Universidade da Região de Joinville

Author Of 3 Presentations

COVID-19 Late Breaking Abstracts

LB1247 - Clinical features of COVID-19 in patients with neuromyelitis optica spectrum disorders  (ID 2133)

Abstract

Background

Brazil is currently considered one of the main epicenters of the coronavirus disease 2019 (COVID-19). There are many concerns related to neuromyelitis optica spectrum disorders (NMOSD) patients. In addition to the older age of onset, higher disability and the higher rate of hospitalization compared to MS, many of the commonly used preventive therapies for NMOSD are cell depleting immunosuppressants with increased risk of viral and bacterial infections.

Objectives

To describe the frequency and clinical characteristics of COVID-19 in neuromyelitis optica spectrum disorder (NMOSD) patients in Brazil.

Methods

The Brazilian Study Group NMOSD of the Brazilian Academy of Neurology has set up the registration of COVID-19 cases in NMOSD patients, using a designed web-based case report form, encompassing neuroimmunology centers and individual neurologists across the country. Data collected between March 19thand July 31th 2020 were uploaded at the REDONE.br platform. Inclusion criteria were: (i) NMOSD diagnosis according to 2015 International Panel; (ii) confirmed SARS-Cov-2 infection (RT-PCR or serology) or clinical suspicion of COVID-19 diagnosed according to CDC/CSTE case definition. Demographic data, NMOSD clinical characteristics pre and post infection, comorbidities, immunosuppressive treatment, COVID-19 clinical features and severity were described.

Results

Among the 2,061 NMOSD patients inscribed at the REDONE.br platform, 34 patients (29 women) aged 37.1 years (range 8-77), with disease onset at 31.2 years (range 4-69) and disease duration of 5.9 years (range 0.2-20.5), developed COVID-19 (18 confirmed and 16 probable cases). Most patients exhibiting mild disease was treated at home (76.5%) and 4 patients needed treatment at intensive care units (severe cases); one patient died. Four patients had NMOSD relapse during the infection; one with partial recovery.

Conclusions

The clinical features of COVID-19 in NMOSD patients were described, stressing the combination of comorbidities and immunosuppression. Mild COVID-19 was the main presentation. Collaborative studies using shared NMOSD data are needed to suitably define factors related to COVID-19 outcome.

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Clinical Outcome Measures Poster Presentation

P0076 - Evaluation of diagnosis and treatment practices in patients with Multiple Sclerosis by Brazilian neurologists’ experts in demyelinating disorders. (ID 994)

Abstract

Background

Recent changes in Multiple Sclerosis (MS) diagnostic criteria and new medications promoted a major impact on the way specialists manage the disease.

Objectives

This study aimed to give an insight into the factors considered by Brazilian neurologists in the management of MS, and to identify how these factors contribute to diagnosis and treatment.

Methods

Potential participants were selected by a Steering Committee, which was assembled of MS experts from eleven Brazilian states and was responsible to development the Survey. Only MS specialists were included in the study (neurologists who have completed a neuroimmunology fellowship or who treat more than 30 patients with MS). Links to the online survey were distributed between March 2019 and January 2020. The questionnaire was composed of 11 question sections with hypothetical scenarios, as radiologically isolated syndrome (RIS), clinically isolated syndrome (CIS), relapsing remitting MS (RRMS), secondary progressive MS (SPMS), and primary progressive MS (PPMS).

Results

Neurologists from 13 Brazilian states responded to Survey (n=94). In CIS scenario, respondents agreed to treat patients with high risk of MS diagnosis, results that was not founded in RIS case, which half of the respondents opted to not treat, even in high risk patients. In RRMS and high-risk CIS, choice of treatment was distributed among interferon beta, glatiramer acetate and teriflunomide, which were changed to dimethyl fumarate and fingolimod as RRMS severity increased. In PPMS case, almost all respondents agreed to start treatment with ocrelizumab or rituximab. In contrast, the majority of respondents opted to treat SPMS only if there is evidence of disease activity. Reasons for switching medication, in a 12-month period, were appearance of one new or enlarging brain T2 lesion; one gadolinium-enhancing lesion in brain imaging; and one clinical relapse. Almost all specialists perform lumbar puncture for diagnoses, and monitor disease through a 12-months interval neuroimaging. Furthermore, almost all specialists check levels of vitamin D and prescribe supplements for low levels.

Conclusions

This study allowed the identification of areas of agreement among Brazilian neurologists on different scenarios related to patients with MS. These results can be used to promote debate among Brazilian experts, with the goal of helping update future protocols and improve patient management.

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Patient-Reported Outcomes and Quality of Life Poster Presentation

P1018 - Differences in perceptions of neurologists and patients about the challenges and outcomes in Multiple Sclerosis. (ID 992)

Speakers
Presentation Number
P1018
Presentation Topic
Patient-Reported Outcomes and Quality of Life

Abstract

Background

Patients perception about Multiple Sclerosis (MS) is a complex multifactor process, which involves physical, social and cognitive aspects. A good relationship between neurologists and patients is essential to their knowledge and interest about the disease.

Objectives

The aim of this study is to promote greater awareness of the differences in perception between patients with MS and neurologists. We perform a cross-sectional study to evaluate neurologist’s and patient’s opinions about challenges, disabling symptoms and quality of life during MS diagnosis and treatment.

Methods

Participants were divided into two groups: one compound of Brazilian neurologists (selected by a Steering Committee, which was composed of MS specialists) and other compound of Brazilian MS patients (selected by a non-governmental patient support organization, called AME - Amigos Múltiplos da Esclerose). Data were collected through online questionnaires, made by the Steering Committee, in a 1-year period. The survey was composed of topics of quality of life, challenges, disabling symptoms and orientations about the disease, and was proposed for both groups.

Results

A total of 330 patients and 182 neurologists answered the questionnaires. In the analysis of symptoms related by patients, the most voted were fatigue, ambulation issues, imbalance, falls and cognitive/memory problems, which were not related to patient’s age or disease duration. However, patients with primarily progressive MS (PPMS) complained more about ambulation issues, imbalance and falls (p < 0.001), when compared to other presentations of the disease. In analysis comparing neurologist’s and patient’s answers, divergent results were found. While almost 90% of the neurologists reported that they include the patient’s opinion in treatment choice, less than 30% of patients revealed to participate in these process (p < 0.001). More than 85% of neurologists reported guiding their patients about future plans, while less than 25% of patients described having been instructed on this (p < 0.001). While more than 90% of neurologists reported to guide their patients to smoking cessation, only almost 25% of the previously smoking patients revealed to be advised to stop the habit (p < 0.001).

Conclusions

This study revealed the need for neurologists to re-evaluate conduct and make them more frequent, with the intention of understanding patient’s priorities and increasing their interest in the disease.

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