AUTHOR=Baptista Abrahão Fontes , Baltar Adriana , Okano Alexandre Hideki , Moreira Alexandre , Campos Ana Carolina Pinheiro , Fernandes Ana Mércia , Brunoni André Russowsky , Badran Bashar W. , Tanaka Clarice , de Andrade Daniel Ciampi , da Silva Machado Daniel Gomes , Morya Edgard , Trujillo Eduardo , Swami Jaiti K. , Camprodon Joan A. , Monte-Silva Katia , Sá Katia Nunes , Nunes Isadora , Goulardins Juliana Barbosa , Bikson Marom , Sudbrack-Oliveira Pedro , de Carvalho Priscila , Duarte-Moreira Rafael Jardim , Pagano Rosana Lima , Shinjo Samuel Katsuyuki , Zana Yossi 

TITLE=Applications of Non-invasive Neuromodulation for the Management of Disorders Related to COVID-19

JOURNAL=Frontiers in Neurology

VOLUME=11

YEAR=2020

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2020.573718

DOI=10.3389/fneur.2020.573718

ISSN=1664-2295

ABSTRACT=<p><bold>Background:</bold> Novel coronavirus disease (COVID-19) morbidity is not restricted to the respiratory system, but also affects the nervous system. Non-invasive neuromodulation may be useful in the treatment of the disorders associated with COVID-19.</p><p><bold>Objective:</bold> To describe the rationale and empirical basis of the use of non-invasive neuromodulation in the management of patients with COVID-10 and related disorders.</p><p><bold>Methods:</bold> We summarize COVID-19 pathophysiology with emphasis of direct neuroinvasiveness, neuroimmune response and inflammation, autonomic balance and neurological, musculoskeletal and neuropsychiatric sequela. This supports the development of a framework for advancing applications of non-invasive neuromodulation in the management COVID-19 and related disorders.</p><p><bold>Results:</bold> Non-invasive neuromodulation may manage disorders associated with COVID-19 through four pathways: (1) Direct infection mitigation through the stimulation of regions involved in the regulation of systemic anti-inflammatory responses and/or autonomic responses and prevention of neuroinflammation and recovery of respiration; (2) Amelioration of COVID-19 symptoms of musculoskeletal pain and systemic fatigue; (3) Augmenting cognitive and physical rehabilitation following critical illness; and (4) Treating outbreak-related mental distress including neurological and psychiatric disorders exacerbated by surrounding psychosocial stressors related to COVID-19. The selection of the appropriate techniques will depend on the identified target treatment pathway.</p><p><bold>Conclusion:</bold> COVID-19 infection results in a myriad of acute and chronic symptoms, both directly associated with respiratory distress (e.g., rehabilitation) or of yet-to-be-determined etiology (e.g., fatigue). Non-invasive neuromodulation is a toolbox of techniques that based on targeted pathways and empirical evidence (largely in non-COVID-19 patients) can be investigated in the management of patients with COVID-19.</p>