Reports are emerging at a rapid pace that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) affects the nervous system in various ways. Preliminary data from Wuhan, China, suggest that neurological manifestations are present in more than 30% of patients presenting with coronavirus disease 2019 (COVID-19).¹ Neurological features range from quite diffuse neurological signs and symptoms like headache, dizziness, reduced level of consciousness, confusion, diffuse corticospinal tract signs, and paraesthesia, to more specific manifestations, such as seizures, stroke, encephalitis, or meningoencephalitis, and myopathy.1, 2 To date, SARS-CoV-2 has not been detected in the neural tissue directly, although it has been isolated from the CSF of some patients.³ The hypothesis of neurotropism with subsequent neuronal injury, either directly or indirectly (through immune mechanisms), is supported by previous findings from other infections with severe acute respiratory syndrome CoV and Middle East respiratory syndrome CoV.³

Pre-existing cardiovascular or pulmonary disease and old age increase the chances of contracting SARS-CoV-2 infection and those risk factors are often present in patients with neurological disorders. Individuals with autoimmune diseases, such as multiple sclerosis, who require immunotherapy, might be at increased risk of SARS-CoV-2 infection and neurologists are in need of tailored recommendations for immunotherapy, relapse management, and delivery of care. Patients with Parkinson's disease have an increased risk for cardiovascular complications and can have multiple comorbidities, including cognitive impairment, depression, and psychosis, which can deteriorate during isolation.⁴ Also, many patients with cognitive impairment might not be able to follow infection prevention and control recommendations, thereby putting themselves and their caregivers at risk of contracting SARS-CoV-2. Additionally, very little is known about potential interaction between various medications for chronic neurological diseases and drug treatment for COVID-19.

Because the effects of SARS-CoV-2 on the nervous system are largely unknown, estimating the neurological morbidity that might occur from the acute phase of the pandemic is difficult. Also, whether patients might have long-term neurological or cognitive sequelae, or whether pre-existing neurological disease might deteriorate (eg, patients with mild cognitive impairment might have little cognitive reserve and develop dementia early) is unknown. Effects of coronavirus in children seem less severe and often the virus is present but children are asymptomatic. Asymptomatic children might still harbour the virus, with so far unknown effects on their health status later in life, including brain development. Additionally, once a vaccine becomes available, careful monitoring across age groups and disease spectra will be required to identify adverse effects and any deterioration of signs and symptoms in patients with neurological diseases. Overall, understanding is needed of whether susceptible groups exist who are at increased risk of deterioration after SARS-CoV-2 infection, how to detect them by use of biomarkers, and whether treatment needs to be specifically targeted in case of neurological signs and symptoms. Systems for clinical surveillance, epidemiological and clinical research, and post-mortem studies will be needed to achieve this aim.

The COVID-19 pandemic necessitates close collaboration on a global scale, with a special emphasis on inclusion of colleagues and partner institutions from low-income and middle-income countries. Inspired by the COVID-19 Clinical Research Coalition described recently in The Lancet,⁵ our proposal is to build on and link existing international neurology partnerships, such as the Brain Infections Global COVID-Neuro Network, that provides a network for interested clinicians, a daily update of all publications relating to neurological COVID-19 disease, and freely accessible downloads of case-record forms; the European Academy of Neurology COVID-19 registry; the Lean European Open Survey on SARS-CoV-2 Infected Patients endorsed by the German Neurological Society; and the activities of the World Federation of Neurology around COVID-19. Additionally, WHO can play an important part in building this coalition through identifying priorities and developing harmonised systems for neurological research. We are therefore launching a call for an inclusive and collaborative global COVID-19 Neuro Research Coalition co-created by the research communities around the world (panel ). In a first step, we will create a platform of exchange and communication. If you are interested in becoming part of this community, please register at the Center for Global Health, Department of Neurology, Technical University of Munich, Germany, by sending an email to covid19.neuro@med.tum.de.Panel

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To create a platform for global scientific exchange and networking

COVID-19=coronavirus disease 2019.