1. Summary
A recent article published by Nikbakht et al. in this journal discussed potential mechanisms of seizure and epilepsy in Sars-CoV-2 infection (Mult Scler Relat Disord, 2020;102535). In addition, a recent study reported that dexamethasone was able to reduce the mortality in COVID-19 patients. Considering that dexamethasone abrogated neuroinflammation and improved astrocyte function in a refractory animal model of epilepsy and reduced seizures in refractory patients, it may be speculated that this steroid, in addition to reducing mortality, could prevent and/or mitigate convulsive and other neurological manifestations in COVID-19 patients.
2. Commentary
A recent article published by Nikbakht et al. in this journal discussed potential mechanisms of seizure and epilepsy in COVID-19 patients (Nikbakht et al., 2020). In fact, COVID-19 affects many systems other than the respiratory system, including the cardiovascular, renal and nervous systems. Neurological manifestations are varied, ranging from a headache and anosmia to convulsion and stroke (Wu et al., 2020; Yachou et al., 2020; Whittaker et al., 2020). These manifestations can be provoked either by a direct viral invasion, since neurons and astrocytes have membrane proteases such as ACE-2 and TMPRSS2 that anchor the entry of Sars-CoV-2, as well as by an inflammatory disorder caused by the cytokine storm described in the disease, as pointed out by Nikbakht et al (Nikbakht et al., 2020).
These data reinforce the idea that an active neuroinflammatory process may be at the basis of epileptic diseases, particularly those resistant to antiepileptic drugs. The cytokine storm has been associated with severe and lethal cases of COVID-19 (Hu et al., 2020), where IL-6 could mediate an exacerbated acute phase response by liver, that in turn could explain, in part, the incidence of atypical coagulopathy in these cases (Gonçalves and Sesterheim, 2020).
Based on such evidence, the use of immunomodulators has been proposed to control the severity of the disease (COVID-19, 2020). A recent trial suggested that dexamethasone reduces mortality in these patients (Group. RC, 2020). Interestingly, in a refractory model of epilepsy, dexamethasone was able to abrogate neuroinflammatory signs and improve astrocyte function (Vizuete et al., 2018); in fact, this anti-inflammatory steroid has been proposed as an adjuvant therapy in cases of refractory epilepsy (Ramos et al., 2019). Therefore, we speculate that dexamethasone, beyond reducing mortality, could be useful for preventing or mitigating convulsive manifestations in COVID-19 patients. Current investigations of the use of dexamethasone in COVID-19 patients will clarify this question and may be able to evaluate the outcome of other neurological manifestations during and post-COVID-19.
Declaration of Competing Interest
The authors declare no conflicts of interest.
Acknowledgements
The authors gratefully acknowledge to public funding agencies in Brazil: National Council for Scientific and Technological Development (CNPq) and Coordination for the Improvement of Higher Education Personnel (CAPES)
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