke the personal, social & occupational context plus specialist services
bit.ly
26/šHereās a refresher from a past š§µ on BRAIN HEALTH in COVIDā¦
Iām so encouraged by the progress science is making YET acknowledge how slow it must feel for the millions suffering without a medical cure š
Iām so encouraged by the progress science is making YET acknowledge how slow it must feel for the millions suffering without a medical cure š
27/ š It can be difficult to distinguish PICS from Long COVID
āŖļøSome pts have #PICS, some #LongCOVID, some BOTH
āŖļøIt may not matter as the pathology may be similar
āŖļøWe donāt know yet
āŖļø15-20% of BOTH hosp & non-hosp pts had memory loss at 2-years
bit.ly
āŖļøSome pts have #PICS, some #LongCOVID, some BOTH
āŖļøIt may not matter as the pathology may be similar
āŖļøWe donāt know yet
āŖļø15-20% of BOTH hosp & non-hosp pts had memory loss at 2-years
bit.ly
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