Intravenous immunoglobulin therapy in COVID-19-related encephalopathy

• DOI: 10.1007/s00415-020-10248-0
• Publication Date: 2020-10-08T14:03:38Z
• Authors: Lorenzo Muccioli; Umberto Pensato; Giorgia Bernabè; Lorenzo Ferri; Maria Tappatà; Lilia Volpi; Ilaria Cani; Olivia J. Henry; Francesca Ceccaroni; Sabina Cevoli; Gloria Stofella; Elena Pasini; Giacomo Fornaro; Caterina Tonon; Simone Vidale; Rocco Liguori; Paolo Tinuper; Roberto Michelucci; Pietro Cortelli; Francesca Bisulli
• Keywords: Brain Diseases; Original Communication; SARS-CoV-2; Clinical Neurology; COVID-19; Immunoglobulins, Intravenous; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Neurology; Humans; Female; IVig;Covid-19;encephalopathy; Aged; Retrospective Studies

Abstract Objective To report on efficacy and safety of intravenous immunoglobulin (IVIg) therapy in a case series of patients with COVID-19-related encephalopathy.

Methods We retrospectively collected data on all patients with COVID-19 hospitalized at two Italian hospitals who developed encephalopathy during disease course and were treated with IVIg.

Results Five patients (two females, mean age 66.8 years) developed encephalopathy after a mean of 12.6 days, since the onset of respiratory/constitutional symptoms related to COVID-19. Four patients suffered severe respiratory distress, three of which required invasive mechanical ventilation. Neurological manifestations included impaired consciousness, agitation, delirium, pyramidal and extrapyramidal signs. EEG demonstrated diffuse slowing in all patients. Brain MRI showed non-specific findings. CSF analysis revealed normal cell count and protein levels. In all subjects, RT-PCR for SARS-CoV-2 in CSF tested negative. IVIg at 0.4 g/kg/die was commenced 29.8 days (mean, range: 19–55 days) after encephalopathy onset, leading to complete electroclinical recovery in all patients, with an initial improvement of neuropsychiatric symptoms observed in 3.4 days (mean, range: 1–10 days). No adverse events related to IVIg were observed.

Conclusions Our preliminary findings suggest that IVIg may represent a safe and effective treatment for COVID-19-associated encephalopathy. Clinical efficacy may be driven by the anti-inflammatory action of IVIg, associated with its anti-cytokine qualities.