Key result
Non-invasive neuromodulation techniques, including tDCS, rTMS, and VNS, offer potential therapeutic pathways for managing COVID-19 related systemic inflammation, musculoskeletal pain, and mental distress.
Why the study?
COVID-19 morbidity affects the nervous system in addition to the respiratory system, highlighting a potential role for non-invasive neuromodulation in treating related disorders.
Non-invasive neuromodulation techniques such as tDCS, rTMS, and VNS present a theoretical framework for managing acute and chronic neurological, respiratory, and psychiatric symptoms of COVID-19.
May support neuromodulation for COVID-19 neurological complications; hypothesis-generating and requires validation in controlled trials.
Background: Novel coronavirus disease (COVID-19) morbidity is not restricted to the respiratory system, but also affects the nervous system. Non-invasive neuromodulation may be useful in the treatment of the disorders associated with COVID-19. Objective: To describe the rationale and empirical basis of the use of non-invasive neuromodulation in the management of patients with COVID-10 and related disorders. Methods: We summarize COVID-19 pathophysiology with emphasis of direct neuroinvasiveness, neuroimmune response and inflammation, autonomic balance and neurological, musculoskeletal and neuropsychiatric sequela. This supports the development of a framework for advancing applications of non-invasive neuromodulation in the management COVID-19 and related disorders. Results: Non-invasive neuromodulation may manage disorders associated with COVID-19 through four pathways: (1) Direct infection mitigation through the stimulation of regions involved in the regulation of systemic anti-inflammatory responses and/or autonomic responses and prevention of neuroinflammation and recovery of respiration; (2) Amelioration of COVID-19 symptoms of musculoskeletal pain and systemic fatigue; (3) Augmenting cognitive and physical rehabilitation following critical illness; and (4) Treating outbreak-related mental distress including neurological and psychiatric disorders exacerbated by surrounding psychosocial stressors related to COVID-19. The selection of the appropriate techniques will depend on the identified target treatment pathway. Conclusion: COVID-19 infection results in a myriad of acute and chronic symptoms, both directly associated with respiratory distress (e.g., rehabilitation) or of yet-to-be-determined etiology (e.g., fatigue). Non-invasive neuromodulation is a toolbox of techniques that based on targeted pathways and empirical evidence (largely in non-COVID-19 patients) can be investigated in the management of patients with COVID-19.
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Baptista et al. (2020) conducted a review in COVID-19 and related disorders. Non-invasive neuromodulation (tDCS, rTMS, VNS) was evaluated. Non-invasive neuromodulation techniques, including tDCS, rTMS, and VNS, offer potential therapeutic pathways for managing COVID-19 related systemic inflammation, musculoskeletal pain, and mental distress.
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