Disclosures: Camille R. Guzel, MD: No financial relationships or conflicts of interest

Objective:To characterize clinical and electrodiagnostic findings in a series of patients with critical illness myopathy following severe COVID-19 requiring inpatient rehabilitation.

Design: Case seriesSetting : freestanding inpatient rehabilitation hospital, academic centerParticipants : Patients with COVID-19 infection admitted to the inpatient rehabilitation hospital who had clinical suspicion for critical illness myopathy (n=8). Patients from the post-COVID rehabilitation unit with clinical signs and symptoms of myopathy were referred for electrodiagnostic testing to aide in clinical diagnosis and prognostication.

Interventions: not applicable

Main Outcome Measures: Chart review yielded patient demographics, date of COVID-19 diagnosis, comorbidities (including BMI and tracheostomy history). Electrodiagnostic characteristics collected included presence of fibrillations, positive sharp waves, motor unit action potentials (MUAP) characteristics, presence of early recruitment, and additional diagnoses on electrodiagnostic testing.

Results: Of the 8 subjects, average age was 58 years old (range 46-77), all were male, race/ethnicity was noted as white (n=4), Hispanic (n=3) and African American (n=1). The most common premorbid comorbidity was hypertension (n=4), most underwent tracheostomy (n=6), and average BMI was 26.0 (range 19.8-33.9). Average duration from time of COVID-19 diagnosis until electrodiagnostic testing was 115 days (range 51-320, median 86). All patients had electrodiagnostic findings consistent with myopathy: polyphasic and low amplitude motor units (n=8), early recruitment (n=7), positive sharp waves (n=7), fibrillations (n=6), and short duration motor units (n=3). Additional diagnoses of either peripheral neuropathy or focal mononeuropathies were seen in all 8 subjects.Conclusions: Patients in this case series with clinically suspected myopathy demonstrated confirmatory findings during electrodiagnostic testing, including: low amplitude polyphasic motor unit action potentials and early recruitment. Superimposed on the myopathic findings, we also observed mononeuropathies and polyneuropathies in these subjects. These findings highlight the neurologic complexity of COVID-19 survivors and the benefit of electrodiagnostic testing to confirm diagnosis of suspected myopathy and identify any comorbid neuromuscular conditions which may go unrecognized in the context of diffuse weakness.

Level of Evidence: Level IV

« Back to AAPM&R Annual Assembly 2021

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/critical-illness-myopathy-in-post-covid-rehabilitation-electrodiagnostic-correlates/