Features of therapy of patients with chronic cerebral ischemia and neurodegenerative diseases during the COVID-19 pandemic

Since first cases of a new coronavirus infection (COVID-19) were detected, as well as World Health Organization named the COVID-19 outbreak as a pandemic, data on the pathogenic potential of the causative agent of SARS-CoV-2 infection has continued to accumulate. In particular, the neurotropic potential of the pathogen was revealed, the mechanisms of microvascular complications were clarified, the persistence of some symptoms within postcovid syndrome was detected. Considering extremely active agent circulation and rapid spread of the new coronavirus among the world's population, high morbidity, the emergence of new strains, vulnerable patient populations, which include people with chronic diseases, require special attention. This article summarizes current data on the pathogenesis and clinical course of the new coronavirus infection in patients with chronic cerebral ischemia and neurodegenerative diseases, draws historical parallels with neurological phenomena that occurred after the well-known pandemics of respiratory infections, in particular, influenza, as well as the impact of the current epidemiological situation, modification of the medical care system with conversion to work with COVID-19, and social restrictions on patients with chronic neurological diseases. The modern updates of the recommendations of the American Academy of Neurology, important for practicing physicians, are given: a new guide to the initial dopaminergic therapy of motor symptoms in Parkinson's disease. A variant of patients managing during a pandemic is proposed in the aspect of organizing doctor – patient interaction and prescribing pharmacotherapy with a pathogenetically justified mechanism of action. Emphasis is placed on the correction of GABA-ergic transmission, which is responsible for a number of functions of the central nervous system (cognition, executive functions, modulation of motor activity), the violation of which is shown both in the acute period of COVID-19 and after its termination in the framework of the postcovid syndrome.

1. WHO. Coronavirus Disease 2019 Situation Report 51-11th March 2020 // WHO Bull. 2020; 2019: 2633.

2. Sanyaolu A., Okorie C., Marinkovic A., et al. Comorbidity and its impact on patients with COVID-19 // SN Compr Clin Med. 2020; 2: 1069-1076.

3. Paudel S. S. A meta-analysis of 2019 novel coronavirus patient clinical characteristics and comorbidities // Research Square. 2020. 10.21203/rs.3.rs-21831/v1.

4. Zayrat'yants O. V., Camsonova M. V., Mikhaleva L. M., Chernyayev A. L., Mishnev O. D., Krupnov N. M., Kalinin D. V. Pathological anatomy of COVID-19: Atlas / Pod obshchey red. O. V. Zayrat'yantsa. M.: GBU «NIIOZMM DZM», 2020. 140 s., il.

5. Hu Y., Yang H., Hou C., et al. COVID-19 related outcomes among individuals with neurodegenerative diseases: a cohort analysis in the UK biobank // BMC Neurol. 2022; 22 (1): 15. Published 2022 Jan 7.

6. Prasad S., Holla V. V., Neeraja K., et al. Parkinson's Disease and COVID-19: Perceptions and Implications in Patients and Caregivers // Mov Disord. 2020; 35 (6): 912-914.

7. Yuki K., Fujiogi M., Koutsogiannaki S. COVID-19 pathophysiology: a review // Clin Immunol. 2020; 215: 108427. DOI: 10.1016/j.clim.2020.108427.

8. Zhang J., Tecson K. M., McCullough P. A. Endothelial dysfunction contributes to COVID-19-associated vascular inflammation and coagulopathy // Reviews in Cardiovascar Medicine. 2020; 21 (3): 315-319.

9. Khaddaj-Mallat R., Aldib N., Bernard M., et al. SARS-CoV-2 deregulates the vascular and immune functions of brain pericytes via Spike protein // Neurobiol Dis. 2021; 161: 105561.

10. Porges E. C., Woods A. J., Edden R. A., Puts N. A., Harris A. D., Chen H. et al. Frontal gamma-aminobutyric acid concentrations are associated with cognitive performance in older adults // Biol Psychiatry Cogn Neurosci Neuroimaging. 2017; 2 (1): 38-44.

11. Versace V., Sebastianelli L., Ferrazzoli D., Romanello R., Ortelli P., Saltuari L. et al. Intracortical GABAergic dysfunction in patients with fatigue and dysexecutive syndrome after COVID-19 // Clin Neurophysiol. 2021; 132 (5): 1138-1143.

12. Toovey S., Jick S., Meier C. Parkinson's disease or Parkinson symptoms following seasonal influenza // Influenza Other Respir Viruses. 2011; 5: 328-333.

13. Stryker B. Encephalitis lethargica: the behavior residuals // Training School Bulletin, 1925; 22: 152-157.

14. Boika A. V. A Post-COVID-19 Parkinsonism in the Future? // Mov Disord. 2020; 35 (7): 1094. DOI: 10.1002/mds.28117.

15. Greenhalgh T., Knight M., A'Court C., Buxton M., Husain L. Management of post-acute covid-19 in primary care // BMJ. 2020; 370: m3026.

16. Davido B., Seang S., Tubiana R., de Truchis P. Post-COVID-19 chronic symptoms: a postinfectious entity? // Clin Microbiol Infect. 2020; 26 (11): 1448-1449. DOI: 10.1016/j.cmi.2020.07.028.

17. Doykov I., Hällqvist J., Gilmour K. C., Grandjean L., Mills K., Heywood W. E. 'The long tail of Covid-19' – The detection of a prolonged inflammatory response after a SARS-CoV-2 infection in asymptomatic and mildly affected patients // F1000Res. 2020; 9: 1349. DOI: 10.12688/f1000research.27287.2. PMID: 33391730; PMCID: PMC7745182.

18. Berlit P., Bösel J., Gahn G. et al. «Neurological manifestations of COVID-19» – guideline of the German society of neurology // Neurol. Res. Pract. 2020; 2: 51.

19. Kovalev G. V., Lebedeva N. V. The use of nootropics in neuropathology. Volgograd, 1990.

20. Tian J., Milddleton B., Kaufman D. L. GABA administration prevents severe illness and death following coronavirus infection in mice // bioRxiv. 2020:2020.10.04.325423.

21. Perfilova V. N., Borodkina L. Ye. Participation of the gamma-aminobutyric acid system in the regulation of cerebral circulation. Rossiyskiy vestnik Voyenno-meditsinskoy akademii. 2014; 1 (45): 203-211.

22. Gusev Ye. I., Skvortsova V. I. Neuroprotective therapy of ischemic stroke // Nervnyye bolezni. 2002. № 1. p. 3-7.

23. Velikopol'skaya M. V., Nikitina A. M., Suchkov Ye. A., Smirnova L. A. Pharmacodynamic and pharmacokinetic properties of drugs, GABA derivatives, developed in Volgograd State Medical University // Volgogradskiy nauchno-meditsinskiy zhurnal. 2016; 2: 22-25.

24. Mirzoyan P. C., Gan'shina T. S. New cerebrovascular drug picamilon. Farmakologiya i toksikologiya 1989; 52 (1): 23-26.

25. Mirzoyan R. S., Gan'shina T. S., Kosoy M. Yu. i dr. Influence of picamilon on cortical blood supply and microcirculation in the system of pial arterioles. Byulleten' eksperimental'noy biologii i meditsiny 1989; 107 (5): 581-582.

26. Roberts B. M., Lopes E. F., Cragg S. J. Axonal Modulation of Striatal Dopamine Release by Local γ-Aminobutyric Acid (GABA) Signalling // Cells. 2021; 10 (3): 709. Published 2021 Mar 23.

27. Chugunov A. V., Kabanov A. A., Kazakov A. Yu. Complex therapy of a patient with chronic cerebral ischemia. // Nervnyye bolezni. 2021. № 3. p. 25-30.

28. Dopaminergic Therapy for Motor Symptoms in Early Parkinson Disease Practice Guideline. A Report of the AAN Guideline Subcommittee. Approved by the Guideline Subcommittee on January 30, 2021; by the AAN Quality Committee on June 21, 2021; and by the AAN Institute Board of Directors on October 7, 2021.