Neuromodulation and Inflammatory Reflex: Perspectives on the Use of Non-Invasive Neuromodulation in the Management of Disorders Related to COVID-19

Background: Novel coronavirus disease (COVID-19) is not restricted to the respiratory system, but also affects the peripheral (PNS) and central (CNS) nervous systems which appear to influence morbidity and mortality. It is urgent to approach all aspects of the disease in order to attenuate the impact of the pandemic. Noninvasive neuromodulation (NiN) might be useful in the management of the disorders related to the infection, considering its efficacy in modulation inflammation, neuroimmunity, musculoskeletal symptoms, and neuropsychiatric aspects associated with the disease. Objective: To describe the empirical basis and rationale for the use of NiN in the management of patients with COVID-19. Methods: Develop a comprehensive review of the SARS-CoV-2 pathophysiology with emphasis on neuroinvasiveness, neuroimmune response, autonomic balance, musculoskeletal and neuropsychiatric aspects of the COVID-19. Construct a rationale for the use of NiN techniques in the management of patients with COVID-19. Results: There is recent evidence that COVID-19 affects many aspects of the PNS and CNS activities, a phenomenon that seems to be mediated by neuroimmune mechanisms. There is also evidence that NiN techniques, such as transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), transcutaneous vagus nerve stimulation (tVNS), transcutaneous spinal direct current stimulation (tsDCS), and transcutaneous peripheral electric stimulation (tPES), can be used to decrease the inflammatory response of the infection. Moreover, they might also help in the management of musculoskeletal, and neuropsychiatric symptoms, and in accelerating the discharge of patients. Conclusion: The neuroimmune mechanisms of SARS-CoV-2 are emerging with recent reports showing the impacts on the nervous system. NiN to decrease inflammatory reflex may be useful in the management of patients with COVID-19. It is urgent to initiate evaluation of NiN usage in basic research and clinical trials in order to establish its actual potential.