Persistence of symptoms and quality of life at 35 days after hospitalization for COVID-19 infection.

BACKGROUND: Characterizing the prevalence and persistence of symptoms associated with COVID-19 infection following hospitalization and their impact is essential to planning post-acute community-based clinical services. This study seeks to identify persistent COVID-19 symptoms in patients 35 days post-hospitalization and their impact on quality of life, health, physical, mental, and psychosocial function. METHODS AND FINDINGS: This prospective cohort study used the PROMIS® Instruments to identify symptoms and quality of life parameters in consecutively enrolled patients between March 22 and April 16, 2020, in New Jersey. The 183 patients (median age 57 years; 61.5% male, 54.1% white) reported persistent symptoms at 35 days, including fatigue (55.0%), dyspnea (45.3%), muscular pain (51%), associated with a lower odds rating general health (41.5%, OR 0.093 [95% CI: 0.026, 0.329], p = 0.0002), quality of life (39.8%; OR 0.116 [95% CI: 0.038, 0.364], p = 0.0002), physical health (38.7%, OR 0.055 [95% CI: 0.016, 0.193], p <0.0001), mental health (43.7%, OR 0.093 [95% CI: 0.021, 0.418], p = 0.0019) and social active role (38.7%, OR 0.095 [95% CI: 0.031, 0.291], p<0.0001), as very good/excellent, particularly adults aged 65 to 75 years (OR 8·666 [95% CI: 2·216, 33·884], p = 0·0019). CONCLUSIONS: COVID-19 symptoms commonly persist to 35 days, impacting quality of life, health, physical and mental function. Early post-acute evaluation of symptoms and their impact on function is necessary to plan community-based services.

Simultaneous Treatment of Epilepsy and Secondary Dystonia After Anterior Temporal Lobectomy and Amygdalohippocampectomy.

BACKGROUND: The relationship between temporal lobe epilepsy and focal limb dystonia is a well-recognized phenomenon, yet its pathogenesis and anatomic foundation are not well understood. Here, we describe 2 patients with refractory focal epilepsy and contralateral focal limb dystonia whose seizures and dystonic symptoms simultaneously resolved after anterior temporal lobectomy and amygdalohippocampectomy. CASE DESCRIPTION: We identified 2 patients within the Mount Sinai Health system with improvement in dystonia after medial temporal lobectomy. Retrospective chart reviews for the clinical history were performed. Patient 1 suffered a traumatic injury of the right temporal lobe, developing left hemidystonia and epilepsy. He received a right amygdala-hippocampectomy, which resolved both. Patient 2 has a history of right temporal glioma resection complicated by an infarct, resulting in left hemidystonia and epilepsy. He received a right medial temporal resection, which nearly resolved both. CONCLUSION: Our cases demonstrate a medial temporal-basal ganglia network dysfunction in dystonia-epilepsy that was modulated and cured by resective surgery. We hypothesize that the mechanisms behind these observed phenomena were due to a pathologic connectivity of the basal ganglia and amygdala-hippocampus. To our knowledge, these are the first reported cases of dystonia and concomitant epilepsy resolving with temporal lobectomy and provide valuable prognostic information for similarly affected patients.