Author Of 3 Presentations
LB1205 - Covid-19 Infection in Patients with Multiple Sclerosis: an observational study by The New York COVID-19 Neuro-Immunology Consortium (NYCNIC) (ID 2054)
Abstract
Background
New York became one of the first epicenters of the COVID-19 pandemic in the United States and many neurologists were faced with the unprecedented challenge of providing medical advice to patients with multiple sclerosis (MS) without the support of evidence-based scientific data. Large collaborative studies are needed to determine whether MS itself, or associated disease-modifying therapies (DMT), increase the risk of acquiring COVID-19 or worsen its course.
Objectives
We aim to characterize the patterns of COVID-19 infection in patients with MS and to identify risk factors for severe infection.
Methods
Demographics, MS and COVID-19 clinical features were collected on patients currently followed at 5 large MS Centers in New York City and the tri state area (MSSM, Columbia, Northwell, NYU, and Neurological Associates Of Long Island). Patients with MS or related disorders, who self-identified as diagnosed with COVID-19 by a healthcare provider (based on characteristic symptoms, radiographic findings and/or positive COVID-19 PCR/serology when available) were included. The severity of COVID-19 infection was measured by a 4-point ordinal scale (home care, hospitalization, ICU, death). Univariate and multivariate logistic regression models were used to assess associations of demographic variables with hospitalization.
Results
Our cohort included 349 patients with median age of 45 (range 13-76), 70.8% female, 25.3% African-American, 23.7% Hispanic. Mean disease duration was 11.5y [SD 9.1]. The prevalence of DMT use was 87.2%, and 80.2% were ambulatory without assistance. Forty-eight (14.2%) patients were hospitalized, and 13 (3.9%) patients died. Multivariate logistic regression models showed associations between EDSS ≥6 (OR 3.9 [95% CI, 1.7-8.8]), obesity (OR 2.4 [95% CI, 1.1-4.9]) and age (OR per 10 year increase: 1.5 [95% CI, 1.1-2.2]) with hospitalization for COVID-19. There were no significant associations between race, ethnicity, comorbidities (cardiac, pulmonary or diabetes), smoking status, or specific DMT and severe COVID-19 infection requiring hospitalization.
Conclusions
Age, obesity, and higher EDSS independently predicted severe COVID -19 infection necessitating hospitalization. This is in agreement with COVID -19 outcome predictors in the general population and other MS cohorts. Older patients with limited mobility should be counseled to maintain increased vigilance during the ongoing pandemic.
LB1244 - Manifestations and Impact of the COVID-19 Pandemic in Neuroinflammatory Diseases (ID 2130)
Abstract
Background
We have limited understanding of the risks and impact of COVID-19 in neuroinflammatory diseases (NID) of the central nervous system, particularly among patients receiving disease modifying therapies (DMTs).
Objectives
To report initial results of a planned multi-center year-long prospective study examining the risk and impact of COVID-19 among persons with NID.
Methods
In April 2020, we deployed online questionnaires to individuals in their home environment to assess the prevalence and potential risk factors of COVID-19 symptoms in persons with and without NID.
Results
Our cohort included 1,115 participants (630 NID, 98% MS; 485 reference) as of April 30, 2020. 202 (18%) participants, residing in areas with high COVID-19 case prevalence, met the April 2020 CDC symptom criteria for suspected COVID-19, but only 4% of all participants received testing given testing shortages. Among all participants, those with suspected COVID-19 were younger, more racially diverse, and reported more depression and liver disease. Persons with NID had the same rate of suspected COVID-19 as the reference group. Early changes in disease management included telemedicine visits in 21% and treatment changes in 9% of persons with NID. After adjusting for potential confounders, increasing neurological disability was associated with a greater likelihood of suspected COVID-19 (ORadj=1.45, 1.17-1.84).
Conclusions
Our study of real-time, patient-reported experience during the COVID-19 pandemic complements physician-reported MS case registries that capture an excess of severe cases. Overall, persons with NID seem to have a risk of suspected COVID-19 similar to the reference population.
P1081 - Social networks in pediatric multiple sclerosis are associated with academic performance (ID 1056)
Abstract
Background
Social connectivity is known to impact health and cognition. In adults with multiple sclerosis (MS), close-knit social networks have been associated with worsened physical function (Levin et al, ECTRIMS 2019). To date, no studies have explored social networks in pediatric MS, a disease that occurs during a period of formative learning, social exploration, and personal identity.
Objectives
To analyze social networks in a small cohort of adolescents with MS and examine how these networks relate to academic performance.
Methods
We deployed a structured social network questionnaire to 14 adolescents with MS. We assessed academic performance using either the Woodcock Johnson Test of Academic Achievement (WJ) or performance on a statewide standardized achievement test. We defined academic impairment as a z score ≤1.5 standard deviations on the WJ or a score <65 on any statewide exam. Using graph theoretical statistics, we calculated three structural metrics for each individual’s social network: size, constraint, and effective size. Size is the number of network members, excluding the patient. Constraint is the extent to which network members have connections to each other. Effective size, conceptually the inverse of constraint, is the number of members who occupy structurally unique positions. We explored the association between network size, constraint, and effective size and academic impairment using a student t test.
Results
13 out of 14 subjects (93%) were female with a mean age of 16.4 (±3.25) years. Median EDSS was 1 (range 0-3). Median grade level was 12 (range 7-14). 8 of 14 (57%) subjects were academically impaired. Subjects who were academically impaired had a lower mean network size than those without academic impairment (9.75 vs 17.2, p = 0.028). The group with academic impairment had a trend towards higher network constraint (mean 54.9 vs. 30.4, p = 0.0507). Academic impairment was associated with lower average network effective size (3.94 vs 7.16, p = 0.004).
Conclusions
In this small cohort of adolescents with MS, we found that academic performance was inversely related to social network size and effective size. Taken together, these findings suggest that small, closely-knit social networks are associated with lower scholastic performance. These social network trends in children with MS are in line with physical disability data in adults with MS. Future plans include analyzing a dataset of 60 pediatric MS subjects and comparing to healthy controls. Larger, longitudinal studies are needed to determine the full impact of social networks on academic achievement in youth with MS.