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COVID-19

SARS-CoV-2 Infection (COVID-19) and Neuropathy

Since the advent of the COVID-19 pandemic in early 2020, many questions have arisen surrounding the relationship between SARS-CoV-2 infection and peripheral neuropathy. As of early 2023, we fortunately have enough information to be able to provide accurate guidance in this area.

Small Fiber Neuropathy Can Result from SARS-CoV-2 Infection

Though our understanding may still be evolving, evidence exists that isolated small fiber sensory neuropathy (diagnosed by skin biopsy, not detectable with EMG testing) can result from SARS-CoV-2 infection. In one case series published by Dr. Rory Abrams and colleagues from Mount Sinai Hospital, six patients were identified with skin biopsy confirmed small fiber neuropathy, presenting as new tingling, burning or numbness within two months of COVID-19 illness. Some patients also had associated autonomic symptoms, such as discomfort or dizziness while standing. The severity of their initial coronavirus illness varied – some had mild initial symptoms, while others a moderate or severe illness. Fortunately, most patients who received medication to help with painful sensations felt better with treatment.

Symptom Management is the Main Focus of Treatment

We know that not all patients with neuropathy symptoms following COVID-19 have diagnostic EMGs or skin biopsy tests – for some patients all testing for neuropathy is normal or negative. We do not have a full explanation for this, however, at this point we do know that some patients who experience symptoms of neuropathy following COVID-19 may notice improvement (even without treatment) within months, which can be reassuring. Some patients with pre-existing neuropathy might also notice a feeling that their neuropathy is getting worse after an infection with the coronavirus; however, we do not have evidence showing that COVID-19 infections worsen pre-existing neuropathy (such as that caused by diabetes). We do not currently have sufficient evidence to know if immunologic treatment (such as with IV immunoglobulin or steroids) is effective for patients with small fiber neuropathy after COVID-19 infection, so the main focus of treatment is on managing symptoms, such as pain or discomfort.

The Link Between COVID-19 and Guillain-Barré Syndrome

Finally, there appears to be an association between COVID-19 infection and a potentially more severe form of neuropathy, known as acute inflammatory demyelinating polyradiculoneuropathy, or Guillain-Barré syndrome (GBS). This is not a common complication of COVID-19 infection, and has also been described as an autoimmune response related to infection with a variety of other viruses. From what we know now, it appears that, fortunately, there may not be as strong a causative link between COVID-19 infection and GBS as with certain other viruses.

Symptoms & Signs

Possible small fiber neuropathy symptoms and signs:

(Not all symptoms and signs may be present.)

  • Numbness
  • Tingling
  • Muscle twitching
  • Burning sensations

Possible autonomic dysfunction symptoms and signs:

  • Discomfort or dizziness with standing
  • Fatigue
  • Cognitive impairment
  • Blurred vision
  • Dry eyes or mouth
  • Palpitations
  • Fainting
  • Sexual dysfunction
  • Abnormalities of sweating

Treatment & Therapy

Neuropathic pain medications for treatment of neuropathy symptoms.

References

Abrams, R. M. C., Simpson, D. M., Navis, A., Jette, N., Zhou, L., & Shin, S. C. (2022). Small fiber neuropathy associated with SARS-CoV-2 infection. Muscle & Nerve, 65(4), 440–443. https://doi.org/10.1002/mus.27458

Alcantara, M., & Katzberg, H. D. (2022). GBS and COVID-19: Untangling the Knots. Canadian Journal of Neurological Sciences, 49(1), 1–2. https://doi.org/10.1017/cjn.2021.128

Finsterer, J. (2022). Small fiber neuropathy underlying dysautonomia in COVID‐19 and in post‐SARS‐CoV‐2 vaccination and long‐COVID syndromes. Muscle & Nerve, 65(6). https://doi.org/10.1002/mus.27554  

Additional Resources

The National Institutes of Health (NIH) created the RECOVER Initiative to learn about the long-term effects of COVID.

Whether or not you have had COVID, you may be able to participate in RECOVER research.

RECOVER: Researching COVID to Enhance Recovery
https://recovercovid.org/

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