Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
Neurology

Author Of 2 Presentations

Internet and Social Media Poster Presentation

LB1157 - Experiences of Latin American MS and/or NMOSD experts in practice during the COVID-19 pandemic: focus in Telemedicine. (ID 1198)

Speakers
Presentation Number
LB1157
Presentation Topic
Internet and Social Media

Abstract

Background

Different scientific associations have elaborated recommendations about MS and/or NMOSD patients care and management during COVID-19 pandemic. They advised to take extra care to minimize their exposure to the virus and use alternatives to face-to-face medical appointments. This has prompted a transition of conventional care to telemedicine (TM) as quickly as possible. There is no data regarding current patient’s follow-up neither TM usage among MS and/or NMOSD Latin American experts.

Objectives

To investigate experiences from Latin American MS and/or NMOSD experts on follow-up of their patients focusing on TM management.

Methods

A cross-sectional study was performed. 141 MS and/or NMOSD experts from Argentina (AR), Chile (CH), Colombia (CO) and Brazil (BR) were invited to answer an anonymous, voluntary web-based survey. The survey was sent via email (3 July 2020) to potential respondents and was available online for only one week to avoid bias regarding epidemic change in our region.

Results

A total of 129 (91.48 %) experts completed the survey (56 from AR, 33 BR, 30 CH, and 10 CO), age 41.23 ±10.20, 43.4% works at public hospital. Regarding medical appointments (virtual or face-to-face), it decreased on a 50% during the pandemic era (14.78 ±16.71 and 7.43 ±9.68 patients/week before and during the COVID-19 pandemic respectively). Only 19.4% had experience in TM previous COVID-19 pandemic (26.8% AR, 0% BR, 23.3% CH, and 30% CO), while 79.8% are currently using TM (89.3% AR, 75.8% BR, 60% CH, and 100% CO). Most of them using video call (52.3%). Using TM, 44.1% of the experts were able to carry out neurological examination, 85.6% believe be able to identify a relapse, 48.6% use Patient Determined Disease Steps (PDDS) and 38.7% continue using the conventional Expanded Disability Status Scale (EDSS). On the other hand, 83.7% continue face-to-face medical appointment, the most frequent causes were: first time appointment (91.8%), therapeutic failure (94.%) and management of a relapse (97.3%) and only 20% for the routine appointment. To decrease virus exposure, only 40% perform a complete and thorough neurological evaluation, most of them avoid funduscopy.

Conclusions

Considering the vertiginous speed of the spread of COVID-19 in Latin American, results from our survey demonstrate preparedness and responsiveness among Latin American MS and/or NMOSD experts. Despite scarce prior TM experience, most experts were able to use TM as a new tool for monitoring their patients.

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COVID-19 Late Breaking Abstracts

LB1241 - Incidence and clinical outcome of COVID-19 in a cohort of 11.560 Brazilian patients with Multiple Sclerosis (ID 2127)

Abstract

Background

Little information is available regarding the incidence and clinical outcome of the SARS-CoV-2 infection in patients with multiple sclerosis (pwMS).

Objectives

To determine incidence and severity of COVID-19 among pwMS, and to describe the impact of COVID-19 on MS clinical features.

Methods

This observational study was prospectively performed on a cohort of 11.560 Brazilian pwMS from 47 MS referral centers that registered patients with flu-like symptoms at the REDONE.br platform, from March 13th to June 4th 2020. Inclusion criteria were: i) MS diagnosis according to revised McDonald criteria and ii) clinical symptoms compatible with COVID-19 (cough, fever and asthenia). It was considered COVID-19 confirmed cases those with positive serological or SARS-CoV-2 polymerase chain reaction (PCR) test. Disease severity was classified as mild (home treatment), moderate (hospitalization) and critical (intensive care unit admission). Data related to demographic profile, comorbidity, COVID-19 symptoms, MS treatment and relapse were collected. Univariate and multi-variable regression logistic analysis were performed to identify the variables associated with a higher severity risk in COVID-19 patients.

Results

The incidence of COVID-19 for pwMS patients was 27.7/10.000 patients and for the general Brazilian population was 29.2/10.000 inhabitants at the same time interval (Risk Ratio [RR] 0.92, Confidence Interval (CI) 0.65-1.31, P=0.64). A total of 94 patients (82% female), aged 40 ±10.25 years, presenting 9.9±8.6 years of MS disease duration, developed COVID-19, 66% of them were classified as probable and 34% as confirmed cases by RT-PCR or antibody testing. Most pwMS presented mild (87%) COVID-19 form, that did not require hospitalization, whereas the remaining patients exhibited moderate (11%) and critical (2%) forms. Among critical patients, two developed sepsis and one pwMS (also diagnosed with cancer) died. Eighty (85%) patients maintained MS disease modifying treatment (DMT) during COVID-19 pandemic, and 14 (15%) patients were not in use of any DMT. New neurological manifestations included headache (54%) and anosmia or ageusia (46%). Thirteen (14%) patients evolved with worsening of previous MS symptoms, and a single case had MS relapse five days after infection. Age over 50 years (P=0.024), hypertension (P=0.036) and chronic pulmonary disease (P=0.021) were associated with COVID-19 severity at the univariate analysis. Applying multi-variable analyses, age over 50 years (P=0.010, OR 3.922, 95%CI 1.383-11.121) and the presence of more than one comorbidity (P=0.011; OR 37.329; 95%CI 2.279-611.445) were associated with unfavorable COVID-19 outcome.

Conclusions

Incidence of COVID-19 in Brazilian pwMS was not different from that observed for the general Brazilian population. Most pwMS exhibited mild COVID-19, despite the maintenance of MS treatment. There was MS relapse in only one patient.

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Presenter Of 1 Presentation

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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