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Background The COVID-19 pandemic leads to disruptions of health services worldwide. To evaluate the particular impact on neurological services a rapid review was conducted. Methods Studies reporting the provision of neurological services during the pandemic and/or adopted mitigation strategies were included in this review. PubMed and World Health Organization’s (WHO) COVID-19 database were searched. Data extraction followed categories used by WHO COVID-19 pulse surveys and operational guidelines on maintaining essential health services during COVID-19. Findings The search yielded 1101 articles, of which 369 fulfilled eligibility criteria, describing data from 210,419 participants, being adults (81%), children (11.4%) or both (7.3%). Included articles reported data from 105 countries and territories covering all WHO regions and World Bank income levels (low income: 1.9%, lower middle: 24.7%, upper middle: 29.5% and high income; 44.8%). Cross-sectoral services for neurological disorders were most frequently disrupted (62.9%), followed by emergency/acute care (47.1%). The degree of disruption was at least moderate for 75% of studies. Travel restrictions due to lockdowns (81.7%) and regulatory closure of services (65.4%) were the most commonly reported causes of disruption. Authors most frequently described telemedicine (82.1%) and novel dispensing approaches for medicines (51.8%) as mitigation strategies. Evidence for the effectiveness of these measures is largely missing. Interpretation The COVID-19 pandemic affects all aspects of neurological care. Given the worldwide prevalence of neurological disorders and the potential long-term neurological consequences of COVID-19, service disruptions are devastating. Different strategies such as telemedicine might mitigate the negative effects of the pandemic, but their efficacy and acceptability remain to be seen.

Acute and post-acute neurological symptoms, signs and diagnoses have been documented in an increasing number of patients infected by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which causes Coronavirus Disease 2019 (COVID-19). In this review, we aimed to summarize the current literature addressing neurological events following SARS-CoV-2 infection, discuss limitations in the existing literature and suggest future directions that would strengthen our understanding of the neurological sequelae of COVID-19. The presence of neurological manifestations (symptoms, signs or diagnoses) both at the onset or during SARS-CoV-2 infection is associated with a more severe disease, as demonstrated by a longer hospital stay, higher in-hospital death rate or the continued presence of sequelae at discharge. Although biological mechanisms have been postulated for these findings, evidence-based data are still lacking to clearly define the incidence, range of characteristics and outcomes of these manifestations, particularly in non-hospitalized patients. In addition, data from low- and middle-income countries are scarce, leading to uncertainties in the measure of neurological findings of COVID-19, with reference to geography, ethnicity, socio-cultural settings, and health care arrangements. As a consequence, at present a specific phenotype that would specify a post-COVID (or long-COVID) neurological syndrome has not yet been identified. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10848-4.

The prevalence of Parkinson's disease (PD) in sub-Saharan Africa is still a matter of debate. The few studies that have been conducted have shown prevalences lower than those in the western world. Whether this represents a genuine finding is unclear to date. In northern Tanzania, we have conducted a hospital-based evaluation and a community-based door-to-door study to assess the prevalence of Parkinsonism, including that of PD. Over a period of 8 months, all patients admitted to a mid-size rural hospital were screened for PD. In parallel, 1,569 people agedor=50 years were recruited from the communities and assessed for PD with standard questions. Sampling was performed according to the method of "multistage cluster sampling." The questions had previously been tested in a pilot study prior to the survey. People who screened positive were examined by a specialist neurologist. In the hospital, eight of 740 people with neurological diagnoses had Parkinsonism, of whom three patients had a diagnosis of PD. In the community-based study, 18 people answered positively to least one of the 12 screening questions. However, the diagnosis of PD could not be confirmed by further examination in any of them. The prevalence of PD in northern Tanzania was found to be very low. This result would need confirmation in studies with larger populations, ideally of different African ethnicities.