ABSTRACT
Objective: We report the approach and initial outcomes for two patients with Post-Acute Sequelae of SARS-CoV-2 (PASC) seen at our clinical transcranial direct current stimulation (tDCS) telehealth service at NYU Langone Health. Background: PASC is the syndrome of persisting (>1 month) symptoms following COVID-19 illness, which often include fatigue, cognitive dysfunction, pain, and emotional disturbance, and can lead to significant reductions in levels of daily functioning and quality of life. As the numbers of individuals who recover from COVID-19 continue to rise world-wide, there is a critical need for therapeutic interventions for this patient population. tDCS has potential for therapeutic targeting of these PASC symptoms, with the advantage of portable and wearable devices for home-based access. Design/Methods: Patients were a 42 and 57-year-old women with PASC seen 7 and 9 months following their acute COVID-19 illness. Each daily tDCS session was delivered at-home via a video visit for 30 minutes x 2.0 mA using a left anodal dorsolateral prefrontal cortex montage. Stimulation was paired with physical exercise, online adaptive computerized cognitive training, and guided mindfulness meditation, individualized to each patient. Sessions were delivered 3-5 days per week. Clinical neuropsychological evaluation was completed before and after the intervention, and we developed a symptom inventory based on the full range of PASC symptoms reported in the literature (Assessment of PASC;A-PASC) to measure treatment outcomes. Results: The patients experienced significant improvements across cognitive, emotional, physical, and functional domains, and both returned to work and resumed most of their daily activities following the intervention. Conclusions: tDCS can be delivered as a teleintervention warranting its evaluation as an accessible and scalable treatment option for PASC. Further study and clinical trials of PASC are warranted.
ABSTRACT
Objective: To test the feasibility of a remotely delivered digital telehealth intervention targeting anxiety and stress in patients with pediatric onset MS. Background: Pediatric onset (<18 years) occurs in approximately 3% of MS cases, representing the youngest affected subpopulation. Emotional distress commonly occurs in MS, and there is a need for accessible and effective interventions. Personal Zen is an app-based version of the established intervention for cognitive bias retraining.Design/Methods: Participants with confirmed pediatric onset MS were recruited for this teleintervention during routine in-person or video outpatient visits during the course of the COVID-19 pandemic. Participants were provided the Personal Zen app for installation, trained on its use, and instructed to train daily (>4 times a week) x four weeks. Measures of anxiety and stress were administered at baseline and repeated weekly.Results: A total n=22 participants (86.4% female, age 17.95 ± 1.94, range 15 to 23 years) with minimal disability (EDSS range 0.0 to 2.5) were enrolled. Adherence was high, averaging 16.6 entries per participant over one month, indicating feasibility of the intervention. At study end there was a significant decrease in symptoms of anxiety (Beck Anxiety Inventory, 2.23±10.71, p=.006), depression (Beck Depression Inventory, 6.08±8.58, p=.025) and negative affect (4.55±7.88, p= .025).Conclusions: The digital telehealth intervention Personal Zen is a feasible and effective tool to reduce distress experienced by younger patients with MS, and particularly relevant as a therapeutic option in the context of the COVID-19 pandemic.
ABSTRACT
Background: COVID-19, the disease caused by SARS CoV2, causes severe respiratory disease, and rarely multisystem inflammatory syndrome, in some pediatric patients. Little is known about the disease course among patients with pediatric-onset multiple sclerosis. Objectives: To describe the demographic and clinical characteristics of a subgroup of pediatric-onset multiple sclerosis (POMS) patients infected with SARS CoV2. Methods: The Network of Pediatric Multiple Sclerosis Centers (NPMSC), a consortium of 10 US pediatric multiple sclerosis (MS) centers contributes clinical information about POMS patients and demyelinating disorders to a centralized database, the Pediatric Demyelinating Disease Database (PeMSDD), to facilitate research for this rare disorder. In addition to collecting clinical data on clinical course, comorbidities, disease modifying therapy use, and functional status, the NPMSC developed a screening questionnaire to administer to patients during standard of care visits to further evaluate their COVID- 19 status. Additionally POMS patients with confirmed or highly suspected COVID-19, will be assessed for risk factors including smoking use, recent glucocorticoid use, comorbidities;clinical presentation, including symptoms, radiological and laboratory data;COVID-19 treatments and outcomes. POMS patients will also complete the COViMS (COVID-19 Infections in MS & Related Diseases) database, a joint effort of the US National MS Society and the Consortium of MS Centers to capture information on outcomes of people with MS and other central nervous system (CNS) demyelinating diseases (Neuromyelitis Optica Spectrum Disease, or MOG antibody disease) who have developed COVID- 19. Together with data collected from the PeMSDD, we will present comprehensive data on the POMS patient experience with COVID- 19 and compare it to POMS patients without known or suspected COVID-19. Results: Data collection continues. Results available by the meeting due date will describe the demographics, risk factors, treatments and outcomes of POMS with COVID-19. Conclusions: will be drawn pending results of data analysis. We anticipate reporting on demographic data, risk factors, outcomes and any associations with disease modifying therapy.