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Symptomatic patients with coronavirus disease 2019 (COVID-19) mostly have flu-like symptoms. However, neurologic manifestations are common and may be the early findings of COVID-19. Data for COVID-19 do not indicate an increased risk of infection in pregnant individuals, but the risk of disease severity and mortality is high in this patient population. We report a case of a pregnant woman in the 10th gestational week, who presented with neurological symptoms of sudden impairment in walking, balance, speech, and consciousness, started the night before, and a seven-day history of fever, chills, myalgia, and general weakness before admission. The polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was positive for the cerebrospinal fluid sample a day before the positive nasopharyngeal sample. Axial brain magnetic resonance imaging revealed the involvement of the spinothalamic tract. Following treatment with intravenous immunoglobulin, the patient's neurological condition gradually recovered, except for lower limb muscle strength, and she was discharged from the hospital on the 10th day of admission. This case is unique as it emphasizes the importance of considering COVID-19 when uncommon neurologic manifestations with negative nasopharyngeal PCR are present.Copyright © 2023, Author(s).
ABSTRACT
Background: Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune, rare demyelinating disease of the central nervous system characterized by recurrent attacks which usually involve optic nerves and spinal cord. Although the most common symotoms are myelitis and optic neuritis, it can be presented as cerebral syndromes mainly those related to the brain stem and diencephalon. Since NMOSD is a rare disease and the epidemiological data on this disorder is still insufficient, the establishment of registry and long-term follow up studies are needed to assess the disease course and behavior over a period of time. Material(s) and Method(s): We stablished an electronic registry system for NMOSD patients in the MS center of Kashani hospital, Isfahan, Iran, since spring 2016. Every patient suspected for NMOSD and documented in our database was included in a follow up study to monitor their disease course and progression. Anti AQP4 antibody and Anti MOG antibody were checked for all patients in a unique lab by cell based assay method. Demographic data and clinical characteristics such as family history, comorbidities,education, number of relapses, presentation signs and radiological findings were recorded. Moreove, relapses, treatment change, triggers, and COVID-19 infection were documented. We investigated the effect of the COVID19 pandemic and vaccination on NMOSD patients. Result(s): This study included 173 cases with definite diagnosis of NMOSD, and 56 ones were seropositive for AQP4 Ab. 142 were females of which 46 were in the seropositive group. Their mean age was 40.02+/-11.11 years (45.78+/-12.88 in AQP4Ab positive group). The mean of age at disease onset was about 30.16+/-11.90 years. The mean time of follow up was 55.84+/-18.94 months until today. In 76 patients, there were LETM in the first cervical MRI. 123 patients revealedbabnormality in the first brain MRI. 27 patients had hypothyroidism as the most common comorbidity. 36 cases reported positive family history of multiple sclerosis and also 4 had a family history of NMOSD. Conclusion(s): The mean age of onset did not differ between seropositive and seronegative group but it was higher than MS patients. Brain MRI showed abnormality in NMOSD patients. Female/male was 4.4/1 which is lower than other studies.Copyright © 2022
ABSTRACT
Background: Coronavirus 2019 (COVID19) created a pandemic since early 2020. NMOSD patients are more affected by psychological effects of the pandemic such as anxiety and fear because they may be worried about suffering COVID19 infection. They often concern about their treatment protocol and disease relapses during the pandemic too. Aim(s): In this study we tried to show some psychological complications epidemic on NMOSD patients in Isfahan province, Iran. the first aim of the study was to evaluate the presence and the prevalence of anxiety among NMOSD patients during the first year from epidemic beginning and also in post vaccination phase after 24 months. The second goal was to see the level of respecting preventive measures among the same group. The follow up period is 2 year after declaring COVID19 epidemic in our country Iran, since late February 2020. Method(s): The objective of the study was to evaluate the anxiety due to COVID19 infection, 3, 12 and 24 months after beginning of epidemic. The study was done in NMOSD Clinic of Isfahan Kashani hospital. We first asked patients if they were anxious or afraid of the pandemic subjectively.To investigate the objective level of anxiety, we benefited Hospital Anxiety and Depression Scale(HADS-A) questionnaire. We asked them about respecting general health cautions to prevent infection. Result(s): Study included 120 patients(96 female) with mean age of 36.37+/-9.69 and mean duration of disease 8.49+/-5.35 years. 96 cases(80%) experienced anxiety during the first 3 months of pandemic and 66 patients(55%) were anxious after a year. The point is that their level of anxiety decreased significantly in post vaccination phase after 24 months and just 35 patients (29.16%) showed anxiety subjectively on the third survey. Based on HADS-A score, 92 patients (76.66%) were anxious on the third month while after one year of epidemic 70 cases(58.33%) and in post vaccination survey just 53(44.16%) were anxious. Respecting preventive measures increased in the first year but decreased after vaccination. Conclusion(s): Results showed that prevalence of anxiety was almost high in the first months of epidemic but it decreased gradually during a year and had a dramatic decline after vaccination. The level of alertness and attention seems to remain high and they respected the sanitary rules. We concluded that vaccination against COVID19 have positive impact on peoples mental health and reduced psychological distress.
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Background: Coronavirus 2019 (COVID19) is a new coronavirus which has created a pandemic since early 2020. Neuromyelitis Optica Spectrum Disorder (NMOSD) patients are more affected by psychological effects of COVID19 pandemic such as anxiety and fear because they may be worried about being infected by COVID19 (due to the nature of disease and treatment by immunosuppressant drugs) and also they are concerned about their treatment protocol and disease relapses during the pandemic. Material(s) and Method(s): The aim of study was to evaluate the anxiety due to COVID19 infection, 3 and 12 months after beginning of epidemic in Iran.The study was performed in patients of NMOSD Cohort Clinic of Kashani hospital, Isfahan. We first asked individuals if they were anxious or afraid of the pandemic subjectively. To investigate the objective level of anxiety, Hospital Anxiety and Depression Scale (HADS-A) questionnaire was filled. Moreover, we asked them about respecting general cautions and sanitary protocols to prevent COVID19 infection. Result(s): Study included 120 patients (96 female) with mean age of 36.37±9.69 and mean duration of disease about 8.49±5.35 years. A total of 96 cases (80%) experienced anxiety during the first 3 months of pandemic. The point is that their level of anxiety decreased significantly with the prolongation of pandemic after 9 months and just 66 patients (55%) showed anxiety subjectively on the second survey. Based on HADS-A score, 92 patients (76.66%) were anxious on the third month while after one year of epidemic 70 cases (58.33%) showed anxiety. Respecting preventive measures increased in the same period. Conclusion(s): Along with the COVID19 pandemic prolongation, the level of anxiety had decreased gradually while the level of alertness and attention was almost high. It should be considered that this awareness must be preserved till the end of pandemic.
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Background: Coronavirus Disease 2019 (COVID-19) recently created a pandemic with high mortality. People with underlying diseases are prone to severe infection. The nature of NMOSD disease and its treatment by immunosuppressants predisposes patients to infection. Objectives: This study aimed to evaluate the effect of the COVID-19 pandemic on the clinical course of NMOSD and the characteristics of COVID-19 infection in NMOSD patients. Materials & Methods: This descriptive study was performed in Isfahan City, Iran, Iran, from March 2020 to March 2021. We considered relapses during the epidemic and the year before and the presentation of COVID-19 infection in the patients of NMOSD Clinic of Isfahan Kashani hospital. Results: The study included 120 patients. Their Mean±SD age was 36.37±9.69 years, and the mean duration of disease was 8.49±5.35 years. Overall, they experienced 36 relapses during the year before the epidemic (ARR:0.3) and 29 during the COVID-19 epidemic (ARR:0.24). The maintenance therapy of NMOSD was rituximab in 96 cases, azathioprine in 22, and methotrexate in 2 ones. 35 patients infected by COVID-19 (based on RT-PCR test). 6 were admitted to the hospital, and two patients received ICU care. There was one death due to respiratory failure. Conclusion: Despite the suppression of the immune system, neither incidence nor the number of severe complications of COVID-19 infection was high. Therefore, regarding the disabling nature of NMOSD and the prolonged epidemic period, it may be reasonable to continue the routine treatment of these patients and train them to stick to health protection instructions. © 2022. The Authors. This is an open access article under the CC-By-NC license. All Rights Reserved.
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Background: Coronavirus 2019 was a new coronavirus created a pandemic with high mortality. People with underlying disease and immune system suppression are potentially prone to infection. The nature of NMOSD disease as well as its treatment by immunosuppressants predisposes patients to infection. Objectives: The aim of study was to evaluate the effect of COVID19 pandemic on the clinical course of NMOSD and the characteristics of COVID19 infection in NMOSD patients after a year. Methods: We considered relapses during the year of epidemic and the year before and the presentation of COVID19 infection in the patients of NMOSD Clinic of Isfahan Kashani hospital. Patients were asked also about changes in maintenance therapy. Results: Study included 120 patients (41 seropositive , 96 female). Mean age was 36.37±9.69 and mean duration of disease was 8.49±5.35 years. Overall 36 relapses reported during the year before epidemic (ARR:0.3)and 29 relapses during COVID19 epidemic, so the ARR is 0.24. The maintenance therapy of NMOSD was rituximab in 96 cases, azathioprine in 22 and methotrexate in 2 ones. 35 patients infected by COVID19 (definite diagnosis by RT-PCR test). 6 of them admitted in hospital and two patients received ICU care. There was one death due to respiratory failure. Five patients experienced gastrointestinal symptoms as the presentation of COVID19. Their mean age was 36.02±10.11 years and the disease duration was 6.82±4.62. 20 of 35 patients reported close contact with COVID19 cases (among their relatives) before infection. Conclusion: Results showed that in spite of suppression of the immune system, neither incidence nor the number of the serious complications of COVID19 infection was high. Therefore, regarding the disabling nature of NMOSD as well as prolonged epidemic period, it may be reasonable to continue the routine treatment of these patients along with training patients to stick to health protection instructions.
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Introduction: Iran is one of the countries with high prevalence of multiple sclerosis (MS) and COVID-19 infection. 2,691,352 patients with COVID- 19 have been identified including 75,568 deaths in Iran until May 12, 2021. Objectives: To determine Epidemiology and the risk of COVID- 19 infection among MS patients in Iran. Methods: The nationwide MS registry of Iran (NMSRI) has set up a COVID-19 infection program in 9 provinces of Iran in 2020. All MS cases with confirmed diagnosis of Covid-19 infection were registered in NMSRI. This system, registering baseline characteristics, clinical presentations and symptoms, diagnostic and treatments, hospital course and outcomes, identification the risk factors that develop Covid-19 infection and improving quality of care among MS patients in regional and national level. The neurologist registers new events into the dataset including demographic characteristics, definite diagnosis of COVID-19 and its symptoms, history of comorbidities, history of hospitalization, Changes in MRI and infection outcomes. Results: A total number of 408 MS cases including 320 (78.4%) females and 88 (21.6%) males enrolled in the study. The majority of subjects 299 (73.3%) had relapsing remitting MS. The mean (SD) of EDSS score was 1.88 (1.80) and 1.91 (1.92) before and after Covid-19 infection respectively (p value ≥0.05). Most common symptoms of infection included body aches 246 (60.3%), weakness and lethargy 242 (59.3%), fever 222 (54.4%), loss of sense of taste 206 (50.5%) and dry cough 167 (40.9%) respectively. The most common comorbidity was diabetes among 15 (3.7%) cases. Totally 77 (16.04%) cases were hospitalized and 4 (1%) were died. Conclusions: This study will provide valuable and novel epidemiological knowledge on Iranian MS patients with COVID-19. COVID-19 infection was more common among female and increased EDSS among subjects. The infection symptoms and mortality rate of COVID-19 in MS subjects are comparable to the general population.
ABSTRACT
Background: Coronavirus 2019 (COVID-19) is a new coronavirus SARS-CoV-2 that has created a global pandemic with high mortality. People with underlying medical conditions and immune system suppression are more prone to severe infection. Neuromyelitis optica spectrum disorder (NMOSD) is a potentially disabling disease that is treated by immunosuppressive drugs. The nature of disease as well as its treatment potentially predisposes patients to various infections, including Covid-19 infection. Objectives: The aim of this study was to evaluate the effect of COVID-19 pandemic on the clinical course of NMOSD patients and to assess the level of anxiety and fear in them as well as to evaluate the characteristics of Covid-19 infection in patients with NMOSD. We report some cases of COVID19 infection among our patients. Methods and Materials: A descriptive study was done in 140 patients (116 female and 24 male) in NMOSD Cohort clinic of Kashani hospital, Isfahan, Iran. All patients were contacted by telephone and were asked about their infection with the Coronavirus and their treatment during its outbreak. Hospital Anxiety and Depression Scale (HADS) questionnaire were filled out via phone calls to assess patients' anxiety in pandemic. Results: The study included 140 patients (43 seropositive). Their mean age was 36.83±9.82 and mean duration of disease was 8.06±5.09 years. They experienced overall 43 relapses within the last year (ARR:0.3) and 9 relapses during COVID19 epidemic (ARR:0.19). A total of 112 patients (80%) experienced anxiety or fear during the pandemic period. Six patients infected by COVID- 19 and one of them experienced ICU admission. There was neither death nor serious complication nor atypical presentation of COVID19. All six patients were treated by rituximab and the prevalence of COVID-19 was 4.8% in patients taking rituximab . The mean age of these 6 patients was 37.80±17.72 and the disease duration was 7.20±3.27 years. There was not statistical difference between the mean age of infected patients and that of the rest of NMOSD population. Of the 124 patients treated with Rituximab, 32 cases postponed their treatment due to fear of infection and hospitalization. (1.95±1.16 months delay averagely). Conclusions: Our results showed that in our NMOSD patients, in spite of suppression of the immune system, neither incidence nor the serious complication of covid-19 infection was high. Therefore, regarding the disabling nature of NMOSD as well as prolonged epidemic period, it may be reasonable to continue the routine treatment of these patients along with more training of patients to stick to health protection instructions. We also found that patients with NMOSD are more prone to anxiety and fear of pandemic.