Telemedicine for routinary multiple sclerosis follow-up during SARS-CoV2 pandemic: A single center experience

Background and aims: Telemedicine in multiple sclerosis (MS) is promising, particularly for patients with high disability and difficulties to reach the treating centre. During SARS-CoV2 pandemic, teleconsults are gaining a central role. The aim of the present study was to report our single-center experience and to verify the effectiveness of teleconsults in diagnosing relapses and rating progression. Methods: During the first lockdown phase (March–May 2020) all the pre-planned consults were converted in teleconsults. The evaluation focused on new symptoms or worsening of known symptoms, disability (PDDS), patients’ satisfaction of such assessment modality (rated form 0 to 10). Patients were then re-evaluated in person within 6 months. We verified the changes in disability and the accuracy of teleconsults in diagnosing MS relapses. Results: Eighty-four patients underwent teleconsult and were re-evaluated in person within 6 months after the lockdown (69% female, mean age 50.5 ± 11.0 y, mean disease duration 13.0 ± 9.7 y 78.6% relapsing-remitting disease form, 76.2% on disease modifying treatment). Median pre-lockdown EDSS was 1.5 (range 0–8) median EDSS post lockdown was 2 (1–8) (p = 0.836);median PDDS during lockdown was 1.5 (0–8). A single disease relapse was detected with teleconsults. In the post lock-down in person evaluation no additional undiagnosed relapses were detected. Patients’ reported satisfaction was very high (median 10, range 8–10). Conclusions: Teleconsult in MS patients allowed us to guarantee a regular neurological follow-up during pandemic lockdown. No unreported relapses were missed, no significant disability changes were reported nor detected compared to pre-lockdown evaluation. Finally, patients' satisfaction of this modality was very high.

Sars-CoV2 pandemic and lockdown reported consequences on people with multiple sclerosis

Background and aims: During SARS-CoV-2 pandemic people with multiple sclerosis (PwMS) may experience a worsening due to increased anxiety and depression, reduction in rehabilitation, and less strict connection to MS centres. The aim of our study was to describe the self-reported impact of SARS-CoV-2 pandemic and lockdown on PwMS. Methods: On June 2020, we enrolled PwMS who underwent teleconsult during the lockdown phase (March–May 2020). Self-rated worries for pandemic, perception of change in anxiety, depression, fatigue and spasticity was asked, as well as changes in weight, physical activity and food intake. We compared patients with and without reported increase in: spasticity, anxiety, depression and fatigue. Binary logistic regression analyses were applied including significant variables. Statistical significance was set at p < 0.05. Results: Ninety-three MS patients were enrolled (71% female, 77% RR, median age 50.3 y, mean disease duration ≅13 y). Many patients reported an increase of anxiety (36.6%), depression (34.4%), fatigue (26.9%) and, spasticity (18.3%), weight (47.3%) and 63.4% of patients reported e reduction of physical activity;moreover 59.1% and 43% reported particular worries for the pandemic and the perception of greater impact on PwMS of the pandemic compared to general population, respectively. In the multivariate models, anxiety was predicted by depression, particular worries for SARS-CoV2 pandemic and reduction in physical activity;depression by anxiety;fatigue by reduction in physical activity;spasticity by EDSS. Conclusions: The self-reported impact of pandemic on PwMS was deep in terms of increased depression, anxiety, fatigue and spasticity, mainly related to reduction in physical activity and pre-existing disability.

Telemedicine during the SARS-Cov-2 pandemic lockdown: Monitoring stress and quality of sleep in patients with epilepsy.

SARS-CoV-2 pandemic heavily hit the western healthcare system saturating the hospital beds in wards and clogging the emergency departments. To avoid the collapse of Italian hospitals, office visits to outpatients were limited to emergencies and the general population went in a lockdown state. Physicians had to approach new problems in the management of chronic patients who could not leave their homes. In our experience as epilepsy clinic, the use of telemedicine was of crucial importance for monitoring our patients: phone call during lockdown let us monitor the stability of our 38 patients and psychometric parameters and habits that could influence seizures frequency. In particular, we found that in our patients, sleep quality was low resulting in high daily sleepiness and associated high stress levels. Secondly, we found an increase in daily screen hours and an association with daily sleepiness. In conclusion, we report our experience in managing people with epilepsy during the lockdown, underlining the utility of telemedicine as a valid monitoring tool and the necessity of a psychometric and behavioral screening.