Elaboração de um protocolo padronizado para avaliação das alterações neurológicas em pacientes com SARS-COV-2

Abstract

Background: Spinocerebellar ataxia is a hereditary neurodegenerative disease characterized by changes in balance, locomotion and motor coordination. Stem cell therapies are currently being investigated as an alternative to delay the evolution of the disease. Objectives: The aim of this review was to investigate the safety and whether the application of stem cells produced an effect on functional recovery in individuals with spinocerebellar ataxia. Methods: The studies included in this review investigated the efficacy and safety of a protocol for the application of mesenchymal stem cells extracted from umbilical cord and adipose tissue. Two studies used intrathecal route for application and one study used intravenous route. Results: Studies have shown clinical improvement in the scores of the ICARS (International Cooperative Ataxia Rating Scale), ADL (Activities of Daily Living Scale), BBS (Berg Balance Scale) and SARA (Scale for the Assessment and Rating of Ataxia), but lacked statistical significance. Conclusions: Further studies are needed with different designs, largest sample sizes and placebo control, to fully understand antecipated outcomes of cellular therapy for spinocerebellar ataxia.

Introdução: O SARS-CoV-2 tem um grande potencial inflamatório no SNC podendo alterar funções cognitivas, sensoriais e motoras. Estudos demonstram que pacientes diagnosticados com COVID-19 não apresentaram sintomas respiratórios típicos; em vez disso, exibiram apenas sintomas neurológicos (NeuroCOVID) ou ambos, assim como alterações no lobo frontal. Objetivos: Avaliar a atividade elétrica cerebral e a função cognitiva em pacientes com COVID-19 ao longo de 1 ano e buscar se há associação entre elas. Metodologia: Trata-se de um estudo de coorte prospectiva e epidemiológica de pacientes com SARS-Cov-2 na cidade de Uberaba com duração de 12 meses. Foram utilizadas as escalas de Ansiedade e Depressão, Montreal Cognitive Assessment, Digit Span Test, Eletroencefalograma em repouso e durante aplicação do Trail Making Test e Box and Blocks Test das áreas F7, F3, Cz, F4 e F8, com follow-up de 0-3 meses, 3-6 meses e 6-12 meses. Os dados foram considerados estatisticamente significante se p<0,05. Resultados: Foi observada diminuição da capacidade cognitiva e da atividade cerebral na região frontal no período de 6-12 meses após a infecção por SARS-Cov-2 com correlação entre os resultados.

Introduction: SARS-CoV-2 has a great inflammatory potential in the CNS and can alter cognitive, sensory and motor functions, negatively impacting functionality. Studies demonstrate that some patients diagnosed with COVID-19 do not have typical respiratory clinicians; instead, they exhibited only neurological symptoms (NeuroCOVID) or both. The electroencephalogram and the use of scales to assess cognitive function are important in investigating these symptoms. Objectives: To evaluate brain electrical activity and cognitive function in patients with COVID-19 over 1 year. Methodology: This is a prospective and epidemiological cohort study of patients with SARS-Cov-2 in the city of Uberaba, lasting 12 months. The work was divided into three stages: preparation and application of the electronic form, screening of participants and application of the neurological assessment protocol, with follow-up periods of 0-3 months, 3-6 months and 6-12 months. Results: The cognitive capacity and brain activity in the frontal region was reduced from 6 to 12 months after SARS-Cov-2 infection.