Evidence map›Paper›PMID 35232750›Full record

ArticleNeurology(R) neuroimmunology & neuroinflammation2022

Peripheral Neuropathy Evaluations of Patients With Prolonged Long COVID.

Anne Louise Oaklander, Alexander J Mills, Mary Kelley, Lisa S Toran, Bryan Smith, Marinos C Dalakas, Avindra Nath

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Article in Neurology(R) neuroimmunology & neuroinflammation, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 95 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
95citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

95 citing papers in PubMed, 2 syntheses or guidelines pooled it.

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  10. Neuroimmune pathophysiology of long COVID.Psychiatry and clinical neurosciences · 2025
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35 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

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5 · Who and what money

Authors and funding

7 authors.

Anne Louise OaklanderFrom the Nerve Unit (A.L.O., A.J.M.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Pathology (Neuropathology) (A.L.O.), Massachusetts General Hospital, Boston, Massachusetts; Department of Neurology (M.K.), Dell Medical School, The University of Texas, Austin, Texas; Department of Neurology (L.S.T.), Confluence Health, Wenatchee; Section of Infections of the Nervous System (B.S., A.N.), National Institute of Neurological Disorders and Stroke (NINDS) at the National Institutes of Health (NIH), Bethesda, Maryland; and Neuromuscular Division (M.C.D.), Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, and National and Kapodistrian University of Athens Medical School, Greece. aloaklander@mgh.harvard.edu.ORCID 0000-0002-9578-1596
Alexander J MillsFrom the Nerve Unit (A.L.O., A.J.M.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Pathology (Neuropathology) (A.L.O.), Massachusetts General Hospital, Boston, Massachusetts; Department of Neurology (M.K.), Dell Medical School, The University of Texas, Austin, Texas; Department of Neurology (L.S.T.), Confluence Health, Wenatchee; Section of Infections of the Nervous System (B.S., A.N.), National Institute of Neurological Disorders and Stroke (NINDS) at the National Institutes of Health (NIH), Bethesda, Maryland; and Neuromuscular Division (M.C.D.), Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, and National and Kapodistrian University of Athens Medical School, Greece.
Mary KelleyFrom the Nerve Unit (A.L.O., A.J.M.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Pathology (Neuropathology) (A.L.O.), Massachusetts General Hospital, Boston, Massachusetts; Department of Neurology (M.K.), Dell Medical School, The University of Texas, Austin, Texas; Department of Neurology (L.S.T.), Confluence Health, Wenatchee; Section of Infections of the Nervous System (B.S., A.N.), National Institute of Neurological Disorders and Stroke (NINDS) at the National Institutes of Health (NIH), Bethesda, Maryland; and Neuromuscular Division (M.C.D.), Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, and National and Kapodistrian University of Athens Medical School, Greece.
Lisa S ToranFrom the Nerve Unit (A.L.O., A.J.M.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Pathology (Neuropathology) (A.L.O.), Massachusetts General Hospital, Boston, Massachusetts; Department of Neurology (M.K.), Dell Medical School, The University of Texas, Austin, Texas; Department of Neurology (L.S.T.), Confluence Health, Wenatchee; Section of Infections of the Nervous System (B.S., A.N.), National Institute of Neurological Disorders and Stroke (NINDS) at the National Institutes of Health (NIH), Bethesda, Maryland; and Neuromuscular Division (M.C.D.), Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, and National and Kapodistrian University of Athens Medical School, Greece.
Bryan SmithFrom the Nerve Unit (A.L.O., A.J.M.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Pathology (Neuropathology) (A.L.O.), Massachusetts General Hospital, Boston, Massachusetts; Department of Neurology (M.K.), Dell Medical School, The University of Texas, Austin, Texas; Department of Neurology (L.S.T.), Confluence Health, Wenatchee; Section of Infections of the Nervous System (B.S., A.N.), National Institute of Neurological Disorders and Stroke (NINDS) at the National Institutes of Health (NIH), Bethesda, Maryland; and Neuromuscular Division (M.C.D.), Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, and National and Kapodistrian University of Athens Medical School, Greece.
Marinos C DalakasFrom the Nerve Unit (A.L.O., A.J.M.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Pathology (Neuropathology) (A.L.O.), Massachusetts General Hospital, Boston, Massachusetts; Department of Neurology (M.K.), Dell Medical School, The University of Texas, Austin, Texas; Department of Neurology (L.S.T.), Confluence Health, Wenatchee; Section of Infections of the Nervous System (B.S., A.N.), National Institute of Neurological Disorders and Stroke (NINDS) at the National Institutes of Health (NIH), Bethesda, Maryland; and Neuromuscular Division (M.C.D.), Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, and National and Kapodistrian University of Athens Medical School, Greece.
Avindra NathFrom the Nerve Unit (A.L.O., A.J.M.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Pathology (Neuropathology) (A.L.O.), Massachusetts General Hospital, Boston, Massachusetts; Department of Neurology (M.K.), Dell Medical School, The University of Texas, Austin, Texas; Department of Neurology (L.S.T.), Confluence Health, Wenatchee; Section of Infections of the Nervous System (B.S., A.N.), National Institute of Neurological Disorders and Stroke (NINDS) at the National Institutes of Health (NIH), Bethesda, Maryland; and Neuromuscular Division (M.C.D.), Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, and National and Kapodistrian University of Athens Medical School, Greece.

Funding

Neuropathogenesis of Retroviral InfectionsZIANS003130 · NINDS · NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE · PI NATH, AVINDRA · 2011 to 2025
$73.7M
Evaluation of Small-Fiber Polyneuropathy in YouthR01NS093653 · NINDS · MASSACHUSETTS GENERAL HOSPITAL · PI OAKLANDER, ANNE LOUISE · 2015 to 2024
$7.2M
DDT-BMQ-000079 Establishing Performance Characteristics of the Epidermal Neurite Density (END) Biomarker to Assist Diagnosis of Small Fiber NeuropathyU01FD007769 · FDA · MASSACHUSETTS GENERAL HOSPITAL · PI OAKLANDER, ANNE LOUISE · 2022 to 2022
$248k
FDA HHS U01 FD007769NINDS NIH HHS R01 NS093653
6 · The paper itself

Abstract

BACKGROUND AND

objectivesRecovery from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection appears exponential, leaving a tail of patients reporting various long COVID symptoms including unexplained fatigue/exertional intolerance and dysautonomic and sensory concerns. Indirect evidence links long COVID to incident polyneuropathy affecting the small-fiber (sensory/autonomic) axons.

methodsWe analyzed cross-sectional and longitudinal data from patients with World Health Organization (WHO)-defined long COVID without prior neuropathy history or risks who were referred for peripheral neuropathy evaluations. We captured standardized symptoms, examinations, objective neurodiagnostic test results, and outcomes, tracking participants for 1.4 years on average.

resultsAmong 17 patients (mean age 43.3 years, 69% female, 94% Caucasian, and 19% Latino), 59% had ≥1 test interpretation confirming neuropathy. These included 63% (10/16) of skin biopsies, 17% (2/12) of electrodiagnostic tests and 50% (4/8) of autonomic function tests. One patient was diagnosed with critical illness axonal neuropathy and another with multifocal demyelinating neuropathy 3 weeks after mild COVID, and ≥10 received small-fiber neuropathy diagnoses. Longitudinal improvement averaged 52%, although none reported complete resolution. For treatment, 65% (11/17) received immunotherapies (corticosteroids and/or IV immunoglobulins). DISCUSSION: Among evaluated patients with long COVID, prolonged, often disabling, small-fiber neuropathy after mild SARS-CoV-2 was most common, beginning within 1 month of COVID-19 onset. Various evidence suggested infection-triggered immune dysregulation as a common mechanism.

Indexed as

Adrenal Cortex HormonesAdultCOVID-19ElectrodiagnosisFemaleHumansImmunoglobulins, IntravenousMaleMiddle AgedNeurologic ExaminationPeripheral Nervous System DiseasesTreatment OutcomeAdrenal Cortex HormonesImmunoglobulins, Intravenous

Identifiers

PMID35232750
PMCPMC8889896

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