A Blueprint on Global Legal Education: The European Perspective

This chapter is based on the report "Blueprint on global legal education” by the International Bar Association and the Law Schools Global League that outlines the main trends and challenges that legal education faces globally. In this chapter, the coordinators of the report describe the quantitative and qualitative research methodology used to develop the report and reach the conclusions from the analysis, including the main key trends, challenges and opportunities emerging globally in current legal education, with a particular focus on Continental Europe. The key trends identified in global legal education include internationalization, technology and the development of new skills, while one of the main challenges identified is the regulation of legal education and the legal profession, an aspect that could hinder internationalization and innovation. Special mention should be made of legal education in the COVID-19 era. Since the outbreak of the pandemic, new challenges in legal education have arisen and need to be addressed. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022.

Treating multiple sclerosis patients with infusion of disease modifying treatments during the COVID-19 pandemic

Background and importance Multiple sclerosis (MS) secondline disease modifying treatments (DMT) cause lymphocyte or B cell depletion, such as therapy with natalizumab, ocrelizumab, alemtuzumab or rituximab. They can present a varying degree of immunodeficiency that can translate into an increased risk of infections. The decision making process should balance the risks of stopping an active treatment and the risk of COVID- 19 infection. Aim and objectives To evaluate the management of MS patients with secondline DMT via infusion with natalizumab, ocrelizumab, rituximab and alemtuzumab during the COVID- 19 pandemic. Material and methods An observational retrospective study was conducted between January 2020 and October 2020 of MS patients on active treatment with natalizumab, ocrelizumab, rituximab or alemtuzumab who were expected to receive new dosages in this period. For data collection, the electronic clinic history system (Selene) and the programme Farmatools were used. Variables collected were: sex, age, expanded disability status scale (EDSS), COVID-19 diagnosis and type of MS. Treatment changes/delays due to COVID-19 were reviewed. In case of delay, the number of days was quantified. Results 40 patients (65% women) treated with different infusion therapies were evaluated with a median age of 47.3 (SD 13,3). The average EDSS was 3.8 (SD 2.1). 29 patients had relapsing-remitting MS (72,5%), 7 had primary progressive MS (17.5%) and 4 had secondary progressive MS (10%). Five (12.5%) COVID-19 cases were diagnosed. No delays were registered in 13 infusions of natalizumab;2 patients, due to a suboptimal response, were changed to ocrelizumab, reducing hospital visits, and one was transferred to another hospital. Three patients were expected to receive alemtuzumab. No one received alemtuzumab and two were changed to ocrelizumab due to the European Medicines Agency (EMA) alert that recommended restricting the use of alemtuzumab during the COVID-19 pandemic. Two patients received rituximab in time;one was changed to natalizumab due to infusion reactions and in one case the dosing interval was extended to 36 days. Eight patients began ocrelizumab treatment, eight received their dose without delay, one died and in five cases the dosing interval was extended to 39 days (SD 23.8). Conclusion and relevance According to the recommendations, a case-by-case analysis should be performed, but it seems that the COVID-19 pandemic has conditioned MS treatments as changes/delays were registered. Five (12.5%) COVID-19 cases were diagnosed, similar to the outcomes obtained in the seroprevalence study in the same region.

4CPS-333 Treating multiple sclerosis patients with infusion of disease modifying treatments during the COVID-19 pandemic

Background and importanceMultiple sclerosis (MS) secondline disease modifying treatments (DMT) cause lymphocyte or B cell depletion, such as therapy with natalizumab, ocrelizumab, alemtuzumab or rituximab. They can present a varying degree of immunodeficiency that can translate into an increased risk of infections. The decision making process should balance the risks of stopping an active treatment and the risk of COVID-19 infection.Aim and objectivesTo evaluate the management of MS patients with secondline DMT via infusion with natalizumab, ocrelizumab, rituximab and alemtuzumab during the COVID-19 pandemic.Material and methodsAn observational retrospective study was conducted between January 2020 and October 2020 of MS patients on active treatment with natalizumab, ocrelizumab, rituximab or alemtuzumab who were expected to receive new dosages in this period. For data collection, the electronic clinic history system (Selene) and the programme Farmatools were used. Variables collected were: sex, age, expanded disability status scale (EDSS), COVID-19 diagnosis and type of MS. Treatment changes/delays due to COVID-19 were reviewed. In case of delay, the number of days was quantified.Results40 patients (65% women) treated with different infusion therapies were evaluated with a median age of 47.3 (SD 13,3). The average EDSS was 3.8 (SD 2.1). 29 patients had relapsing–remitting MS (72,5%), 7 had primary progressive MS (17.5%) and 4 had secondary progressive MS (10%). Five (12.5%) COVID-19 cases were diagnosed. No delays were registered in 13 infusions of natalizumab;2 patients, due to a suboptimal response, were changed to ocrelizumab, reducing hospital visits, and one was transferred to another hospital.Three patients were expected to receive alemtuzumab. No one received alemtuzumab and two were changed to ocrelizumab due to the European Medicines Agency (EMA) alert that recommended restricting the use of alemtuzumab during the COVID-19 pandemic. Two patients received rituximab in time;one was changed to natalizumab due to infusion reactions and in one case the dosing interval was extended to 36 days. Eight patients began ocrelizumab treatment, eight received their dose without delay, one died and in five cases the dosing interval was extended to 39 days (SD 23.8).Conclusion and relevanceAccording to the recommendations, a case-by-case analysis should be performed, but it seems that the COVID-19 pandemic has conditioned MS treatments as changes/delays were registered. Five (12.5%) COVID-19 cases were diagnosed, similar to the outcomes obtained in the seroprevalence study in the same region.References and/or acknowledgementsConflict of interestNo conflict of interest

Encephalopathy and encephalitis during acute SARS-CoV-2 infection. Spanish Society of Neurology COVID-19 Registry. / Encefalopatías y encefalitis durante la infección aguda por SARS-CoV2. Registro de la Sociedad Española de Neurología SEN COVID-19.

OBJECTIVES: Since the beginning of the COVID-19 pandemic, the Spanish Society of Neurology has run a registry of patients with neurological involvement for the purpose of informing clinical neurologists. Encephalopathy and encephalitis were among the most frequently reported complications. In this study, we analyse the characteristics of these complications. PATIENTS AND METHODS: We conducted a retrospective, descriptive, observational, multicentre study of patients with symptoms compatible with encephalitis or encephalopathy, entered in the Spanish Society of Neurology's COVID-19 Registry from 17 March to 6 June 2020. RESULTS: A total of 232 patients with neurological symptoms were registered, including 51 cases of encephalopathy or encephalitis (21.9%). None of these patients were healthcare professionals. The most frequent syndromes were mild or moderate confusion (33%) and severe encephalopathy or coma (9.8%). The mean time between onset of infection and onset of neurological symptoms was 8.02 days. Lumbar puncture was performed in 60.8% of patients, with positive PCR results for SARS-CoV-2 in only one case. Brain MRI studies were performed in 47% of patients, with alterations detected in 7.8% of these. EEG studies were performed in 41.3% of cases, detecting alterations in 61.9%. CONCLUSIONS: Encephalopathy and encephalitis are among the complications most frequently reported in the registry. More than one-third of patients presented mild or moderate confusional syndrome. The mean time from onset of infection to onset of neurological symptoms was 8 days (up to 24hours earlier in women than in men). EEG was the most sensitive test in these patients, with very few cases presenting alterations in neuroimaging studies. All patients treated with boluses of corticosteroids or immunoglobulins progressed favourably.