THE IMPACT OF THE COVID-19 PANDEMIC ON THE MENTAL HEALTH OF MND PATIENTS

Background Motor neurone disease (MND) is an isolating condition that has many implications on patients mental health. Throughout the COVID-19 pandemic, patients with chronic health conditions, including those with MND, have been further removed from the support of their specialist teams. Objectives 1) To determine the impact of the COVID-19 pandemic on the mental health of the Salford Royal MND patients. 2) To improve the mental health support offered by the service by addressing patient concerns and feedback. Methods A survey was sent to patients who had been receiving care by the Salford Royal MND Team since the 1st of January, 2020. The answers were reviewed and measures were put in place to address concerns. Patients were resurveyed two months later and answers were compared. Results Patients reported a higher proportion of issues with their mental health during the pandemic compared to prior. The service was seen as doing adequately but areas were identified to address. Our interventions were largely successful with many patients reporting an increase in the support they receive from the Salford Royal MND Team. Conclusions Areas of improvement were identified to accommodate the change in the way the Salford Royal MND Team deliver their care.

POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME (PRES) IN MILD AND SEVERE COVID-19

As the COVID-19 pandemic progresses neurological complications are increasingly being reported. Posterior reversible encephalopathic syndrome (PRES) is a clinico-radiological syndrome characterised by headache, visual loss, encephalopathy and seizures, and the development of vasogenic white matter lesions in a classically parieto-occipital distribution. The pathophysiology of PRES is incompletely understood, but both hyperperfusion secondary to hypertension, and endothelial dysfunction leading to vasogenic oedema have been implicated. Here we present a case series of 2 hospitalised COVID-19 patients with markedly different disease severity, both of whom developed PRES. Patient 1 presented with confusion and headache without significant systemic features, on a background of known hypertension. Patient 1 had a single generalised seizure and was managed with levetiracetam and antihypertensives, and showed complete clinical recovery. In contrast, patient 2 presented with respiratory distress, metabolic disturbance and encephalopathy requiring critical care admission. Patient 2 had a protracted admission, developing marked visual disturbance and generalised seizures requiring multiple agents. In both cases initial CT/MRI showed characteristic posterior PRES-like leukoencephalopathy with resolution on follow-up imaging, and CSF biochemistry, cytology and virology were normal. This case series highlights the potential for neurological complications in COVID-19 patients across the spectrum of disease severity.