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Reduced TMS-evoked EEG oscillatory activity in cortical motor regions in patients with post-COVID fatigue
Elias P Casula1, Romina Esposito2, Sabrina Dezi3
1Department of System Medicine, University of Tor Vergata, Via Cracovia 50, 00133, Rome, Italy; Experimental Neuropsychophysiology Laboratory, IRCCS Santa Lucia Foundation, Via Ardeatina 354, 00179, Rome, Italy.
Objective:
Persistent fatigue is a major symptom of the so-called 'long-COVID syndrome', but the pathophysiological processes that cause it remain unclear. We hypothesized that fatigue after COVID-19 would be associated with altered cortical activity in premotor and motor regions.
Methods:
We used transcranial magnetic stimulation combined with EEG (TMS-EEG) to explore the neural oscillatory activity of the left primary motor area (l-M1) and supplementary motor area (SMA) in a group of sixteen post-COVID patients complaining of lingering fatigue as compared to a sample of age-matched healthy controls. Perceived fatigue was assessed with the Fatigue Severity Scale (FSS) and Fatigue Rating Scale (FRS).
Results:
Post-COVID patients showed a remarkable reduction of beta frequency in both areas. Correlation analysis exploring linear relation between neurophysiological and clinical measures revealed a significant inverse correlation between the individual level of beta oscillations evoked by TMS of SMA with the individual scores in the FRS (r(15) = -0.596; p = 0.012).
Conclusions:
Post-COVID fatigue is associated with a reduction of TMS-evoked beta oscillatory activity in SMA.
Significance:
TMS-EEG could be used to identify early alterations of cortical oscillatory activity that could be related to the COVID impact in central fatigue.
