Possibilities of Applying Non-invasive Multichannel Electrical

Stimulation Technology for Treatment Neuropsychiatric Disorders

Associated with Post COVID-19 Condition

Timur Petrenko

, Anna Petrenko

and Vladimir Kublanov

Ural Federal University, Yekaterinburg, Russian Federation

Keywords: Pandemic COVID-19, Post COVID-19 Condition, Telemetry, Physiotherapy Services,

Neuroelectrostimulator.

Abstract: The possibilities of using multichannel neuroelectrostimulation of nerve formations in the neck for the

treatment of neuropsychiatric disorders arising from the Post Covid-19 condition are considered. Three

clinical cases of the use of such technology, implemented in the device "SYMPATHOCOR-01", are presented.

All patients were previously diagnosed with coronavirus infection of varying severity. The patients' condition

was assessed clinically and based on psychometric scales: depression - HDRS and BDI-II, anxiety - SPRAS,

asthenia - MFI-20. The duration of the disease was 4-6 months. The course of treatment was three weeks. All

patients showed marked positive clinical dynamics. The proposed methods of hardware treatment of Post

COVID-19 condition can be implemented in telemedicine projects for the provision of services in real time,

which minimizes the contact between doctor and patient, and undoubtedly may be in demand in the future

post-pandemic society.

1 INTRODUCTION

According to a WHO study, the COVID-19 pandemic

has increased the need for neurological and mental

health services: bereavement, isolation, loss of

income and fear of the future disrupt mental health

and exacerbate existing problems. High levels of

social stress push people towards substance and

alcohol abuse. Meanwhile, there is compelling

evidence that the coronavirus has neurotoxic effects,

leading to impaired perception, anxiety, asthenia,

depression. People with pre-existing mental, drug and

neurological disorders are more vulnerable to

coronavirus infection - they are at high risk of severe

outcomes and even death (WHO, 2020).

Under these conditions, there is a need for non-

invasive medical neurorehabilitation technologies

capable of restoring neuropsychiatric disorders

resulting from depression, stroke, brain and spinal

cord trauma, or progressive degenerative and

hereditary diseases.

https://orcid.org/0000-0001-7328-9894

https://orcid.org/0000-0001-5906-5755

https://orcid.org/0000-0001-6584-4544

Despite the successes of modern medical science,

the main method of treating neuropsychiatric

disorders is still the use of pharmacological drugs

(drugs, medicines). Not infrequently, this leads to

undesirable reactions, side effects and complications.

The treatment process in conditions of individual

sensitivity and tolerance of pharmacological agents

becomes difficult to control and poorly predictable.

In this regard, frequent clinical monitoring of the

patient's condition is required, requiring the doctor to

make frequent face-to-face visits, to assess various

physiological parameters, blood composition

parameters, etc. At each meeting, the doctor has to

solve the time-consuming task of adjusting the doses

of drugs, balancing their effectiveness and safety.

Physiotherapy services do not have many of the

above problems.

The paper discusses some of the possibilities of

using multichannel neuroelectrostimulation of the

nerve formations of the neck for the treatment of

anxiety, depressive and asthenic conditions arising

from Post COVID-19 condition (U09.9). The

332

Petrenko, T., Petrenko, A. and Kublanov, V.

Possibilities of Applying Non-invasive Multichannel Electrical Stimulation Technology for Treatment Neuropsychiatric Disorders Associated with Post COVID-19 Condition.

DOI: 10.5220/0011013800003123

In Proceedings of the 15th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2022) - Volume 1: BIODEVICES, pages 332-337

ISBN: 978-989-758-552-4; ISSN: 2184-4305

organization of services in real time will minimize the

contact between the doctor and the patient and, as a

result, the risks of the spread of COVID-19, while

maintaining the ability to effectively manage the

treatment process. The presented solutions are quite

in demand at the present time and undoubtedly may

be in demand in the future post-pandemic society.

(Palacín-Marín et al., 2013).

2 MATERIAL AND METHODS

The coronavirus is still poorly understood, but its

neurotropic (the ability to infect nerve cells) has been

proven - and it is higher than that of other viruses. It

has been established that the virus penetrates into the

nervous system through the blood-brain barrier, that

is, from any organs - into the brain; through blood

cells; transneurally (through peripheral nerves).

Accordingly, neurological disorders can manifest in

any part of the body (Bao et al., 2020).

Virtually all original published studies of

COVID-19 cases indicate that, in addition to impaired

respiratory function, a third of patients (30% -35%)

show signs of nervous system damage (Li et al.,

2020a). Nonspecific neurological complications in

COVID-19 are varied: headache, myalgia, fatigue,

weakness, nausea, vomiting, anorexia, confusion,

dizziness, malaise, shortness of breath (Rahman et al.,

2020). ACE2 receptors, which facilitate the

penetration of the virus into the cell, are expressed in

the neuronal centers of the medulla oblongata and

midbrain (Whittaker et al., 2020).

Specific neurological damage occurs due to the

direct damaging effect of the virus on the cells of the

nervous system. Represented by acute

cerebrovascular disorders, myelitis (spinal cord

lesions); polyneuropathy (damage to the peripheral

nervous system); imbalance is often detected;

convulsions. With damage to the central nervous

system, 30% –80% of patients with COVID-19

experience disturbances in taste, smell, vision

(Niazkar et al., 2020).

More and more works appear describing the long-

term consequences of the postponed coronavirus

infection in the form of psychological and

psychopathological disorders, which sometimes

transform into independent mental disorders.

According to various studies, patients with COVID-

19 show psychopathological symptoms for several

reasons: the presence of symptoms of coronavirus

infection and their progression; collateral

the effects of ongoing drug treatment; fear for

your life; fear of transmitting the virus to others;

social isolation and loneliness; feeling insecure and

insecure; physical discomfort; negative media

pressure (Talevi et al., 2020).

Up to 96.2% of clinically stable patients with

COVID-19 develop psychological problems and

symptoms of stress disorders, which leads to a

decrease in the quality of life and disrupts work

stability. A significant level of stress is observed

during the period of illness, especially in the older

population (Lai et al., 2020). One of the possible

mechanisms of psychological disorders during

infection with COVID-19 is an increased activation

of the hypothalamic-pituitary-adrenal axis. This leads

to the production of a large amount of stress

hormones that have a damaging effect on somatic and

nerve cells (Kang et al., 2020).

In the period from 2 to 12 months, 50% of those

who have undergone COVID-19 experience

depression, 55% - anxiety, about 70% -

psychosomatic symptoms; 67.92% of these same

patients suffered from insomnia, approximately 25%

had suicidal thoughts (Taquet et al., 2021).

Patients with pre-existing mental disorders

receive significantly less attention than is required

during a pandemic. In most cases, such patients

already have chronic somatic diseases, weakened

health, which makes them more susceptible to the

possibility of infection with SARS-CoV-2.

Psychiatric patients with COVID-19 have a less

pronounced effect of treatment and a high emotional

response to illness (Umapathi et al., 2021).

The approaches to the treatment of neurological,

mental and psychological disorders in patients who

have recovered from COVID-19 remain nonspecific.

Mainly used are neurometabolic drugs, vascular

drugs, antidepressants, and in rare cases,

antipsychotic drugs. It is known that all of these drugs

do not have high therapeutic efficacy against

neuropsychiatric disorders (Li et al., 2020b).

Scientists are constantly looking for alternative

methods of treatment for depressive and anxiety

disorders, chronic fatigue syndrome (resulting from

various diseases), insomnia, chronic headache, a

number of cerebrovascular diseases, vegetative-

vascular and vegetative-vestibular disorders.

Earlier, we proposed an alternative, non-drug

method of treating neuropsychic disorders, based on

the correction of the activity of the autonomic

nervous system. In the development of this method, it

is possible to influence a spatially distributed field of

current pulses in the projection of the cervical ganglia

of the sympathetic nervous system, the vagus nerve,

branches of the glossopharyngeal and hypoglossal

Possibilities of Applying Non-invasive Multichannel Electrical Stimulation Technology for Treatment Neuropsychiatric Disorders

Associated with Post COVID-19 Condition

333

nerves, and the carotid nerve plexus (Kublanov et al.,

2018).

The principles of organizing technical means for

stimulating the cervical ganglia of the sympathetic

division of the autonomic nervous system were

proposed in the early 90s of the last centuries and

implemented in the device "Corrector of the activity

of the sympathetic nervous system

SYMPATHOCOR-01". This device is structurally

made in the form of a Monoblock, consisting of two

multi-element electrodes (ME) and an electronic unit.

13 electrodes are placed on the cuff of each ME. The

appearance of the device and the layout of its

electrodes on the patient's neck during the treatment.

Between two MEs, a spatially distributed field of

monopolar positive current pulses is formed, the

vector of which is projected into the target area. The

developed method of medical application of the

device was named dynamic correction of the activity

of the autonomic nervous system (DCASNS)

(Kublanov et al., 2008).

The modern version of the "SYMPATHOCOR-

01" device is divided into two blocks, one of which

forms the physical fields, the second is engaged in the

control of the biotropic parameters of the field. The

exchange of information between them is provided

via wireless communication (Kublanov et al., 2021).

The radius of action between the blocks of the

neuroelectric stimulator is up to 10 m. The doctor and

the patient are within the social (physical) distance,

which is a measure to prevent the spread of the

coronavirus COVID-19 (Thu et al., 2020).

The second block is implemented as an original

cross-platform application for mobile devices based

on Android and iOS. At the same time, a virtual

control panel for the treatment process is formed,

which allows real-time monitoring of the battery

charge level, the health of the telemetric

communication channel, the structure of the field of

current pulses, their biotropic parameters and the

position of stimulation targets (Kublanov et al.,

2018).

The organization of services in real time will

minimize the contact between the doctor and the

patient and, as a result, the risks of the spread of

COVID-19, while maintaining the ability to

effectively manage the treatment process.

When implementing the neurorehabilitation

process, it is of great importance which of the

technologies will be used to control the effectiveness

of the treatment process. Observations of the state and

changes in the autonomic nervous system are of great

interest, since it is known that "there are practically

no such pathological forms in the development and

course of which the autonomic nervous system would

not play a role." At the same time, changes in heart

rate variability are an indicator of autonomic

disorders (Vein, 2000).

The device is effectively used in the treatment of

vegetative-vascular dystonia, migraine, headache,

tension pain, autonomic dysregulation syndrome,

headache, hyperhidrosis syndrome, orthostatic

hypotension syndrome and postural tachycardia,

neurosis-like syndromes and neuropathies of various

origins, vestibulopathy, tic disorders, hypertension,

sensorineural hearing loss, vasomotor rhinitis,

degenerative diseases of vision and atrophy of the

optic nerve, glaucoma, computer visual syndrome

and asthenopia, drug-resistant epilepsy, attention

deficit hyperactivity disorder, children with

psychosomatic disorders, panic attacks, anxiety

disorders, depressive disorder (Kublanov et al., 2004,

2014, 2016, 2019; Retyunskiy et al., 2017; Petrenko

et al., 2018, 2019).

This paper presents three separate clinical cases of

the treatment of patients with neuropsychiatric

disorders associated with COVID-19, which

corresponds to the code U09.9 (ICD-10). The

patients' condition was assessed by a psychiatrist

using a clinical method and psychometric scales: the

Hamilton Depression Rating Scale (HDRS)

(Hamilton, 1960), the Beck Depression Self-

Assessment Scale (BDI-II) (Powles, Beck, 1974), the

Sheehan scale for assessing Anxiety (SPRAS)

(Sheehan, 1983), Subjective Asthenia Rating Scale

(MFI-20) (Smets et al., 1995). In all cases, a

psychiatric disorder was diagnosed by a physician.

All patients gave written consent to treatment with an

innovative method and the provision of clinical data

in this article in anonymized form.

3 RESULTS

The following is a series of clinical cases using

DCASNS technology for the treatment of post

COVID syndrome.

Patient M, male, 28 years old. Diagnosis:

recurrent depressive disorder, current episode severe

(F33.2). He suffered COVID-19 in a mild form (self-

isolation at home). Patient turned to a psychiatrist for

help 6 months after recovery. The patient's anamnesis

revealed one depressive episode about 5 years ago.

The patient received treatment on an outpatient basis.

An antidepressant was used for 6 months with a

positive effect. More depressive episodes did not

occur, the patient did not use psychotropic drugs.

RMHM 2022 - Special Session on Remote Management and Health Monitoring

334

During the first visit, there were pronounced signs

of depression, which was externally manifested by

experiences of vital melancholy with an improvement

in well-being in the evening, noticeable motor

inhibition during the day, depression combined with

a slowdown in associative processes, up to subjective

thoughts of rapidly growing dementia. The content of

thoughts reflected anxiety about life's failures and

mistakes, feelings of guilt towards loved ones,

excessive concern for health. Suicidal thoughts were

steadfastly identified, with which they managed to

cope. Complaints - pronounced disturbances in short-

term sleep with late falling asleep, frequent

awakenings during sleep and early morning

awakening 2 hours earlier than usual. Assessment of

the severity of symptoms of depression: on the

Hamilton scale (HDRS) - 33 points, on the Beck scale

(BDI-II) - 54 points.

Conducted 10 sessions of neuroelectrostimulation

using DCASNS technology for 3 weeks. Significant

improvement was noted: mood was restored, strength

and motivation appeared, suicidal thoughts

disappeared, sleep was restored. The strength for

work has appeared. Assessment of the severity of

symptoms of depression: on the Hamilton scale

(HDRS) - 7 points, on the Beck scale (BDI-II) - 5

points.

One month after the end of treatment, the

condition remains stable. Additional funds, including

pharmaceuticals, were not used.

Patient B, female, 23 years old. Diagnosis: panic

disorder (F41.0). Has suffered a moderate form of

COVID-19 (hospitalization for three weeks; lung

damage on X-ray examination of 7%; mechanical

ventilation was not performed). Patient turned to a

psychiatrist for help 4 months after recovery.

Previously, the patient did not go to a psychiatrist.

At the first visit, Patient complained of a lowered

mood, frequent panic attacks (sudden attacks of

anxiety with a feeling of fear of death, tachycardia,

increased blood pressure). Patient was afraid to enter

the street, she was afraid in public places, she was

afraid to be without help. Patient stopped working as

felt a slowdown and disorganization of the thought

process. At home, Patient often experienced feelings

of melancholy and loneliness with feelings of self-

pity. Decreased appetite. Had trouble falling asleep

(fell asleep only with the lights on), frequent night

awakenings with panic attacks, lack of a sense of rest

after a night's sleep. Assessment of the severity of

symptoms of depression on the Hamilton scale

(HDRS) - 27 points. Severity of anxiety symptoms on

the Sheehan scale (SPRAS) - 75 points.

5 sessions of neuroelectrostimulation using

DCASNS technology were performed for one week.

The frequency and severity of panic attacks

decreased. Along with this, a worsening of nocturnal

sleep was noted - nocturnal awakenings became more

frequent. Another 10 sessions of

neuroelectrostimulation using DCASNS technology

were carried out for two weeks. There was a slight

improvement in the condition - the severity and

frequency of panic attacks decreased. Improved night

sleep, a feeling of rest after a night's sleep.

Assessment of the severity of symptoms of

depression on the Hamilton scale (HDRS) - 13 points.

Assessment of the severity of symptoms of anxiety on

the Sheehan scale (SPRAS) - 32 points.

One month after the end of treatment, there was a

complete cessation of panic attacks, an improvement

in mood, and a complete restoration of night sleep.

She returned to work. Additional funds, including

pharmaceuticals, were not used.

Patient D, male, 33 years old. Diagnosis: asthenic

disorder (R53). Transferred COVID-19 in a moderate

form (hospitalization for five weeks; lung damage by

X-ray examination of 22%; was on mechanical

ventilation for four days). Patient turned to a

psychiatrist for help 6 months after recovery.

Previously, the patient did not go to a psychiatrist.

At the first visit, Patient complains of pronounced

mood swings in the form of bouts of irritability and

exhaustion that quickly follows it. Signs of affective

lability with a predominantly low mood with features

of moodiness and displeasure, as well as tearfulness,

are revealed. Additionally, reports on recurrent

headaches, worsening in the evening. Also, notes a

pronounced decrease in performance, difficulty

concentrating, sleep disturbances (long period of

falling asleep, lack of a sense of rest after sleep).

Complains of a complete lack of strength.

Assessment of the severity of symptoms of

depression on the Hamilton scale (HDRS) - 17 points.

Assessment of the severity of asthenia symptoms

(MFI-20) - 67 points.

15 sessions of neuroelectrostimulation using

DCASNS technology were performed over three

weeks. There was a gradual improvement in well-

being during the treatment. The mood swings and

irritability disappeared, sleep improved, strength

appeared, the intensity and duration of headaches

decreased. Noted a subjective improvement in

memory and reaction speed. Assessment of the

severity of symptoms of depression on the Hamilton

scale (HDRS) - 6 points. Assessment of the severity

of asthenia symptoms (MFI-20) - 24 points.

Possibilities of Applying Non-invasive Multichannel Electrical Stimulation Technology for Treatment Neuropsychiatric Disorders

Associated with Post COVID-19 Condition

335

One month after the end of treatment, there were

no symptoms of asthenia, a normal night's sleep. He

returned to work. Additional funds, including

pharmacological preparations, were not used.

4 CONCLUSIONS

The article discusses the possibilities of using

multichannel neuroelectrostimulation of the nerve

formations of the neck for the treatment of some

neuropsychiatric disorders arising from the Post

Covid-19 condition.

The positive clinical dynamics as a result of

device exposure in all three considered clinical cases

is the result of many years of work on the study of the

effect of polyfactorial neurostimulation on the

structures of the autonomic and central nervous

system (Petrenko, 2020). As a result, the DCASNS

technique was developed and continues to be

improved for the treatment of neuropsychic diseases

similar to those presented.

An embodiment of a device with two units (a field

shaping unit and a field control unit) with a wireless

communication method between the units can be used

in telemedicine projects to provide services in real

time. Such implementation of the treatment process

minimizes the contact between the doctor and the

patient. Such technologies will undoubtedly be in

demand in the future post-pandemic society.

ACKNOWLEDGEMENTS

The reported study was funded by RFBR according

to the research project № 18-29-02052 and supported

by Act 211 Government of the Russian Federation,

contract № 02.A03.21.0006.

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