ABSTRACT
Introduction: Despite better characterization of the spectrum of MOG IgG-associated disorders (MOGAD) in children, the role of infection in its pathophysiology remains unclear. Objectives: The goal of this study was to evaluate if public health measures put in place to prevent the spread of SARS-CoV-2 in March 2020 in Ontario (Canada) have been associated with a change in the incidence of MOGAD and other neuroinflammatory disorders in children. Methods: We reviewed a single-centre cohort of children referred for a suspicion of neuroinflammatory disorder between 2015-2020. Age, date, sex, diagnosis, MOG IgG antibodies status and detected pathogens at presentation were identified. Comparative statistical analysis was performed between years and seasons using Pearson's Chi-squared test or Fisher's exact test for categorical variables and using ANOVA or Kruskal-Wallis test for continuous variables, as appropriate. Post-hoc pairwise comparisons between 2020 and previous years were performed on significant results. The analyses were repeated twice including either complete data from 2020 (January 1st to December 31st, 2020) or only data acquired after the spring lockdown (March 17th to Dec 31st, 2020). A false discovery rate adjustment with an adjusted p-value (q-value) < 0.05 was computed. It was hypothesized that the number of new MOGAD would be significantly lower in 2020 compared to previous years due to decreased regional pathogen transmission. Results: Among 479 referred cases, we identified 364 confirmed new cases of neuroinflammatory disorder between 2015 and 2020. The number of new neuroinflammatory disorder diagnoses did not change between years. We noted significantly fewer new MOGAD diagnoses in 2020 compared to previous years (q=0.003), with no MOGAD patient presenting in 2020 after the spring lockdown. Parallelly, there were significantly fewer parainfectious neuroinflammatory cases (q=0.038) and pathogen detected (q=0.045) in the post-lockdown period. The number of new multiple sclerosis (MS) and aquaporin-4 neuromyelitis optica spectrum disorders (AQP4-NMOSD) cases remained stable despite the lockdown (q-value=0.237 and 0.505 respectively). Conclusions: Enhanced population-based infection control strategies may have a role in modulating the incidence of MOGAD and parainfectious neuroinflammatory disorders, but not MS or AQP4-NMOSD.
ABSTRACT
Objective: To assess changes in anxiety, fatigue, depression, physical activity, and sleep associated with the COVID-19 pandemic in youth with neuroinflammatory disorders. Background: Children with neuroinflammatory disorders have high rates of anxiety, depression, and fatigue, plus reduced physical activity compared to healthy counterparts. We examined whether patients with neuroinflammatory disorders would show changes in the above domains associated with COVID-19, hypothesizing poorer outcomes in patients with chronic/recurrent disease. Design/Methods: Children with neuroinflammatory disorders completed questionnaires from March-August 2020 (n=129): Screen for Childhood Anxiety and Related Disorders, Centre for Epidemiologic Studies Depression scale for Children, Pediatric Quality of Life Multidimensional Fatigue Scale, Godin Leisure-Time Exercise Questionnaire, and Children's Sleep Habits Questionnaire. Clinical/demographic data were collected via standardized Case Report Form. We used pre-pandemic data for paired analysis where available (n=87). Results: Participants were 57% female (mean age: 13±4 years). Children with monophasic Acquired Demyelinating Syndrome (monoADS) engaged in moderate/vigorous physical activity a mean of 6±4 times/week pre-pandemic (n=61), and 5±4 during the pandemic (n=62). Children with chronic/recurrent neuroinflammation (crNI;Multiple Sclerosis (MS) and neuroinflammation with systemic involvement) exercised 4±3 times/week pre-pandemic (n=21 (14 MS)), and 4±2 during (n=25 (15 MS)) (monoADS vs crNI: p=0.076). Across all groups, the pandemic brought a rise in sleep time (9±1 versus 10±2 hours, p<0.001), and improved sleep-rest fatigue (p=0.05). Despite this, children with MS reported more sleep-rest fatigue compared to monoADS (p=0.043). Average rates of depression and anxiety were similar pre/post-pandemic (29%/31%, p=0.507;16%/17%, p=0.857). During the pandemic, however, rates of depression/anxiety were significantly different by disease type: systemic involvement (60%/50%), MS (33%/27%), monoADS (22%/16%)(Chi-square, p=0.048/0.049). Conclusions: With the pandemic, despite increased sleep, youth with neuroinflammatory disorders continued to display high rates of depression/anxiety and reduced physical activity. There were significantly different rates of depression/anxiety between disease types. Individuals with recurrent disease had more fatigue than those with monophasic disease.