BENIGN PARTIAL ROLANDIC EPILEPSY FOLLOWING SARS-COV-2 INFECTION AND NEUROCOVID-19 EXPERIENCE: A CASE STUDY

Abstract

Early evidence described by a number of scholars worldwide suggests that neuroCOVID-19 has both mild [e.g. loss of smell (anosmia), loss of taste (ageusia), neurological tics (heterophilia), visual disturbances, headaches, dizziness, disorientation] and more severe sequelae (e.g. cognitive impairment, seizures, delirium, psychosis, strokes). Long-term neurological problems or neurological deficits may also occur. The aim of this study was to describe the examination and neurotherapy of a boy following SARS-CoV-2 infection and NeuroCOVID-19 in whom neurological tics and motor automatisms as well as cognitive impairment, particularly attention deficit disorder, developed as a consequence. We present a boy K.S., 7 years old, without any neurodevelopmental disorders, following a SARS-CoV-2 infection in May 2021 and the contraction of neuroCOVID-19 confirmed by a genetic test for the quantitative detection of neutralising antibodies (responsible for immunity) in the IgG class against SARS-CoV-2. The boy had relatively mild pseudomonal symptoms of the illness: temperature 38.5, runny nose, cough, muscle aches, headaches and general weakness. He was treated symptomatically and recovered after 2 weeks. Two months later, at the beginning of July 2021, neurological tics consisting of an upward turning of the eyeballs to the left appeared. These tics intensified in August 2021 and were accompanied by motor automatisms consisting of the left hand stiffening in a salute-like position, while at the same time there was an inclination of the head to the left. In September 2021, after exertion in the swimming pool, an epileptic seizure occurred which caused the boy to start drowning. In the days that followed the above described tics and motor automatisms increased. He also developed sleep disorders, which consisted of him waking up several times during the night, during which time neurological tics and motor automatisms also appeared. Gradually, cognitive dysfunctions, especially attention deficits and behavioural changes, joined in, making it impossible for the boy to function independently at school and in many situations of daily life. Neurophysiological examination: qEEG, ERPs and sLORETA tomography performed on 11.09. 2021 using automatic seizure activity detection software showed the presence of the neuromarker benign partial rolandic epilepsy (BPERS) and neurocognitive disturbances resembling the symptoms of attention deficit hyperactivity disorder (ADHD), compared with the neuromarkers of children with this condition (n=100) from the normative database of the Human Brain Index (HBI) in Switzerland. Detection of the neuromarkerBPERS was helpful in selecting an individualised neurostimulation protocol. The patient participated in 20 neurofeedback sessions using (1) SMR reinforcement, theta inhibition; (2) theta inhibition, B1 reinforcement (15-18 Hz); (3) qEEG-guided neurofeedback. Neurostimulation with neurofeedback was conducted twice a week, for 15-20 minutes gradually increasing to 30-40 minutes per session. The patient also received individual goal-directed psychotherapy After successive sessions of neurofeedback, a gradual reduction neurological symptoms was observed. By the end of neurotherapy, neurological tics, motor automatisms, neurocognitive disorders and behavioural disturbances had completely disappeared. The patient functions well in school and achieves very good results. HBI methodology was helpful in finding functional neuromarkers of benign partial Rolandic epilepsy and disturbed cognitive control. Therefore, it was possible to offer more effective neurorehabilitation of the disorders, which contribute to a better quality of life for the patient.