Neuroimmunology Reports<\/em><\/a> on November 25.<\/p>\n\n\n\nFocus on a Brain Area With Unique Properties<\/h2>\n\n\n\n
Executive functioning, working memory, and attention regulation are carried out by a recently evolved area in brain called the prefrontal cortex. Neural circuits in this region are \u201cremarkably vulnerable\u201d to inflammation and stress, says Arnsten, who has spent decades studying the circuits behind cognition.<\/p>\n\n\n\n
\u201cThe circuits that generate higher cognitive function have very special molecular needs because they\u2019re having to create neural activity without any sensory stimulation\u2014abstract thoughts and memories, for example,\u201d she says. \u201cThe neurons have to generate and sustain their own activity.\u201d Arnsten says inflammatory factors can interfere with these molecular needs and inhibit the circuits\u2019 ability to function. Hence, brain fog.<\/p>\n\n\n\n
Guanfacine, one of the two drugs tested in this trial, is designed to strengthen prefrontal cortex connections and protect against inflammation and stress. While originally developed to treat ADHD, it is being used to treat other conditions associated with prefrontal cortex dysfunction, and studies show that the drug is effective in restoring executive functioning and memory. NAC, the second medication, is a robust antioxidant and anti-inflammatory agent that can also be used to treat this neural region.<\/p>\n\n\n\n
Fesharaki-Zadeh is a clinical neuroscientist with special interests in traumatic brain injury and PTSD who has been treating his patients successfully with a combination of guanfacine and NAC for years. After encountering his first long COVID patient in June 2020, he became interested in using this regimen to treat the post-COVID brain fog.<\/p>\n\n\n\n
\u201cI had the idea of approaching the treatment from two different perspectives\u2014modifying the pro-inflammatory, pro-oxidation pathway with NAC, and treating the post-COVID neurocognitive sequelae impacting executive functioning with guanfacine,\u201d he says. \u201cWe wanted to attack this using a multi-model approach that took advantage of the synergistic relationship between NAC and guanfacine.\u201d<\/p>\n\n\n\n
Guanfacine and NAC Relieve Long COVID Brain Fog<\/h2>\n\n\n\n
Faced with his first long COVID case, Fesharaki-Zadeh recognized the overlap between the brain fog his patient was facing and symptoms in his post-concussive patients. So he started with NAC, which is commonly used to treat symptoms following concussions, and noticed partial benefits in energy and memory. Encouraged, he tried adding in guanfacine and saw even more improvement.<\/p>\n\n\n\n
Since then, Fesharaki-Zadeh has treated 12 patients experiencing post-COVID brain fog with this regimen. He instructed patients to take 1 mg of guanfacine at bedtime, and if well-tolerated, to increase the dosage to 2 mg after one month. Patients also took 600 mg of NAC once a day.<\/p>\n\n\n\n
Eight patients reported substantial benefits, including improved memory, organizational skills, and ability to multi-task. For some, the brain fog completely resolved, and they were able to resume their normal activities. Two patients were unavailable for follow up, and the other two discontinued the medication due to side effects including low blood pressure and dry mouth. Since then, the researchers have modified the regimen from an immediate-release form of guanfacine to an extended-release form, which reduces the risk of side effects.<\/p>\n\n\n\n
One patient in the cohort was a nurse who had become so debilitated that she had to significantly reduce her hours at work. Although she found relief with the treatment, she had to briefly stop due to dizzy episodes, and her cognitive deficits returned. When she resumed treatment, her brain fog once again lifted. She has not experienced any dizziness since.<\/p>\n\n\n\n
\u201cThis was not a placebo-controlled trial, but anecdotes like this make one more confident that the relief is really due to the drug and not the placebo effect,\u201d says Arnsten.<\/p>\n\n\n\n
\u201cShe needed to greatly reduce her working hours at a time when she was needed most,\u201d says Fesharaki-Zadeh. \u201cTreating her condition not only helps her, but also all of us.\u201d<\/p>\n\n\n\n
Hope for Long COVID Patients and Beyond<\/h2>\n\n\n\n
As one patient after another began reporting relief, Fesharaki-Zadeh grew excited. For most of his patients, this was the first time a treatment was successful in alleviating their brain fog.<\/p>\n\n\n\n
\u201cI was just struck by these younger folks who are being devastated by this disease that was continuing to persist,\u201d he says. \u201cAs a physician, in the beginning, I felt powerless. We feel urgency to get this case report out so that more patients could be treated.\u201d<\/p>\n\n\n\n
The researchers hope that their case study will lead to the funding of placebo-controlled clinical trials involving a larger cohort of patients undergoing this treatment. But long-haulers who are debilitated by their symptoms need treatment now. Fortunately, the researchers say, they can ask their physicians for a prescription for guanfacine, and NAC is available over the counter.<\/p>\n\n\n\n
\u201cIf patients have a physician who can read our paper, we\u2019re hoping that they can access help right now,\u201d says Arnsten.<\/p>\n\n\n\n
The researchers also hope that this regimen can be helpful in other groups of patients. Long-COVID is not the only post-viral syndrome to cause brain fog\u2014patients with conditions including post-Lyme and myalgic encephalomyelitis\/chronic fatigue syndrome (ME\/CFS), for example, can also experience debilitating cognitive deficits. Indeed, Fesharaki-Zadeh has already seen promising results while treating one post-Lyme patient. Furthermore, the treatment may be beneficial in other inflammatory conditions. He has also seen cognitive benefits in one of his multiple sclerosis (MS) patients who was struggling with cognitive and memory deficits.<\/p>\n\n\n\n
\u201cI just feel so grateful for my collaboration with Amy Arnsten and that my understanding of traumatic brain injury could be helpful,\u201d says Fesharaki-Zadeh. \u201cOur success was a combination of having the right knowledge at the right place and time while working with the right people.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"
December 12, 2022 by Isabella Backman Individuals with long COVID, sometimes referred to as \u201clong-haulers,\u201d experience symptoms that may persist for weeks, months, or even years after their acute viral […]<\/p>\n","protected":false},"author":2,"featured_media":7099,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[59],"tags":[],"class_list":["post-7073","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-brain-fog"],"_links":{"self":[{"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=\/wp\/v2\/posts\/7073","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=7073"}],"version-history":[{"count":0,"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=\/wp\/v2\/posts\/7073\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=\/wp\/v2\/media\/7099"}],"wp:attachment":[{"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=7073"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=7073"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=7073"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}