originally published at King´s College London

MELD Graph is an AI tool that could drastically change the care for 30,000 patients in the UK and 4 million worldwide with one cause of epilepsy, researchers say.

The study, published today in JAMA Neurology by a team at King’s College London and University College London (UCL), shows how the tool significantly improves the detection of focal cortical dysplasia’s (FCDs) which is a leading cause of epilepsy.

Researchers say the tool will speed up diagnosis times, get patients the surgical treatment they need quicker, and reduce costs to the NHS by up to £55,000 per patient.

In the UK, 1 in 100 people are affected by epilepsy and seizures often present in childhood. 1 in 5 people with epilepsy have seizures caused by a structural abnormality (“lesion”) in the brain. FCDs are a common structural cause of epilepsy and in people with this type of epilepsy, seizures are usually not able to be controlled with medications. Surgery to remove the lesion can be an effective and safe way to stop the seizures. However, the challenge is that FCDs can be subtle and difficult to see with the human eye and up to half of these lesions are missed by radiologists. Delays to diagnosis and surgery mean more seizures, more visits to A&E, and more disruption to school, work and home life.

In the study, the researchers pooled MRI data from 1185 participants – including 703 people with FCD and 482 controls – from 23 epilepsy centres around the world in the Multicentre Epilepsy Lesion Detection project (MELD). Half of the dataset is from children. They then trained the artificial intelligence tool, MELD Graph, on the scans to detect these subtle brain abnormalities that might otherwise go undetected.

Project lead-author, Dr Konrad Wagstyl, from King’s College London, said: “Radiologists are currently inundated with images they have to review. Using an AI-powered tool like MELD Graph can support them with their decisions, making the NHS more efficient, speeding time to treatment for patients and relieving them of unnecessary and costly tests and procedures.”

Co-author Dr Luca Palma, from Bambino Gesù Children’s Hospital, Italy, said: “MELD Graph identified a subtle lesion missed by many radiologists in a 12-year-old boy who had daily seizures and had tried nine anti-seizure medications with no improvement to his condition. This tool could identify patients with surgically operable epilepsy and help with surgical planning – reducing risks, saving money, improving outcomes.”

While the tool is not yet clinically available, the research team have released the AI-tool as an open-source software. They are running workshops to train clinicians and researchers around the world, including Great Ormond Street Hospital and the Cleveland Clinic, in how to use it.

First author, Dr Mathilde Ripart from UCL, said “One of the highlights for me is hearing from doctors around the world, including the UK, Chile, India and France have been able to use our tools to help their own patients.”

Co-author Professor Helen Cross, Prince of Wales’s Chair of Childhood Epilepsy, President of the International League Against Epilepsy, Consultant Epileptologist at Great Ormond Street Hospital, and Director of the UCL Great Ormond Street Institute of Child Health, OBE said: “Many of the children I see have experienced years of seizures and investigations before we find a lesion. The epilepsy community is searching for ways to speed up diagnosis and treatment. Initiatives such as MELD have the potential to rapidly identify abnormalities that can be removed and potentially cure the epilepsy.”

Co-lead Dr Sophie Adler from UCL said: “This type of research is only possible with international collaboration. We were privileged to work with 75 researchers and clinicians towards this common goal of “no missed epilepsy lesions worldwide”.”

Reference 

• Ripart M et al., 2025. Detection of epileptogenic focal cortical dysplasia using graph neural networks: a MELD study. JAMA Neurology, Feb 24. doi:10.1001/jamaneurol.2024.5406

Press release from the American Academy of Neurosciences

MINNEAPOLIS – People with long COVID who experience anxiety and depression months after a mild case of COVID-19 may have brain changes that affect the function and structure of the brain, according to a preliminary study released today, February 20, 2023, that will be presented at the American Academy of Neurology’s 75th Annual Meeting being held in person in Boston and live online from April 22-27, 2023.

“There is still much to learn about long COVID, which includes a wide range of health problems, including anxiety and depression, months after infection,” said Clarissa Yasuda, MD, PhD, of the University of Campinas in São Paulo, Brazil. “Our findings are concerning, as even people with a mild case of COVID-19 are showing changes in their brains months later. More studies are needed to hopefully identify treatments to prevent any long-term effects on people’s quality of life.”

The study involved 254 people with an average age of 41 who had a mild COVID-19 infection an average of three months earlier. Participants completed tests to assess symptoms of depression and anxiety. A total of 102 people had symptoms of both anxiety and depression and 152 people had no symptoms.

Participants also had brain scans. Researchers looked at damage to the brain’s gray matter to determine if there was brain shrinkage. They also compared the brain scans of the people with COVID-19 with the scans of 148 people who did not have a COVID-19 infection.

The people with COVID-19 and anxiety and depression had shrinkage in the limbic area of the brain, which plays a role in memory and emotional processing, while the people who had COVID-19 without anxiety and depression and the people without COVID-19 had no brain shrinkage.

Researchers also looked at brain function and changes in connectivity—how the brain communicates—between areas of the brain. Using a special type of software to analyze brain networks with resting-state brain activity, they looked at 84 people from the asymptomatic group, 70 people from the anxiety and depression group, and 90 people who did not have COVID-19.

Researchers found that the group with both symptoms of anxiety and depression had widespread functional changes in each of the 12 networks that were tested, while the group without symptoms showed changes in only five networks.

“Our results suggest a severe pattern of changes in how the brain communicates as well as its structure, mainly in people with anxiety and depression with long COVID syndrome, which affects so many people,” Yasuda added. “The magnitude of these changes suggests that they could lead to problems with memory and thinking skills, so we need to be exploring holistic treatments even for people mildly affected by COVID-19.”

A limitation of the study was that symptoms of anxiety and depression were self-reported, so people may have misjudged or misreported symptoms.

The study was supported by the São Paulo Research Foundation.

Written by Kathleen Doheny for WebMD

June 2, 2023 — Anxiety, depression, and COVID-19 can be a bad combination for your brain — and your long-term health.

Having anxiety and depression before a COVID infection increases the risk of developing long COVID, researchers have found.

Those with long COVID who develop anxiety and depression after an infection may have brain shrinkage in areas that regulate memory, emotion, and other functions as well as disruption of brain connectivity.

While many questions remain about these intertwined relationships, the associations aren’t a complete surprise. Experts already know that depression and anxiety are associated with inflammation and immune dysfunction, perhaps helping to explain the link between these mental health conditions, the risk of long COVID, and the changes in the brain.

Brain changes accompanying a COVID infection have concerned researchers since earlier in the pandemic, when U.K. Biobank researchers found brain atrophy, loss of grey matter, and decline in cognition in those infected with COVID compared with those not infected.

Common Conditions

The ramifications of the research linking anxiety, depression and long COVID are far-reaching. According to the CDC, 12.5% of U.S. adults have regular feelings of anxiety (as well as nervousness and worry), and the latest Gallup Poll found that nearly 18% of adults currently have or are being treated for depression.

As of May 8, 10% of U.S. infected adults have long COVID, according to the CDC, and among U.S. adults ever infected, 27% have reported long COVID. Long COVID has been defined by the CDC as symptoms such as fatigue, brain fog, and cough that persist longer than 4 weeks and by the World Health Organization as symptoms persisting for 3 months or more.

Here’s a roundup of what the research shows about mental health and long COVID risk — along with other research finding that paying attention to health habits may reduce that risk.

Pre-Existing Depression, Anxiety, and Long COVID Risk

A history of mental health issues — including depression, anxiety, worry, perceived stress, and loneliness — raises the risk of long COVID if infection occurs, Harvard researchers have found.

The researchers evaluated data from three large, ongoing studies including nearly 55,000 participants to determine the effects of high levels of psychological distress before a COVID infection.

“Our study was purely survey based,” said Siwen Wang, MD, the study’s lead author and a research fellow at Harvard’s T.H. Chan School of Public Health at Harvard University.

At the start of the survey in April 2020, none of the participants reported a current or previous COVID infection. They answered surveys about psychological distress at the start of the study, at 6 monthly time points, then quarterly until November 2021.

Over the follow up, 3,193 people reported a positive COVID test and 43% of those, or 1,403, developed long COVID. That number may seem high, but 38% of the 55,000 were active health care workers. On the final questionnaire, they reported whether their symptoms persisted for 4 weeks or longer and thus had long COVID by the standard CDC definition.

Wang’s team then looked at the infected participants’ psychological status. Anxiety raised the risk of long COVID by 42%, depression by 32%, worry about COVID by 37%, perceived stress, 46%, and loneliness, 32%.

COVID patients with a history of depression or anxiety are also more likely than others to report trouble with cognition in the weeks after a COVID infection and to develop brain fog and long COVID, UCLA researchers found. They evaluated 766 people with a confirmed COVID infection; 36% said their thinking was affected within 4 weeks of the infection. Those with anxiety and depression were more likely to report those difficulties.

Long COVID, Then Anxiety, Depression, Brain Changes

Even mild cases of COVID infection can lead to long COVID and brain changes in those who suffer anxiety or depression after the infection, according to Clarissa Yasuda, MD, PhD, assistant professor of neurology at the University of Campinas in Sao Paulo, Brazil. She has researched long COVID’s effects on the brain, even as she is coping with being a long COVID patient.

In one of her studies, presented at the 2023 American Academy of Neurology meeting in April, she found brain changes in people with anxiety, depression, and COVID but not in those infected who did not have either mental health issue. She evaluated 254 people, median age 41, after about 82 days from their positive PCR test for COVID.  Everyone completed a standard questionnaire for depression (the Beck Depression Inventory) and another for anxiety (the Beck Anxiety Inventory). She further divided them into two groups — the 102 with symptoms and the 152 who had no symptoms of either depression or anxiety.