The COVIVAX study assessed the association between COVID-19 vaccination and the risk of common neurological disorders in a multicenter case-control design. Vaccination exposure was compared between individuals with a first diagnosis of a neurological disorder (cases) and age- and sex-matched controls. A total of 624 participants were enrolled, and after random 1:1 matching 265 cases and 265 matched controls (total 530 participants) were included in the analyses. The most frequent neurological diagnosis in cases were stroke (60.4%), multiple sclerosis (11.3%) and seizures (6.4%). The proportion of vaccinated participants was 72.1% among cases and 79.6% among controls. A protective role of vaccination on the risk of developing a new neurological disorder was detected in the unadjusted analysis (OR 0.50; 95% CI 0.29–0.86; p = 0.0114). After adjustment for confounders, the number of vaccination doses received was associated with a reduced risk of developing new neurological disorders for participants aged over 60 years ( p = 0.0472; OR 0.14, 95% CI 0.03–0.68), with pre-existing comorbidities (p = 0.0122; OR 0.04, 95% CI 0.01–0.99) and for stroke (p = 0.0232; OR 0.04, 95% CI 0.02–0.97). The COVIVAX study provided no warning sign regarding an increase in the risk of developing new neurological disorders following COVID-19 vaccination of any type or doses. A potentially protective effect of multiple doses of COVID-19 vaccines against the risk of stroke in people aged over 60 needs to be confirmed by further studies.

OBJECTIVE:The STANDLOW trial investigated whether first-line antiseizure monotherapy with low doses has a similar efficacy to standard doses, but with fewer adverse events, improved quality of life, and reduced costs for the National Health System. METHODS:Multicenter, randomized, parallel-arm, single-blind, non-inferiority trial, comparing low dose versus standard dose of antiseizure medications (carbamazepine, levetiracetam, valproate, zonisamide, oxcarbazepine, topiramate, lamotrigine, gabapentin, lacosamide) in adults with newly diagnosed focal epilepsy. RESULTS:The intention-to-treat (ITT) population consisted of 58 randomized patients, 29 in the low dose arm and 29 in the standard dose arm, 27 (46.6%) females and 31 (53.4%) males, with an age between 18 and 87 years (median 54.9, IQR 32-71). The seizure type was focal impaired awareness seizures in 44 (75.9%) and focal aware seizures in 14 (24.1%). Etiology was unknown in 43 (74.1%) and structural in 15 (25.9%). At study entry, EEG was epileptiform in 28 (48.2%) and seizure frequency was low (≤2 seizures/month) in 41 (70.7%). The estimated relapse proportions at 12 months were 47% for the low dose and 48% for the standard dose, with a difference of 1% (95% CI: -30%; 27%). At the end of the study visit (12 months of follow-up, or immediately after seizure relapse or study withdrawal for other reasons, whichever came first), no differences in the number or severity of adverse events or quality of life measures were observed between the two treatment groups. The total drug-related costs over the entire study period were lower in the low dose arm (median per participant 253 € versus 475 € in the standard dose arm). SIGNIFICANCE:Although the efficacy of low doses versus standard doses appeared similar, non-inferiority could not be demonstrated due to slow recruitment and premature termination of the trial. Although statistically inconclusive, our findings suggest that a low dose of antiseizure medications may be considered as a first-line option in adult patients with a new diagnosis of focal epilepsy of unknown etiology and low seizure frequency. PLAIN LANGUAGE SUMMARY:This study aimed to see if low doses of anti-seizure medications (ASMs) could be as effective as standard doses in treating adults with newly diagnosed epilepsy. Subjects were assigned to receive either a low or standard dose of ASMs. 58 adults participated. Both low and standard doses seemed to have a similar effect on controlling seizures. The study was stopped early due to slow enrollment, making it difficult to definitively prove that low doses were non-inferior to standard doses. Low doses of ASMs might be a reasonable option for adults with newly diagnosed epilepsy with no clear cause and few seizures.

The COVIVAX study investigated the attributable risk of common neurological disorders in previously neurologically-healthy persons exposed to COVID-19 vaccines. In a multicenter, case-control study, the proportions of individuals with a first diagnosis of a neurological disorder (cases) and controls were compared in vaccinated versus unvaccinated participants. A total of 624 participants were enrolled. The most frequent neurological diagnosis in cases were stroke (60.4%), multiple sclerosis (11.3%) and seizures (6.4%). The risk of developing a new neurological disorder was reduced in vaccinated participants, compared to unvaccinated ones (OR 0.50; 95% CI 0.29–0.86; p = 0.0114). The number of doses received was associated with a reduced risk of developing new neurological disorders for participants aged over 60 years ( p = 0.0472; OR 0.14, 95% CI 0.03–0.68), with pre-existing comorbidities (p = 0.0122; OR 0.04, 95% CI 0.01–0.99) and for stroke (p = 0.0232; OR 0.04, 95% CI 0.02–0.97). The COVIVAX study provided no warning sign regarding the risk of developing new neurological disorders following COVID-19 vaccination of any type or doses. A potentially protective effect of multiple doses of COVID-19 vaccines against the risk of stroke in people aged over 60 needs to be confirmed by further studies.

OBJECTIVE:In Eastern European countries, suicide rate are among the highest in the world and suicide attempts are among the most important risk factors. The aim of this study is to identify factors associated with suicide attempt (SA) in non-psychotic patients with suicidal ideation (SI). METHODS:Among 6204 consecutive adult patients (residents of Moscow) with non-psychotic mental disorders (NPMD), 361 individuals aged 18-77 years (median 24 years) were enrolled in the study after screening for lifetime SI with the Self-Injurious Thoughts and Behaviors Interview (SITBI). All participants were assessed for sociodemographic variables, psychiatric diagnosis, family history of mental disorders, history of abuse, sexual behavior, psychiatric treatments, suicide plan, SA, and nonsuicidal self-injury (NSSI). Results of multivariable analyses (MV) are presented as odds ratios (OR) with 95% confidence intervals (CI). RESULTS:166 patients (46%) reported lifetime SA. In MV, variables associated with SA included smoking (OR 2.1; 95% CI 1.2-3.7), having made a suicide plan (OR 3.4; 95% CI 2.0-5.7), and scars covered by tattoos (OR 5.2; 95% CI 1.5-17.9). History of law violation (OR 2.0; 95% 1.0-4.2) was of borderline significance. CONCLUSIONS:Transition from SI to SA in patients with NPMD was associated with smoking, suicide planning, history of law violation and presence of tattoos covering scars.

Background Neurological manifestations frequently occur in individuals with COVID-19, manifesting during the acute phase, persisting beyond the resolution of acute symptoms, and appearing days or weeks after the initial onset of COVID-19 symptoms. However, predicting the incidence, course, and outcome of these neurological manifestations at the individual patient level remains challenging. Biases in study design and limitations in data collection may contribute to the inconsistency and limited validity of the reported findings. Herein, we focused on critically appraising pitfalls and biases of prior reports and provide guidance for improving the quality and standardization of future research. Review summary Patients with COVID-19 exhibit diverse demographic features, sociocultural backgrounds, lifestyle habits, and comorbidities, all of which can influence the severity and progression of the infection and its impact on other organ systems. Overlooked or undocumented comorbidities and related treatments may contribute to neurological sequelae, which may not solely be attributable to COVID-19. It is crucial to consider the potential side effects of vaccines in relation to neurological manifestations. Conclusion To investigate neurological manifestations of COVID-19, it is essential to employ valid and reliable diagnostic criteria and standard definitions of the factors of interest. Although population-based studies are lacking, well-defined inception cohorts, including hospitalized individuals, outpatients, and community residents, can serve as valuable compromises. These cohorts should be evaluated for the presence of common comorbidities, alongside documenting the primary non-neurological manifestations of the infectious disease. Lastly, patients with COVID-19 should be followed beyond the acute phase to assess the persistence, duration, and severity of neurological symptoms, signs, or diseases.

BACKGROUND AND OBJECTIVES:A variety of neurologic disorders have been reported as presentations or complications of coronavirus disease 2019 (COVID-19) infection. The objective of this study was to determine their incidence dynamics and long-term functional outcome. METHODS:The Neuro-COVID Italy study was a multicenter, observational, cohort study with ambispective recruitment and prospective follow-up. Consecutive hospitalized patients presenting new neurologic disorders associated with COVID-19 infection (neuro-COVID), independently from respiratory severity, were systematically screened and actively recruited by neurology specialists in 38 centers in Italy and the Republic of San Marino. The primary outcomes were incidence of neuro-COVID cases during the first 70 weeks of the pandemic (March 2020-June 2021) and long-term functional outcome at 6 months, categorized as full recovery, mild symptoms, disabling symptoms, or death. RESULTS:Among 52,759 hospitalized patients with COVID-19, 1,865 patients presenting 2,881 new neurologic disorders associated with COVID-19 infection (neuro-COVID) were recruited. The incidence of neuro-COVID cases significantly declined over time, comparing the first 3 pandemic waves (8.4%, 95% CI 7.9-8.9; 5.0%, 95% CI 4.7-5.3; 3.3%, 95% CI 3.0-3.6, respectively; p = 0.027). The most frequent neurologic disorders were acute encephalopathy (25.2%), hyposmia-hypogeusia (20.2%), acute ischemic stroke (18.4%), and cognitive impairment (13.7%). The onset of neurologic disorders was more common in the prodromic phase (44.3%) or during the acute respiratory illness (40.9%), except for cognitive impairment whose onset prevailed during recovery (48.4%). A good functional outcome was achieved by most patients with neuro-COVID (64.6%) during follow-up (median 6.7 months), and the proportion of good outcome increased throughout the study period (r = 0.29, 95% CI 0.05-0.50; p = 0.019). Mild residual symptoms were frequently reported (28.1%) while disabling symptoms were common only in stroke survivors (47.6%). DISCUSSION:Incidence of COVID-associated neurologic disorders decreased during the prevaccination phase of the pandemic. Long-term functional outcome was favorable in most neuro-COVID disorders, although mild symptoms commonly lasted more than 6 months after infection.

The authors regret that the co-authors which are members of the Global NeuroResearch Coalition have erroneously not been listed in the main body of the article, but the supplement. The collaborators of the Global NeuroResearch Coalition and co-authors for the purpose of this study include the survey respondents: Maritoni Abbariao, Shafiq Dexter Abou Zaki, Dejan Aleksic, Nicole Aliling, Susana Arias Rivas, Godard Artajos, Melody Asukile, Arife Çimen Atalar, Jong Seok Bae, Chimeglkham Banzrai, Michal Bar, Valentina Barone, Betul Baykan, Ettore Beghi, Thomas Berger, Ivica Bilic, Jose Biller, Mateja Boskovic, Verónica Cabreira, Sofia Calado, Maria Teresa Canete, Nese Celebisoy, Ike Leon Chen, Lorraine Chishimba, Mashina Chomba, Glenn Anthony Constantino, Maria Sofia Cotelli, Harald De Cauwer, Thomas Debroucker, Luis Del Carpio Orantes, Rashmi Devaraj, Michelle D'Souza, Esme Ekizoglu, Ayse Deniz Elmali, Ana Catarina Fonseca, Roberto Furloni, Sunil Gajre, David Garcia Azorin, Vanessa Garfoot, Irena Gasparic, Hamit Genç, Marinka Glavica, Luiz Gustavo Guanaes, Gizem Gürsoy, Nauman Hafiz, Buse Hasırcı, Raimund Helbok, Chee Peng Hor, Stella Hughes, Sungeun Hwang, Irem Ilgezdi Kaya, Adi Jakupi, Roland Dominic Jamora, Jamil Kahwagi, Ara Kaprelyan, Nfwama Kawatu, Manho Kim, Hyunji Kim, Hyun Kyung Kim, Desmond Koffie, Filipa Ladeira, Suzannah Lant, Woo-Jin Lee, Sukyoon Lee, Zerlyn Leonardo, Christian Emmanuel Lim, Marijana Lisak, Hong Chuan Loh, Lay Khoon Loo, Arijana Lovrencic Huzjan, Rosie Sue Luan Lu Koh, Mesu'a Kabwa Luabeya, Alessandra Lugaresi, Bernadette Macrohon, Maja Majdak, Sheryl Manalili, Filippo Manelli, Yacouba Njankouo Mapoure, Davide Mascarella, João Massano, Mataa Mataa, Jessica Leika Matibag, Alexandria Matic-Gerodias, Kate McMullen, Miguel Miranda, Margaret Modequillo, Abul Kalam Mohammed Shoab, Cristina Motto, Sinead M. Murphy, Naluca Mwendaweli, Chen Fei Ng, Rong Xiang Ng, Mohd Khairul Nizam Nor Ihsan, Aye Myat Nyein, Karen O'Connell, Seong-il Oh, Ohnmar Ohnmar, Aynur Özge, Azalea Pajo, Filipe Palavra, Larysa Panteleienko, Catherine Payne, Umberto Pensato, João Peres, Steven Peters, Burcu Polat, Zdravka Poljakovic, Martin Nicholas Michael Punter, Liz Edenberg Quiles, Angelo Ranieri, Marija Ratković, Maria Lina Renales, Jose Robles, Marina Roje Bedeković, Paulus Rommer, Lidija Šapina, Helena Sarac, Deanna Saylor, Erich Schmutzhard, Anahita Sharma, Aleksandra Šimić, Jussi O.T. Sipilä, Dilraj Sokhi, Mauro Stagno, Kristina Stancheva, Marija Stojsavljević, Ahamed Subir, Sushee Surdhar, Loreto Jr. Talabucon, Hui Jan Tan, Sing Chiek Teoh, Dionis Vallejo, Sibel K. Velioglu, Rafaela Vukasović, Wong Wai Kit, Tamara Welte, Barbara Willekens, Nilufer Yesilot, Nilufer Yesilot, Jeryl Ritzi T. Yu, Moe Moe Zaw, Sashka Zhelyazkova, Eva Žitnik. The authors would like to apologise for any inconvenience caused. Global uncertainty in the diagnosis of neurological complications of SARS-CoV-2 infection by both neurologists and non-neurologists: An international inter-observer variability studyJournal of the Neurological SciencesVol. 449PreviewUniform case definitions are required to ensure harmonised reporting of neurological syndromes associated with SARS-CoV-2. Moreover, it is unclear how clinicians perceive the relative importance of SARS-CoV-2 in neurological syndromes, which risks under- or over-reporting. Full-Text PDF

BACKGROUND:The aim of this study was to investigate the frequency and characteristics of pediatric epilepsy in the geographic isolate of Sardinia island and to calculate the prevalence of active epilepsy. METHODS:The study was retrospective, observational and involved a systematic review of medical records and computerized archives containing all clinical and EEG recordings of patients with epilepsy referred to the regional structures that could have followed patients with epilepsy in South Sardinia, during the period 2003-2021. RESULTS:The study population included 112,912 children and adolescents (age ≤ 18 years). 618 children and adolescents (women 42.4 %) were identified. Family history of epilepsy was reported in 153 (26.1 %). Etiology was genetic in 64.5 % and structural in 26.7 % subjects. Focal seizures were reported in 51.6 % of subjects, followed by 34.7 % with generalized seizures and 10.6 % of patients experienced both type of seizures. A total of 301 subjects with active epilepsy in 2019 were identified resulting in a prevalence of 2.67 per 1000 (95 % CI 2.37-2.97). Prevalence in the age class 5-14 years was 4.21 per 1000 (95 % CI 3.72-4.76). CONCLUSION:Compared to the previous studies in distinct geographic isolates, the present study showed a significantly low prevalence rate of active epilepsy; a high percentage of focal seizures and genetic etiology.

Introduction: Uniform case definitions are required to ensure harmonised reporting of neurological syndromes associated with SARS-CoV-2. Moreover, it is unclear how clinicians perceive the relative importance of SARSCoV-2 in neurological syndromes, which risks under- or over-reporting. Methods: We invited clinicians through global networks, including the World Federation of Neurology, to assess ten anonymised vignettes of SARS-CoV-2 neurological syndromes. Using standardised case definitions, clinicians assigned a diagnosis and ranked association with SARS-CoV-2. We compared diagnostic accuracy and assigned association ranks between different settings and specialties and calculated inter-rater agreement for case definitions as "poor" (kappa <= 0.4), "moderate" or "good" (kappa > 0.6). Results: 1265 diagnoses were assigned by 146 participants from 45 countries on six continents. The highest correct proportion were cerebral venous sinus thrombosis (CVST, 95.8%), Guillain-Barre ' syndrome (GBS, 92.4%) and headache (91.6%) and the lowest encephalitis (72.8%), psychosis (53.8%) and encephalopathy (43.2%). Diagnostic accuracy was similar between neurologists and non-neurologists (median score 8 vs. 7/10, p = 0.1). settings with few neurologists. However, encephalopathy, encephalitis, and psychosis were often misdiagnosed,

Sudden unexpected death in epilepsy (SUDEP) is a sudden, unexpected, witnessed or unwitnessed, non-traumatic and non-drowning death, occurring in benign circumstances, in an individual with epilepsy, with or without evidence for a seizure and excluding documented status epilepticus in which postmortem examination does not reveal other causes of death. Lower diagnostic levels are assigned when cases met most or all of these criteria, but data suggested more than one possible cause of death. The incidence of SUDEP ranged from 0.09 to 2.4 per 1000 person-years. Differences can be attributed to the age of the study populations (with peaks in the 20-40-year age group) and the severity of the disease. Young age, disease severity (in particular, a history of generalized TCS), having symptomatic epilepsy, and the response to antiseizure medications (ASMs) are possible independent predictors of SUDEP. The pathophysiological mechanisms are not fully known due to the limited data available and because SUDEP is not always witnessed and has been electrophysiologically monitored only in a few cases with simultaneous assessment of respiratory, cardiac, and brain activity. The pathophysiological basis of SUDEP may vary according to different circumstances that make that particular seizure, in that specific moment and in that patient, a fatal event. The main hypothesized mechanisms, which could contribute to a cascade of events, are cardiac dysfunction (included potential effects of ASMs, genetically determined channelopathies, acquired heart diseases), respiratory dysfunction (included postictal arousal deficit for the respiratory mechanism, acquired respiratory diseases), neuromodulator dysfunction, postictal EEG depression and genetic factors.

The infectious disease phenotype of acute stroke associated with COVID-19 has been poorly characterized. We investigated the neurovascular and infectious disease phenotype of stroke patients with and without COVID-19 infection, and their effect on in-hospital mortality. This is a retrospective cohort study of consecutive patients with acute stroke, admitted to any ward of a hub hospital for stroke in Lombardy, Italy, during the first wave of COVID-19. Demographic, neurovascular, infectious disease, and respiratory characteristics were collected. The effect of clinical variables on survival was evaluated using logistic regression models. One hundred thirty-seven patients with acute stroke were recruited; 30 (21.9%) patients had COVID-19 and represented 2.5% of the 1218 COVID-19 patients hospitalized in the study period. Demographics, comorbidities, stroke type, stroke severity, and etiology did not differ between COVID + stroke patients and non-COVID stroke patients, except for an excess of multi-embolic ischemic stroke in the COVID + group. Most COVID + stroke patients had symptomatic infection (60%) and interstitial pneumonia (70%). COVID + stroke patients required more frequently respiratory support (77% versus 29%; p < 0.0001) and had higher in-hospital mortality (40% versus 12%; p = 0.0005) than non-COVID stroke patients. Mortality was independently associated with symptomatic interstitial pneumonia (aOR 6.7; 95% CI 2.0–22.5; p = 0.002) and, to a lesser extent, with NIHSS on admission (aOR 1.1; 95% CI 1.03–1.2; p = 0.007) and recanalization therapies (aOR 0.2; 95% CI 0.04–0.98; p = 0.046). Symptomatic interstitial pneumonia was the major driver of in-hospital mortality in COVID + stroke patients.

The epidemiology of coma is unknown because case ascertainment with traditional methods is difficult. Here, we used crowdsourcing methodology to estimate the incidence and prevalence of coma in the UK and the USA. We recruited UK and US laypeople (aged >= 18 years) who were nationally representative (i.e. matched for age, gender and ethnicity according to census data) of the UK and the USA, respectively, utilizing a crowdsourcing platform. We provided a description of coma and asked survey participants if they-'right now' or 'within the last year'-had a family member in coma. These participants (UK n = 994, USA n= 977) provided data on 30 387 family members (UK n = 14 124, USA n = 16 263). We found more coma cases in the USA (n = 47) than in the UK (n = 20; P = 0.009). We identified one coma case in the UK (0.007%, 95% confidence interval 0.00-0.04%) on the day of the survey and 19 new coma cases (0.13%, 95% confidence interval 0.08-0.21%) within the preceding year, resulting in an annual incidence of 135/100 000 (95% confidence interval 81-210) and a point prevalence of 7 cases per 100 000 population (95% confidence interval 0.18-39.44) in the UK. We identified five cases in the USA (0.031%, 95% confidence interval 0.01-0.07%) on the day of the survey and 42 new cases (0.26%, 95% confidence interval 0.19-0.35%) within the preceding year, resulting in an annual incidence of 258/100 000 (95% confidence interval 186-349) and a point prevalence of 31 cases per 100 000 population (95% confidence interval 9.98-71.73) in the USA. The five most common causes were stroke, medically induced coma, COVID-19, traumatic brain injury and cardiac arrest. To summarize, for the first time, we report incidence and prevalence estimates for coma across diagnosis types and settings in the UK and the USA using crowdsourcing methods. Coma may be more prevalent in the USA than in the UK, which requires further investigation. These data are urgently needed to expand the public health perspective on coma and disorders of consciousness.

The current study, conceived with the contribution of the Commission for Epilepsy Surgery of the Italian League Against Epilepsy (LICE) and the Epilepsy Study Group of the Italian Neurological Society (SIN), aimed to assess potential physician-related barriers to refer subjects for epilepsy surgery. All the members of SIN and LICE were invited by email to complete a 28-item online questionnaire. The survey items included: (1) individual and medical practice characteristics, (2) knowledge of current indications to select candidates for epilepsy surgery, (3) factors potentially affecting the attitude toward epilepsy surgery. Overall, 210 physicians completed the survey. More than half (63.3%) of the participants showed proper knowledge of the ILAE drug-resistance. Definition and almost two-thirds of them (71.9%) considered themselves adequately informed about indications, risks, and benefits of epilepsy surgery. Surgery was regarded as a valid option to be used as early as possible by 84.8% of the interviewees, and 71% of them estimated its complication rate to be low. However, more than half (63%) of the respondents reportedly referred patients for surgery only after the failure of 3-5 antiseizure medications. Overestimation of risks/complications of surgery and inadequate healthcare resources were identified as the main factor contrasting the patient referral for surgery by 43% and 40.5% of the participants, respectively. In conclusion, this survey confirms the existence of knowledge gap within both physicians and the healthcare system, as well as an educational need regarding epilepsy surgery. Further researches are warranted to define learning outcomes and optimize educational tools.

Objective: Data on and increase of the incidence of amyotrophic lateral sclerosis (ALS) are conflicting and reflect the use of differing populations and designs. We investigated the incidence of ALS using data from a large population-based registry (SLALOM) in two three-year periods using the same diagnostic criteria and equal methods of case ascertainment. Methods: The registry is based in Lombardy, a 10 million population area of Northern Italy. Using different sources of cases (hospital discharge and ambulatory records, regional claims and prescription records) from nine Lombardy provinces (population, 5,485,163), all patients with newly diagnosed ALS during the periods 1998-2000 and 2008-2010 were included. Results: A total of 235 and 440 newly diagnosed patients were traced during the two study periods. The corresponding incidence rates were, respectively, 1.61 and 2.72 per 100,000 person-years. Data varied with age, sex and province by a significant increase was found only in men aged 65 through 74 years. Conclusions: Based on our findings, the increased incidence of ALS with time is real and can be largely interpreted as a reflection of the advancing age of the general population.

BACKGROUND AND PURPOSE:The aim of this study was to assess the neurological complications of SARS-CoV-2 infection and compare phenotypes and outcomes in infected patients with and without selected neurological manifestations.METHODS:The data source was a registry established by the European Academy of Neurology during the first wave of the COVID-19 pandemic. Neurologists collected data on patients with COVID-19 seen as in- and outpatients and in emergency rooms in 23 European and seven non-European countries. Prospective and retrospective data included patient demographics, lifestyle habits, comorbidities, main COVID-19 complications, hospital and intensive care unit admissions, diagnostic tests, and outcome. Acute/subacute selected neurological manifestations in patients with COVID-19 were analysed, comparing individuals with and without each condition for several risk factors.RESULTS:By July 31, 2021, 1523 patients (758 men, 756 women, and nine intersex/unknown, aged 16-101 years) were registered. Neurological manifestations were diagnosed in 1213 infected patients (79.6%). At study entry, 978 patients (64.2%) had one or more chronic general or neurological comorbidities. Predominant acute/subacute neurological manifestations were cognitive dysfunction (N = 449, 29.5%), stroke (N = 392, 25.7%), sleep-wake disturbances (N = 250, 16.4%), dysautonomia (N = 224, 14.7%), peripheral neuropathy (N = 145, 9.5%), movement disorders (N = 142, 9.3%), ataxia (N = 134, 8.8%), and seizures (N = 126, 8.3%). These manifestations tended to differ with regard to age, general and neurological comorbidities, infection severity and non-neurological manifestations, extent of association with other acute/subacute neurological manifestations, and outcome.CONCLUSIONS:Patients with COVID-19 and neurological manifestations present with distinct phenotypes. Differences in age, general and neurological comorbidities, and infection severity characterize the various neurological manifestations of COVID-19.

ObjectiveTo identify the rates of neurological events following administration of mRNA (Pfizer, Moderna) or adenovirus vector (Janssen) vaccines in the U.S.MethodsWe used publicly available data from the U.S. Vaccine Adverse Event Reporting System (VAERS) collected between January 1, 2021 and June 14, 2021. All free text symptoms that were reported within 42 days of vaccine administration were manually reviewed and grouped into 36 individual neurological diagnostic categories. Post‐vaccination neurological event rates were compared between vaccine types and to age‐matched baseline incidence rates in the U.S. and rates of neurological events following COVID.ResultsOf 306,907,697 COVID vaccine doses administered during the study timeframe, 314,610 (0.1%) people reported any adverse event and 105,214 (0.03%) reported neurological adverse events in a median of 1 day (IQR0‐3) from inoculation. Guillain‐Barre Syndrome (GBS), and cerebral venous thrombosis (CVT) occurred in fewer than 1 per 1,000,000 doses. Significantly more neurological adverse events were reported following Janssen (Ad26.COV2.S) vaccination compared to either Pfizer‐BioNtech (BNT162b2) or Moderna (mRNA‐1,273; 0.15% vs 0.03% vs 0.03% of doses, respectively, p < 0.0001). The observed‐to‐expected ratios for GBS, CVT and seizure following Janssen vaccination were ≥1.5‐fold higher than background rates. However, the rate of neurological events after acute SARS‐CoV‐2 infection was up to 617‐fold higher than after COVID vaccination.InterpretationReports of serious neurological events following COVID vaccination are rare. GBS, CVT and seizure may occur at higher than background rates following Janssen vaccination. Despite this, rates of neurological complications following acute SARS‐CoV‐2 infection are up to 617‐fold higher than after COVID vaccination. ANN NEUROL 2022;91:756–771