Repetitive transcranial electromagnetic stimulation, RTMS, does improve fatigue, depression and cerebral symptoms in severe Long COVID syndrome.

Long COVID is characterized by severe fatigue after exertion, stress intolerance, lack of concentration, and cerebral impairment more than 12 weeks after SARS-CoV-2 infection. 6,5% of the infected are involved. An effective therapy is not available. Repetitive transcranial electromagnetic Stimulation, RTMS, is a noninvasive treatment with minor side effects to selectively stimulate or suppress selected cerebral regions. We applied RTMS to patients with long COVID syndrome. <bold>Methods:</bold> 7 patients (6f, 1m) who remained severely compromised and unable to work because of fatigue syndrome according to the Canadian criteria (Carruthers BM 2003) were treated with 10Hz RTMS on the left dorsolateral prefrontal cortex for 20 sessions within 4 weeks. <bold>Results:</bold> The Canadian Criteria of fatigue showed a consistent improvement in fatigue in the 7 patients by 24%, 14%, 35%, 53%, 24%, 8% and 37%, mean 27,8%. The Fatigue Severity Scale (Krupp, Arch Neurol, 1989) improved importantly by 16,4 points. Bell Score (Bell 1995), measuring severity of fatigue, improved by 25 points. In Beck´s inventory II (Hautzinger et al, 2007), the depression score decrease from 33 points, severe depression, to 17 points, reflecting only minor depression after RTMS. <bold>Conclusion:</bold> Repetitive transcranial electromagnetic stimulation, RTMS, on the left dorsolateral prefrontal cortex caused an important improvement of severe Long COVID symptoms in 6 of 7 patients. A randomized study is necessary. Until then RTMS should be offered to Long COVID patients in face of the lack of any treatment, of minor side effects and the consistent effects in our study.