#headache treatment Cochrane

[synergycochrane]

Synergy Collaborative Health provides the best migraine headache treatment therapy in Calgary & Cochrane at an affordable cost. Book a free consultation today at 403-981-1999.

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[dharmahomoeo]

Power of Homeopathy as an Effective Treatment for Migraine

Millions of individuals worldwide suffer from the frequent neurological ailment known as migraines. Migraine is a condition that causes severe headaches, nausea, and light sensitivity that can last anywhere from a few minutes to days. A person's quality of life may be negatively impacted by the debilitating nature of migraine headaches and their potential to interfere with daily activities. Even though homeopathy is an alternative therapy, traditional medicine provides several migraine remedies, such as painkillers and prophylactic drugs. Homoeopathy is a type of complementary medicine that stimulates the body's own healing mechanisms by using greatly diluted natural chemicals. Homoeopathy has been used as an alternative medicine for over 200 years.

Homoeopathy for Migraine

Homoeopathy is a well-liked complementary treatment for migraines. Among the homoeopathic migraine treatments are Natrum muriaticum, Bryonia, Iris versicolor, and Belladonna. These treatments are thought to function by bringing the body's own energy into balance, lowering inflammation, and enhancing blood flow.

One benefit of using homoeopathy for migraines is that it doesn't have the potential side effects of using painkillers and anti-inflammatory drugs, which are common traditional migraine remedies. When administered as prescribed, homoeopathic medications are generally safe, though some patients may develop allergic responses or other negative effects.

There isn't enough data to say whether homoeopathy works to cure migraines, according to a review of clinical trials on the subject that has been released in the Cochrane Database of Systematic Reviews. The general caliber of the data is regarded as being low, despite the fact that certain individual research has shown encouraging results. To evaluate whether homoeopathy is useful for treating migraines, more research is required.

Types of Migraine: 

There are two main forms of migraine.     

Auratic migraine

Classical migraine is another name for migraine with aura. In this form, a feeling of aura (neurological symptoms) such as visual disturbance, hemisensory complaints, hemiparesis, or dysphasia frequently precede the attack. Most often, a visual aura is present. The aura often lasts a maximum of sixty minutes and develops over a period of 5 to 20 minutes. A headache, feeling of unwellness, and/or photophobia accompany it. The agonizing headache could persist for four to seventy-two hours.

Migraine without an aura

Ninety percent of migraine sufferers in women have this type of migraine, making it the most prevalent. This form of headache does not have an aura and only happens in episodes. An emotional condition, such as tension, euphoria, or any intense light or odor, may be the source of the headache. The headache primarily affects one side and gradually gets worse. The headache is frequently accompanied by nausea, vomiting, food intolerance, or sensitivity to bright lights and strong odors.

Prevalence of Migraine:

Females are more likely than males to experience migraines, with a male to female ratio of 1:3. Ninety percent of migraineurs have a family history of the condition.  As people get older, migraine attacks become less common.

What Causes Migraines?

Genetic Propensity

High Oestrogen Levels

Sleep Deprivation

Emotional Strain

Noxious Odors

Migraine Symptoms:

Migraine Symptoms Without An Aura

 The sort of vascular headache that occurs the most frequently is a migraine without aura. Moderate to severe headaches, a pulsating quality, a unilateral location, worsening by climbing stairs or engaging in other common activities, nausea and/or vomit, photophobia and phonophobia, and repeated attacks, each ranging 4 to 72 hours, are among the symptoms.

Migraine With Auratic Symptoms 

The premonitory symptoms of headache can include motor, sensory, or visual complaints. Most victims have stated that visual problems are the most prevalent. Headache, feeling dizzy, and photophobia follow the aura.

Homoeopathic Migraine Treatments

Belladonna

A popular homoeopathic treatment for migraines is belladonna. The deadly nightshade plant's byproduct, belladonna, is said to have anti-inflammatory and blood flow-improving properties. Migraines with throbbing discomfort, redness, and heat are frequently treated with belladonna.

Bryonia

A typical homoeopathic treatment for migraines is bryonia. Bryonia, which is produced by the white bryony plant, is thought to function by easing pain and promoting blood flow. When a migraine occurs accompanied by a monotonous, throbbing pain that gets worse with movement, bryonia is frequently prescribed.

Versicolor iris

Homoeopathic treatment for migraines that is frequently used is iris versicolor. Iris versicolor, which comes from the blue flag plant, is thought to have anti-inflammatory and blood-flow-improving properties. Iris versicolor is frequently prescribed for migraines that come with severe, excruciating pain and nausea.

Muriatic natrum

A typical homoeopathic treatment for migraines is natrum muriaticum. Natrum muriaticum, which is made from sea salt, is thought to act by easing inflammation and enhancing blood circulation. Natrum muriaticum is frequently prescribed for migraines that come with throbbing pain and susceptibility to light.

Conclusion

There are generally no risks associated with using homoeopathy to treat migraines, unlike conventional migraine treatments.  While homoeopathy may offer some migraine patients some relief, it's vital to speak with a doctor before utilizing it as a therapy. To guarantee that you obtain the right care for your migraines, it is crucial that you see a doctor. Visit us and book an appointment now with Dr. Shubham Tiwary. 

#homeopathy #homeopathy doctor #homeopathic medicines #homeopathy treatment #Homeopathic remedies #best homeopathy doctor near me #homeopathy doctor near me #homeopathy near me #consult a doctor

[cochraneespanol]

Paracetamol oral para la cefalea tensional episódica aguda en adultos

Stephens G, Derry S, Moore RA. Paracetamol (acetaminophen) for acute treatment of episodic tension‐type headache in adults. Cochrane Database of Systematic Reviews 2016, Issue 6. Art. No.: CD011889. DOI: 10.1002/14651858.CD011889.pub2

#first aid #paracetamol #cefalea #primeros auxilios

[cesreliefblog]

CES Alpha Stim Therapy Device

The CES Alpha Stim Therapy Device is a non-invasive device that helps relieve symptoms of depression and anxiety. It works through mild electrical stimulation to calm overactive areas of the brain, such as the limbic system. In a recent study, CES applied to earlobes decreased Hamilton Anxiety Rating Scale (HAMRS) scores by 40.4%.

This therapy is approved by the Food and Drug Administration (FDA) to treat insomnia, pain, and depression. The device is available on prescription and can be administered in the comfort of your own home. Unlike traditional electroshock treatments, which are administered under general anesthesia, Alpha-Stim is relatively free of side effects.

The device is used by a mental health professional to trigger certain neurological activities. While the exact mechanism behind the device is unclear, experts believe that the current may travel to the brain in a diffuse manner. One theory suggests that alternating microcurrents may stimulate afferent branches of cranial nerves, such as the glossopharyngeal and facial nerves. Another theory says that the current may interfere with high- and low-frequency noise.

CES is different from electroconvulsive therapy in that it is intended to interrupt ongoing cortical activity. Instead of using a large electrical current, it transmits tiny microcurrents through handheld electrodes. These devices have been used by mental health professionals for years.

Various studies have shown that Alpha-Stim is effective at treating depression. Some studies have found that nine out of ten patients experience significant relief after one treatment. Other reports show that Alpha-Stim has been found to reduce the intensity of pain and headaches. There is also a report of CES calming down the amygdala, an area of the brain involved in emotional processing.

CES has been studied in monkeys and humans, and is believed to produce a calming effect on the central nervous system. Alpha EEG waves slowed after CES in the monkeys. Itil et al., published a study in the Journal of Pain and Symptom Management. They found that CES reduced the frequency of the alpha EEG wave by more than 0.5Hz.

Similarly, a Cochrane review of randomized trials of CES for chronic pain uncovered positive outcomes for CES. However, the results are insufficient to establish whether the improvements in net health outcome are clinically significant.

The primary symptom in a pilot study was a reduction in generalized anxiety disorder. In this study, participants were randomly assigned to receive a sham CES or an active CES. During the scan, participants were instructed to keep their eyes closed and not think about anything. After each scan, they completed a validated questionnaire that assessed their symptoms. Compared to the sham group, the active group did not have any changes in their symptoms.

Disclaimer: This is not professional advice and is simply an answer to a question and that if professional advice is sought, contact a licensed practitioner, or doctor in the appropriate administration.

Seek Professional Help

When you need a help to cure your anxiety, Contact CES Relief to get a prescription from a professional licensed practitioner.

Cranial Electrotherapy Stimulation (CES) Device is a safe, painless microcurrent treatment scientifically proven to treat anxiety and insomnia in children, teenagers, and adults alike.

CES Relief

1875 N Lakes Place Meridian, ID 83646 (208)846–8448 CES Relief Website

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[human-nature-medicine]

The Immediate Analgesic Effect of Acupuncture for Pain:

Acupuncture has been shown to be an effective treatment for pain in a number of clinical trials. The aim of this review was to assess the evidence for the immediate analgesic effect of acupuncture for pain. A systematic search was conducted in five electronic databases. Twenty-two trials involving 3,993 participants were included. The results showed that acupuncture was effective for reducing pain in a variety of conditions, including headaches, dental pain, postsurgical pain, and musculoskeletal pain. The effect was immediate, with a significant reduction in pain reported within one hour of treatment. Acupuncture is a safe and effective treatment for pain, with a rapid onset of action. It should be considered as a first-line treatment for pain, particularly when drug therapy is not effective or not tolerated.

Acupuncture is a traditional Chinese medicine technique that has been used for centuries to treat a variety of health conditions. In recent years, acupuncture has been shown to be an effective treatment for pain in a number of clinical trials. The aim of this review was to assess the evidence for the immediate analgesic effect of acupuncture for pain.

A systematic search was conducted in five electronic databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, and ClinicalTrials.gov. Studies were eligible for inclusion if they were randomized controlled trials that assessed the immediate analgesic effect of acupuncture for pain.

Twenty-two trials involving 3,993 participants were included in the final analysis. The results showed that acupuncture was effective for reducing pain in a variety of conditions, including headaches, dental pain, postsurgical pain, and musculoskeletal pain. The effect was immediate, with a significant reduction in pain reported within one hour of treatment.

Acupuncture is a safe and effective treatment for pain, with a rapid onset of action. It should be considered as a first-line treatment for pain, particularly when drug therapy is not effective or not tolerated.

Acupuncture, a key component of traditional Chinese medicine practices, is commonly used to relieve pain. There is significant evidence that acupuncture can effectively treat both acute and chronic pain. Until recently, however, most of the research on acupuncture has been conducted in Asia. A recent systematic review and meta-analysis of clinical trials published in the journal Pain Medicine provides an up-to-date evaluation of the evidence for the efficacy of acupuncture in treating pain.

The systematic review included 22 randomized controlled trials that enrolled a total of 3,993 participants. The trials were conducted in a variety of settings, including outpatient clinics, hospitals, and dental offices. All of the trials compared acupuncture to either sham acupuncture or no treatment.

The results showed that acupuncture was effective for reducing pain in all of the conditions studied, including headaches, dental pain, postsurgical pain, and musculoskeletal pain. The effect was immediate, with a significant reduction in pain reported within one hour of treatment.

The authors of the review conclude that acupuncture is a safe and effective treatment for pain, with a rapid onset of action. They recommend that acupuncture be considered as a first-line treatment for pain, particularly when drug therapy is not effective or not tolerated.

The evidence reviewed in this systematic review and meta-analysis provides strong support for the use of acupuncture as a treatment for pain. Acupuncture should be considered as a first-line treatment option for pain, particularly when drug therapy is not effective or not tolerated.

[maakbaaby-blog]

Step-By-Step Details For Buy Drugs Online

If you haven’t given it a though yet, it’s high time you should! A handful of really active people posting way to get everyone they know involved, hoping that a real grassroots movement happens to stop this thing in it’s tracks. If you feel it is quite wasteful, another alternative way that can be sought is changing your flooring to tile or wooden floors. People who do not have access to certain drugs due to any reason like unavailability can benefit by ordering for these medicines online and receiving an express delivery, they also offer easy and affordable shipment options. For example, there are codes that a Qualified Specialist Coder uses to code treatment options that health professionals give. But there were always health constraints on water extraction and cleansing process as not every patient could stand high flow settings for blood to flow faster during the dialysis process. Advanced stage renal patients could not urinate and water intake through eating and drinking were supposed to be extracted through dialysis process. This brings us to our next problem: Prescription drugs can cause serious complications, however, many ill patients in the nation need medications such as these being misused. ” The doughnut hole, or perhaps the coverage gap, could be the period for Medicare Part D patients by which they must pay a significantly higher cost on the drugs until they achieve the limit. In many cases, the individual clicks on a website or responds to an email advertising prescription drugs and they fill out an order. With automation, uncooked products could be shipped quickly and successfully to the required projects and finished items could be delivered out for shipping and delivery. We need to reach out to allies, and in the political world, sometimes that means people we otherwise disagree with completely. Generally, you need to use the laser comb for about 10 to 15 minutes, three times per week. Within 20 minutes, it was back down to 80/120. Four days later, I gave her 0/25 ml. On the fourth day, it started climbing again, and I gave her another shot, this time 0.5 ml (half). In all of my years of careful research on Viagra and Cialis, this is the first time I have found this conflict. Please do not hesitate to contact us any time of day or night. Despite the major brand after Frontline Spray i.e., Advantage is comparatively cheaper in price than the former, yet Frontline has an upper hand for being rated in many of the pet pharmacies. Frontline pet medications are said to be one of the best pet remedies available at any pet pharmaceuticals around the city or even online. 4. More concerning: The contaminants not listed on the label are frequently present. This is something you do on your own, you are in complete control. The following will explain where Frontline stands in comparison to other major generic flea and tick control for your pets. If your sleep-depriving symptoms originate from common cold, you can try the following medication that had been found by German doctors, which is able to relief cold. Symptoms after being bitten are nausea, vomiting, headaches, stomach cramps, dizziness and possibly convulsions. Their jaws are big enough to fit a grown mans hands in, both hands at once. The difference between the price of both the versions are too large as the generic form is sold at 80% lesser price value of the brand name. Herbal remedies, which fall under dietary supplements, are not clearly defined and separated from foods. It is available in the form of capsule and has been used to treat millions of people, both children and adults, till date. A best sleeping pill is one of the most powerful sleeping aids. I've never been one to do a lot of skin care - i buy strivectin on ebay for 1/3 of the regular price and - that's bout it! While searching for your Drug & Alcohol Rehab options, be cautious of those “exclusive” alcohol rehabs who will assure that the curing procedure will be simple. Your Community - Drug and alcohol abuse takes a heavy toll on a community as well. • Driving or doing other risky activities when you're under the influence of the Drug. Many companies have clearly stated policies that govern drug usage. Many identity theft rings have side ventures, perhaps an illicit online drug store, that serves as a vehicle in the gathering of personal information. It appears to be updated frequently and is very well puttogether! Most of the food we eat is turned into glucose, or sugar, for our bodies to use for energy. This is safe because the probe is too short to reach the eardrum, online pharmacies canada and is larger than an infants ear canal. Read also our customer-friendly Shipping policy and Shipping terms. We moved from the mind numbing dreariness of Al Quoz Industrial 2 Emirates Accomodation Al Khail Gate, (enjoy that Google Search Terms) to the interesting (yet still dreary sand-laden) area of Nahda 2, Dubai. A Prescription Drugis a licensed medicine that is regulated by legislation to require a medical prescription before it can be obtained. If it is a substitution, a comprehensive assessment of the older belt will give insight into specifically what you require. Cochran (MS) to be a good secondary target for the 'fight big government' angle. Practicality is also a good ground why having a shaver that doesnt require parts replacement is beneficial.

[healthboundetobicokeservice]

Acupuncture Benefits for Treating Migraines

Headache migraines are crippling for the people who experience the ill effects of the aggravation. As indicated by the Migraine Research Foundation, around 39 million individuals in the U.S. experience the ill effects of headache illness.

Some headache studies foresee that up to 12% of grown-ups in the U.S. have headaches, with 4 million experiencing ongoing headaches. Around the world, it is assessed that 1 billion men, ladies, and even kids experience the ill effects of headache sickness. There are a few acupuncture benefits for treating headaches.

Headaches are not kidding and regularly crippling. Here are some extra insights from the Migraine Research Foundation:

Headache infection is the sixth most crippling disease on the planet. At regular intervals, somebody in the U.S. goes to the trauma center grumbling of head torment, and around 1.2 million visits are for intense headache assaults.

While most victims experience assaults a few times per month, multiple million individuals have persistent every day headache, which is characterized as something like 15 headache days of the month, book your appointment here today.

Over 90% of headache victims can't work or capacity regularly during their headache.

The following are three advantages to utilizing acupuncture to treat headaches

1) Prevention

Proof additionally shows that acupuncture can lessen headache recurrence and potentially even forestall the beginning of headaches in certain individuals. 

A recent report distributed by the American Headache Society observed that acupuncture might assist with forestalling headache migraines or lessening events and could be more successful than more customary cerebral pain cures including doctor prescribed drugs.

2) Saving Money

It's additionally vital to take note of that some headache medicines are costly. Acupuncture therapies very well could assist you with lessening the expense of dealing with your ongoing headache torment. Check with your insurance agency as certain plans truly do cover acupuncture medicines.

3) Fewer Side Effects

A great many people experiencing headache infection manage it by taking physician endorsed medicine. In any case, concentrates on show acupuncture might assist with assuaging the aggravation related with headaches. 

As indicated by a 2016 Cochrane survey, roughly 50% of individuals consistently seeing an acupuncturist say they have decreased their dependence on pain relievers later they have gotten acupuncture treatment. Likewise with numerous physician endorsed meds, some convey huge secondary effects. Acupuncture is an awesome medication free choice to explore assuming that you experience the ill effects of ongoing headache torment.

Converse with your acupuncturist and see what therapy choices are accessible for your ongoing headache torment. It's likewise useful to keep a log of migraine indications both previously, then after the fact treatment. 

Before treatment notes can assist your acupuncturist with understanding your manifestations and expected triggers so they can tailor a treatment plan that is ideal for you. Following your side effects in a log during your acupuncture medicines assist you with perceiving how significant the medicines are.

[lupinepublishers-ojnbd]

Lupine Publishers| Neurological, Neuropsychiatric and Psychiatric Symptoms During COVID- 19 Infection and After Recovery: A Systematic Review of Observational Studies

Lupine Publishers| Journal of Neurology and Brain Disorders

Abstract

Background: The SARS-CoV-2 virus causes a wide spectrum of disease severity. Initial manifestations include fever, dry cough, and constitutional symptoms, which may progress to respiratory disease. There may also be neurological and psychiatric manifestations, involving both the central and peripheral nervous system.

Methods: We performed a literature search of the databases PubMed, EMBASE, The Cochrane Library and Web of Science for observational studies reporting neurological, psychiatric, and neuropsychiatric effects of COVID-19. This was followed by a narrative synthesis to summarise the data and discuss neuropsychiatric associations, symptom severity, management, and recovery.

Findings: The most frequently reported neurological symptoms were ageusia, hyposmia/anosmia, dizziness, headache, and loss of consciousness. Statistically significant relationships were noted between Asian ethnicity and peripheral neuropathy (p=0·0001) and neuro-syndromic symptoms (p=0·001). ITU admission was found to have a statistically significant relationship with male sex (p=0·024). Depression and anxiety were also identified both during and after infection. The most frequent treatments used were intravenous immunoglobulins, followed by antibiotics, antivirals, and hydroxychloroquine; with mean treatment duration of 6 days.

Interpretation: Various neuropsychiatric symptoms have been associated with COVID-19 infection. More studies are required to further our knowledge in the management of neurological and psychiatric symptoms during and after COVID-19 infection

Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Introduction

Severe acute respiratory syndrome coronavirus 2 (SARSCoV- 2) is a novel virus, initially discovered in the city of Wuhan, China [1]. SARS-CoV-2 causes coronavirus disease (COVID-19), which has led to an ongoing global pandemic. Despite belonging to the coronavirus family, which usually cause self- limiting upper respiratory tract infections, SARS-CoV-2 is often more virulent than most coronaviruses and may lead to severe respiratory disease [2].

The mechanism of action for SARS-CoV-2 may relate to a specific tropism for respiratory tract mucosal cells through the attachment of viral surface proteins to angiotensin-converting enzyme (ACE) 2 receptors [3]. After infection, the virus causes a wide spectrum of disease severity, with most patients suffering a mild self-limiting disease. Initial manifestations include fever, dry cough and constitutional symptoms (headache, fatigue, myalgia, arthralgia), progressing to respiratory disease of mild to moderate severity [2,4]. Other disease manifestations include gastrointestinal symptoms (nausea, vomiting, diarrhoea), sore throat, skin rashes, anosmia, ageusia, and chest pain [5]. In patients with underlying comorbidities or advanced age, the infection may be complicated with acute respiratory distress syndrome (ARDS), acute renal failure, sepsis, multi-organ failure and death [6,7]. As the pandemic of COVID-19 persists, the knowledge of the clinical disease spectrum is still unfolding. Medical literature of COVID-19 infected patients reveals a variety of extra-pulmonary organ involvement [8]. Among these, COVID-19 has been associated with several neurological and psychiatric effects, involving both the central and peripheral nervous system [9].

Methods

This systematic review follows the Preferred Reporting Items for Systematic reviews and MetaAnalyses (PRISMA) statement [10] and was registered in the PROSPERO International Prospective Register of Systematic Reviews (number CRD42020203770 at www.crd.york.ac.uk/PROSPERO).

Search Strategy

The literature search was performed in August 2020 using the databases PubMed, EMBASE, The Cochrane Library and Web of Science, from their respective inception dates. The following search terms were used:

(Neuro* OR Nervous OR Psychiatry* OR Mental) AND (COVID OR Corona*)

The search strategies incorporated both medical subject headings (MeSH) and free-text terms, which were adapted according to the database searched. Grey literature was also searched. Reference lists of the identified papers and reviews were hand-searched. Publication languages included English and Greek. There were no publication period restrictions.

Inclusion and Exclusion Criteria

Included studies were observational studies reporting neurological, psychiatric, and neuropsychiatric effects of COVID-19. The included participants were COVID-19 patients of any ethnic origin, sex/gender, age, country, and were either actively infected from COVID-19 at the time of the study or had recovered. We did not include studies examining psychiatric effects on the general population as an indirect result of the pandemic.

Main Outcomes

The main outcomes included neurological, psychiatric, and neuropsychiatric effects of COVID-19, either based on clinical diagnosis or relevant diagnostic questionnaires. Information about recovery and treatment was reported when available.

Screening

Titles were screened for inclusion, followed by screening of abstracts, and then content. One author (SS) screened the papers, and any disagreements were resolved by discussion with the review’s primary author (MS) and the other authors.

Data Extraction

The Cochrane good practice data extraction form was used for data extraction. Data extraction from reviews involved the NICE extraction form, and the data were extracted in an electronic format.

Risk of Bias/Quality Assessment

The quality and risk of bias were assessed by the Mixed Methods tool for Appraisal (MMAT). The guidance from the Centre for Reviews and Dissemination was used for the appraisal of review papers. Discrepancies were resolved by discussion within the authors’ team.

Strategy for Data Synthesis

We performed a narrative synthesis review of original studies and reviews reporting neurological, psychiatric, and neuropsychiatric effects in COVID-19 patients.

We summarised the data and discussed:

a) Neuropsychiatric associations

b) Symptom severity

c) Management and

d) Recovery

Information from the various identified studies was analysed, summarised, and compared.

Results

Following our literature search, we identified a total of 7,460 papers. After removing the duplicated and irrelevant papers, 328 full text articles remained to be assessed for eligibility using the inclusion and exclusion criteria. Of these, 313 studies were included in the final narrative synthesis: specifically, 307 studies for neurological symptoms and 7 studies for psychiatric symptoms, as shown in Figure 1. A total of 15 full text papers were excluded as they were either not relevant (n=4) or unrelated to COVID-19 infection (n=11).

Figure 1: PRISMA flowchart of selected studies.

Neurological Symptoms

A total of 307 studies for neurological symptoms were included in the narrative synthesis, as mentioned above, of which 202 were case reports, 53 case series, 2 retrospective studies, 21 cohort studies, 15 systematic reviews, 8 cross-sectional studies, 3 casecontrol studies, and 3 retrospective case series. A summary of the studies included in the systematic review is shown in Table 1, and a complete list of the studies is provided in Supplementary Material 1. The mean age of the patients included was 55·11 (±17.91) years. Most of the patients in our cohort were males (61%) and the majority of the participants were Asians (57%).

Table 1: Summary of studies included in the systematic review for neurological symptoms.

Clinical Presentation

A total of 107 studies (42·7%), involving 26,758 patients, included a full account of neurological symptoms experienced by the participants following COVID-19 infection. Table 2 presents the frequency of symptoms and their resolution. The most reported symptoms were ageusia (n=390), hyposmia/anosmia (n=480), dizziness (n=230), headache (n=860), and loss of consciousness (n=310).

Table 2: Frequency and recovery rates of different COVID-19 neurological presentations.

Moreover, a significant number of patients experienced severe neurological manifestations, such as seizures (n=260), acute cerebrovascular events (n=500), cerebellar syndromes (n=70), peripheral neuropathies (n=90), meningitis/encephalitis (n=380), encephalopathies (n=380), neurological syndromes such as Guillain-Barre syndrome (n=320), and spinal cord syndromes (n=30).

A statistically significant relationship was noted between ethnicity and peripheral neuropathy (p=0·0001) as well as between ethnicity and neuro-syndromic symptoms (p=0·001), with Asian patients being more likely to experience these symptoms. Both sexes were statistically as likely to present with symptoms of ageusia (p=0·0001), dizziness (p=0·033), gastrointestinal symptoms (p=0·0001), and anorexia (p=0·0001). However, flu-like symptoms were statistically more prevalent in females (p=0·008), whereas hyposmia (p=0·037) and haemoptysis (p=0·0001) was more frequent in males.

Following recovery from COVID-19 infection, a large proportion of patients demonstrated a complete resolution of their symptoms. Specifically, patients presenting with loss of consciousness and ageusia reported the highest resolution rates (93% and 92% respectively), while the patients that experienced spinal cord syndromes had the lowest resolution rates of their symptoms (33%).

Treatments

The most frequent treatments used in the studies analysed were intravenous immunoglobulins (IVIG) (20·17%), followed by antibiotics such as azithromycin (19·29%), antivirals (14·91%), and hydroxychloroquine (10·52%). However, a combination of therapies was required for treatment in some patients. Figure 2 illustrates the different types of drugs that the COVID-19 patients received during their admission and how the drug therapy is markedly heterogeneous among this group of patients.

Figure 2: Drug type administered to COVID-19 patients.

The most common route of drug administration was intravenous (65%), although oral drug administration and intramuscular injections were also utilised. Patients received treatment for a mean duration of 6 (±4) days.

Prognosis

Patients admitted to an Intensive Therapy Unit (ITU) were reported in 126 studies. Figure 3 shows the different types of management that patients received when admitted to ITU and illustrates that the most common cause of ITU admission was the need for respiratory support with intubation and mechanical ventilation (84% of the cases).

Figure 3: Types of ITU management received by patients.

ITU admission was found to have a statistically significant relationship with males (p=0·024), but not age. Interestingly, there was a statistically significant relationship with ITU admission and symptoms of hyposmia/anosmia (p=0·0001), headache (p=0·035), acute CVA (p=0·0001), seizure (p=0·001), meningitis (p=0·034), and encephalopathies (p=0·0001).

Psychiatric Symptoms

We identified seven studies reporting psychiatric effects, of which five were cross-sectional studies, one was a retrospective cohort study, and one was a case report. Details of the six studies are reported in Table 3. The studies involved 299,000 patients in total, of which 44% were male and 56% were female. Half of the studies were reported in China. Three studies involved 171 patients in hospital settings while having active COVID-19 infection, three studies involved 498 patients at home after recovery, and one study involved 62,354 patients covering both inpatients during infection and those at home after recovery. All studies identified depression and anxiety as being relevant to COVID-19 infection, both during and after infection. Additionally, one study reported suicidality during infection, two studies reported post-traumatic stress disorder after infection, one study suggested obsessivecompulsive disorder after infection, one study suggested insomnia after infection, one study suggested a higher incidence of psychosis, and two studies suggested a higher incidence of dementia diagnosis as being relevant to having been diagnosed with COVID-19.

Table 3: Studies reporting psychiatric effects related to COVID-19 infection.

Discussion

The literature published on the neurological symptoms observed in patients with COVID-19 is vast. Through our review, we aimed to summarise all available literature, as well as include more recent studies that older reviews may not have included. Our review specifically served to identify and examine the frequency and severity of these symptoms through combining this existing literature. In total, 307 neurological studies covering 60,097 patients, were included in this systematic review, which has shown that COVID-19 is associated with a large variety of neurological symptoms. The most frequently reported symptoms included ageusia, hyposmia/anosmia, dizziness, headache, and loss of consciousness. These symptoms are not specific to SARSCoV- 2 infection and are of low severity, however they may suggest neurotropism. They also associate with high resolution rates (all >80%). The most common severe neurological complication of COVID-19 was acute cerebrovascular events. This result is in keeping with other systematic reviews [18,19].

Direct neurological damage including ischemic strokes, meningitis/encephalitis, or Guillain-Barre syndrome are relatively common extra-pulmonary neurological presentations according to our review. These results should be the springboard for further research efforts aiming to distinguish whether these neurological entities are a consequence of direct brain injury/infection or an interaction with other vascular comorbidities of patients suffering severe/critical COVID-19 disease.

A significant proportion of COVID-19 patients were asymptomatic due to the course of SARS-CoV-2 infection. In addition, patients may not present with respiratory symptoms or fever but still have initial neurological manifestations. Thus, when patients present with neurological symptoms, despite the absence of respiratory symptoms, clinicians should maintain a high level of clinical suspicion for the possibility of underlying COVID-19 asymptomatic infection.

The resolution rates of neurological symptoms also varied. Patients presenting with loss of consciousness and ageusia reported the highest resolution rates (93% and 92% respectively), with ageusia resolution rates being 100% in one study [20]. On the other hand, patients who experienced spinal cord syndromes, such as acute myelitis, had the lowest resolution rates of their symptoms (33%). This finding is supported by the established poor overall outcomes associated with acute myelitis, with only approximately one-third of patients experiencing a favourable outcome [21].

A statistically significant relationship was noted between Asian ethnicity and peripheral neuropathy. The relationship between ethnicity and peripheral neuropathy in the context of COVID-19 has yet to be explored. However, peripheral neuropathy as a complication of diabetes has been found to be more prevalent among Caucasian patients [22] and less common in those with Indo- Asian and African- Caribbean origins [23]. Moreover, a statistically significant relationship was noted between Asian ethnicity and neuro-syndromic symptoms. Nonetheless, it is important to note that both of these relationships may have been influenced by the fact that the majority of the participants in the studies included were Asian and that a number of papers did not disclose the ethnicity of their participants.

Additionally, flu-like symptoms were statistically more prevalent in females, possibly because males have been found to have a higher risk of severe illness with COVID-19 [24]. Hyposmia and haemoptysis were statistically more prevalent in males. This is in contrast to several previous studies that found hyposmia to be more common in females with COVID-19 infection [25-28]. However, our patient cohort was predominantly male (62%), which may have contributed to the differing results. Regarding haemoptysis, it is a very uncommon presentation that was only present in 10 patients.

ITU admission was found to have a statistically significant relationship with male sex, but not with age. A meta-analysis of patients with COVID-19 also demonstrated a relationship between sex and ITU admission, with male patients having almost three times the probability of requiring ITU admission compared to females [29]. Surprisingly, our study did not determine any relationship between age and ITU admission. In contrast, another meta-analysis found that patients greater than 70 years old have a higher risk of needing intensive care [30]. Furthermore, there was a statistically significant relationship between ITU admission and the symptoms of hyposmia/anosmia, headache, acute CVA, seizure, meningitis, and encephalopathies.

Treatment varied, with several different therapies and drug routes being used depending on the neurological manifestation and severity of the presentation. The most frequent treatments used were intravenous immunoglobulins (IVIG), followed by antibiotics such as azithromycin, antivirals, and hydroxychloroquine, with patients receiving treatment for a mean duration of 6 days. A systematic review assessing treatment strategies for COVID-19 similarly found antivirals, antimalarials, and antibiotics to be the mainstay of treatment [31]. The frequency of IVIG can be attributed to its use in treating many different neurological conditions, most notably Guillain-Barre Syndrome, which was the fourth most common neurological complication reported in this review. Finally, it is important to consider that the COVID-19 pandemic is rapidly evolving and that treatment options are continually being trialled and developed.

Even though we established an abundance of studies for neurological symptoms, there appears to be a lack of studies regarding the psychiatric effects during and after COVID-19 infection. Nonetheless, all the studies we were able to identify reporting psychiatric effects have found depression and anxiety to be relevant, both during and after infection with COVID-19. In severe cases, there may even be a risk of patients attempting suicide. Compared to people who had flu or other respiratory tract infections, COVID-19 survivors were more likely to receive a diagnosis of anxiety of depression over the same period [17]. It was found that involving psychiatric care for these patients was effective in reducing their symptoms of anxiety and depression. Without proper psychiatric intervention, there is a risk that these psychiatric symptoms could increase the risk of suicidal ideation. Overall, it is recommended that psychiatric and/or psychological support should be available in hospitals to patients admitted to medical wards due to COVID-19, as well as in the community following recovery. This process may involve both the use of pharmacological and/or psychological interventions. Given the fact that COVID-19 survivors were at higher risk of receiving a diagnosis of dementia at 6-months follow-up, access to memory clinics should also be available to this group of patients. More studies examining the short-term and long-term psychiatric effects during and after COVID-19 infection are required in the future to obtain a better understanding of the symptoms, as well as to develop effective management strategies.

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