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Amantadine has begun to be used as a possible alternative in COVID-19 therapy to mitigate its effects. There is anecdotal evidence that patients with Parkinson's disease (PD) treated with amantadine and who test positive for COVID-19 often do not develop clinical manifestations of COVID-19. Objective(s): to compare the clinical course of COVID-19 in patients with PD who took or did not take amantadine sulfate. Patients and methods. A prospective continuous study included 142 patients with PD who were treated in Republican Clinical Diagnostic Center for Extrapyramidal Pathology and Botulinum Therapy in Kazan from October 2021 to January 2022. Patients filled out a proprietary internally developed questionnaire. Results and discussion. Out of 142 individuals with PD COVID-19 occurred in 77 (54.2%), of which 52.0% had a mild course, 39.0% had a moderate course, 2.6% had a severe course, and in 6.5% the severity of the disease has not been established. Deterioration after COVID-19 infection was noted by 36% of patients: the appearance or increase in motor fluctuations (41%), increased tremor, stiffness or slowness (31%), the appearance of "exhaustion" of the effect of a single dose of levodopa (13%), the appearance or increased dyskinesia (21%), hallucinations (3.5%). Patients taking amantadine sulfate had PD much longer (11.5+/-5.62 years versus 5.12+/-3.24 years) and had a more pronounced (III-IV) stage of the disease. These patients were more likely to experience mild COVID-19 (in 60.87% of cases), in contrast to patients not receiving amantadine sulfate (only in 48.15% of cases). There was no correlation between the severity of COVID-19 and levodopa intake. Conclusion. The results of the study showed that patients with PD taking amantadine sulfate are more likely to have a mild course of COVID-19.Copyright © 2022 Ima-Press Publishing House. All rights reserved.
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BACKGROUND AND AIM: Clinical services were severely affected globally during the COVID-19 pandemic. This study aimed to characterize the clinical experience of using botulinum toxin (BTX) injections during the COVID-19 pandemic. Method(s): This is a retrospective chart review of patients who received BTX injections from April 2019 to January 2022. Result(s): A total of 105 patients received an BTX injections, out of which 76 (72.4%) were men. The mean age of the patients was 47.9 +/- 15.1 years. The most common indication for receiving BTX injections was dystonia (n = 79;75.2%), followed by hemifacial spasm (n = 22;21%) and miscellaneous movement disorders (n = 4;3.8%). Focal dystonia (n = 45;57%) was the most frequent form of dystonia, followed by segmental dystonia (n = 24;30%). The percentage of generalized dystonia and hemidystonia was 12% and 1%, respectively. Cervical dystonia (44.4%), blepharospasm (17.8%), and writer's cramp (15.6%) were the most frequent forms of focal dystonia. The miscellaneous group included four patients (3.8%) with trigeminal neuralgia, Holmes tremor, dystonic tics, and hemimasticatory spasm. The mean ages of patients in the dystonia, hemifacial spasm, and the miscellaneous groups were 47.7 +/- 14.9 years, 49.2 +/- 14.0 years, and 44.2 +/- 26.0 years, respectively. The mean BTX dose was 131.6 +/- 104.1 U. The mean BTX doses for the dystonia group, hemifacial spasm, and the miscellaneous group were 158.7 +/- 105.3 U, 40.1 +/- 11.3 U, and 100.0 +/- 70.7 U, respectively. Conclusion(s): Most patients in our cohort had dystonia, followed by hemifacial spasm. Among the patients with dystonia, most had focal dystonia, with cervical dystonia being the most common movement disorder. The data obtained in our study is important to increase awareness of the effectiveness of BTX injections in patients with chronic disorders.Copyright © 2023 Annals of Movement Disorders.
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Functional movement disorders (FMDs) are a heterogenous group of movement abnormalities that greatly affect the quality of life of patients. They usually manifest as a result of underlying psychological or psychiatric illnesses without any known structural or neurochemical diseases. Various neurological disorders such as encephalitis, stroke, demyelination, seizures, and neuropathy have been reported by otherwise healthy individuals during the ongoing coronavirus disease 2019 (COVID-19) pandemic. Here, we describe the case of a 27-year-old woman who presented to our outpatient department with episodes of deviation of angle of mouth with variability and distractibility. Following thorough clinical evaluation and appropriate investigation, the underlying etiology was identified as FMD secondary to the restrictions imposed during the COVID-19 pandemic to contain the transmission of the virus. The lockdown, isolation, financial strain, and other pandemic-related issues are stressors that may contribute to psychogenic disorders in people.Copyright © 2021 Annals of Movement Disorders Published by Wolters Kluwer - Medknow.
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Objective: Hypokinetic movement disorder and parkinsonian picture has been well described in literature following covid-19 but hyperkinetic MDS are very in global literatures. To investigate the epidemiology,clinical picture,the diagnostic and therapeutic challenges in patients hyperkinetic MDS in this context and to know the time schedule of the onset of the MDS with exploring the possible pathogenesis Background: Infections are up to 20% of movement disorders.The most frequent agents are beta-hemolytic streptococcus,and flavivirus causing Japanese encephalitisThe role of the viral stimulation of microglial activation in neuroinflammation has regained attention in the context of covid19 Methods: Patients of MDS attended the clinic from 31st march 2020 to March 2022,with recent onset of hyperkinetic movements were screened. Subjects had medical history either prior to the study or medical history reviewed by physicians suggestive of covid.PCR +VE or Presence of covid antibody in blood or csf in patients with recent onset hyperkinetic MDS within 6-12 weeks of onset of symptoms except.Ventilatory cases Other markers were used to rule out other viral infections causing MDS.MRI brain and EEG as a routine in all Immune markers in very selected cases in suspected immuomediated MDSThe attempted treatment were symptomatic and immunotherapy Results: In last 2 years 50 cases of new onset Hyperkinetic MDS are recorded, out of which only 9 cases were directly or indirectly linked to Covid,Nystagmus, orofacial dyskinesia and segmental or generalized myoclonus and ataxic gait associated delirium,tremors and ocular movement disorders along with epileptic seizures are also seen.Positive EEG findings are in the form of diffused bihemispheric slowing or periodic complexes with polyspikes at irregular interval and delta brush in few cases .MRI findings varied between non-specific changes to bitemporoparietal hyperintensities in flair and T2 both cortical and subcortical or bilateral basal ganglia. Treatment response in all the cases are statisfactory Conclusion(s): observational study revealed MDS in covid do happen Myoclonus is the most Frequent movement disorder associated with COVID-19 followed by dystonia and tremors .pathophysiology included neuro inflammation, autoimmune mechanisms and small vessels thrombosis hence not be co-incidental , response to steroid also s/o immune mediated.
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The proceedings contain 40 papers. The topics discussed include: sex, bugs microwave attacks: how bad science, mating insects psychogenic illness created an international incident with Cuba;Covid-19 and neuropsychiatry;clinical update on delirium;fibromyalgia and myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS): an interoceptive predictive coding model of pain and fatigue expression;when the spark goes out: the neurology of apathy and motivation;is subjective cognitive decline (SCD) a better marker of susceptibility to functional cognitive disorder (FCD) than to neurodegeneration?: the caerphilly prospective study;temporal and spectral dynamics of reward and risk processing in the amygdala revealed with stereo-EEG recordings in epilepsy;a systematic review of extra-motor symptom evaluation in clinical trials for amyotrophic lateral sclerosis;and stimulation of the ventrolateral prefrontal cortex speeds up evidence accumulation in conflictual-uncertain environments.
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Background: Many central and peripheral nervous system complications, following COVID-19 vaccination, have been described. We report an unusual case of central demyelinating disorder, following the administration of the ChAdOx1 nCoV-19 SARS-CoV-2 (COVISHIELDTM) vaccine. Case-report: The 28-year female developed sudden onset headache followed by weakness of the left upper and lower limbs, and gait ataxia. Neurological symptoms developed two weeks after administration of the first dose of the ChAdOx1 nCoV-19 SARS-CoV-2 (COVISHIELDTM) vaccine. Magnetic resonance imaging brain revealed T2/FLAIR hyperintense lesions involving bilateral subcortical white matter, splenium of the corpus callosum, and both cerebellar hemispheres. Few lesions showed blooming on gradient echo sequence suggestive of a hemorrhagic component. Post-contrast T1 images showed mild enhancement of demyelinating lesions. The patient was treated intravenously with methylprednisolone. After 12 weeks of follow-up, there was a substantial improvement in her symptoms. She became independent in all her activities of daily living. Conclusion(s): In conclusion, this is an unusual case of acute hemorrhagic leukoencephalitis following ChAdOx1 nCoV-19 SARS-CoV-2 (COVISHIELDTM) vaccination.Copyright © 2022 The Author(s)
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Caregivers are especially likely to be more psychologically affected during the social and health care system constraints generated by the COVID-19 pandemic. Caregivers of children with neurodevelopmental disorders (i.e., autism, intellectual disability, attention deficit, hyperactivity, motor disability) have a more essential role than caregivers of healthy children. A quantitative cross-sectional study was designed, using descriptive, comparative and correlational statistical techniques to analyze health-related quality of life, emotional distress and overload in four subgroups of caregivers, classified according to the child's diagnosis. A total of 132 caregivers (86.4% women) were included. In group 1 (cognitive disability), 28 caregivers participated;in group 2 (ADHD), 51 were included;in group 3 (autism spectrum disorder), 33 caregivers participated, and in group 4 (motor disability), 20 were included. The main findings of this study were: i) alterations in physical role, bodily pain, general health and vitality;ii) very low percentages of depression, anxiety, stress and overload symptomatology;iii) differences in social functioning between the motor disability and ADHD groups;and in stress and overload between the autism and motor disability groups;and iv) moderate correlations between the dimensions of bodily pain and emotional role and depression, anxiety, stress and overload. It was concluded that there is more impairment in variables associated with physical health than with mental health.Copyright © 2023
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Objective: to assess the awareness of Parkinson's disease (PD) diagnosis and treatment among medical professionals in Kazakhstan. Background(s): PD is one of the most common neurodegenerative disease (1). Data on PD prevalence and incidence is lacking in Kazakhstan (2,3). Method(s): The original Thai questionnaire (4,5) was adapted, translated into the Russian language and validated. Questionnaire includes 20 questions divided into 3 groups: diagnosis of PD, treatment of PD and progression. The survey questionnaire was uploaded and shared online;printed forms were distributed to the medical staff in Almaty city. Result(s): 187 forms were collected, 20 printed forms were excluded after revising because of incorrect and incomplete filling (Fig.1): 48 male and 119 female responders. Mean age of responders was 36.34+/-10.933 years. 47.3% (79) of them work in the government hospitals, 50 (29.9%) are in the outpatient clinics, 33 (19.8%) are in the private clinics. The average experienced years after graduation are 12.16+/-11.696. Some of the responders has no practice with PD patients, but some of them accept 70 PD patients per month, average meaning is 5.23+/-9.562 patients per month. Average duration of residency of neurologists is 18.52+/-9.135 months. Only 14.4% of responders refer patients with PD to movement disorders specialist. Most popular medicines for PD treatment are Levodopa (70.06%), Pramipexol (25.75%), Amantadine (22.16%), only 9.58% of responders use DBS and less than 3% use pallidotomy and thalamotomy. 17.37% of responders has patients with foreign country treatment (43.8% other form of levodopa, 25% of levodopa +entocapone). 30.5% responders answered without mistakes, and only 9.6% mentioned all correct symptoms (Fig.2). 4.79% of responders mentioned all correct non-motor symptoms of PD (Fig.3). 74.3% of responders has supposed that neuroimaging is mandatory for diagnosing PD, 79.1% mentioned the rest tremor as obligatory symptom of PD (Fig.4). 81.4% of medical staff know that levodopa is the most effective medicine for PD patients. 50.9% of responders considered that SARSCov- 2 vaccine is contraindicated for PD patients (Fig.5). 83.8% of medical staff mentioned that PD medicines could slow down the progression of PD (Fig.6). Conclusion(s): Awareness of medical professionals in Kazakhstan about PD are poor. Educational programs are needed to improve quality and awareness of medical staff about PD.
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Background: The majority of adverse reactions (ARs) induced by COVID-19 vaccines were considered as mild-to- moderate reactogenicity events. but, despite the well proven efficacy and the safety of COVID-19 vaccines, some serious adverse have been emerging including neurological and thromboembolic complications (TEC) that are rare but life-threatening Method: we had included all patients with thromboembolic complications following COVID-19 vaccines notified the department of pharmacovigilance of the university hospital of Monastir Results: From total of 339 ADRs related to COVID-19 vaccination, 8 patients had TEC (two females and 6 males with median age of 68 years (31 -82 and)). The most common thromboembolic adverse events were ischemic cerebral stroke (62.5%) and deep vein thrombosis (37.5%). Medium time to the onset of TEC was 13.3 days (1-30 days). TEC were associated with the first dose of vaccine. Related vaccines with TEC were COMIRNATY (Pfizer/BioNTech) in 6 cases and Vaxzevria (Oxford/ AstraZeneca) in 2 cases. All patients were hospitalised. Seven patients had recovered with two of them having motor deficit sequelae while one patient had a fatal evolution. Vaccine's imputability was probable in four cases taking into consideration the clear temporal relationship between their administration and the onset of symptoms and the exclusion of other alternative causes after exhaustive investigations. However, three patients had predisposing factors for thrombosis and the imputability of the vaccines were uncertain. Since the gravity of these ARs, the second dose of the related vaccine was contraindicated. An inactivated COVID-19 vaccine were recommended as an alternative to the second dose of vaccination. Conclusion(s): In literature, reports of TEC had been increasingly described with mRNA and adenoviral vaccines with unproven causality. Vaccine's benefits outweigh the risk of any adverse complications associated with its use. As causal association is still controversial, further study is, however, necessary to better prove it.
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We present a rare case of meningoradiculitis occurring after mRNA COVID-19 vaccination. This patient, with a history of inflammatory arthritis following rubella vaccination, presented to the emergency department 4 days after her vaccination with both central and radicular nervous system symptoms. Symptoms included pain, sensory and motor deficits in L5 roots distribution, along with signs of central irritation, such as headache, difficulty concentrating and a Babinski sign. MRI showed bilateral L5 nerve roots enhancement. Lumbar puncture showed elevated protein and IgG, and relevant serologies excluded common causes. Prednisone and physical therapy helped the patient to achieve near complete recovery nine weeks after presentation. We concluded that this patient presented meningoradiculitis probably secondary to her vaccination in a context of possible overactive immune system. While such presentations might be rare, and do not constitute a general reason to abstain from vaccination, they must be well recognized and treated.Copyright © 2022
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Chronic diseases are steadily increasing as a result of demographic change and medical progress. Non-drug therapies and the provision of remedies are highly relevant in this context, but face an insufficient quantitative and qualitative supply situation. The digitalization of the healthcare industry is currently experiencing an upswing, driven by the Hospital Future Act [4] as well as by the relaxation of the ban on remote treatment by the 2018 Physicians' Congress [24],and most recently by the COVID-19 pandemic. Digitalization enables a redesign of treatment and care processes through telemedicine, digital health applications (DiGAS), the electronic prescription, tele-monitoring and patient portals. The present paper aims to work out opportunities, challenges of digital offers as well as necessities for the supporting use from the previous experiences of a telemedicine-supported day clinic for Parkinson's disease and movement disorders. These experiences and conceptual approaches give rise to new future-oriented treatment concepts that have enormous potential for complementing conventional therapy with digital offers in an interdisciplinary, cross-sectoral and patient-centered way individually and symptom-specifically.Copyright © Hippocampus Verlag 2023.
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Aim: To determine the long-term impact of telemedicine in child neurology care during the COVID-19 pandemic and with the reopening of outpatient clinics. Method(s): We performed an observational cohort study of 34 837 in-person visits and 14 820 telemedicine outpatient visits across 26 399 individuals. We assessed differences in care across visit types, time-period observed, time between follow-ups, patient portal activation rates, and demographic factors. Result(s): We observed a higher proportion of telemedicine for epilepsy (International Classification of Diseases, 10th Revision G40: odds ratio [OR] 1.4, 95% confidence interval [CI] 1.3-1.5) and a lower proportion for movement disorders (G25: OR 0.7, 95% CI 0.6-0.8;R25: OR 0.7, 95% CI 0.6-0.9) relative to in-person visits. Infants were more likely to be seen in-person after reopening clinics than by telemedicine (OR 1.6, 95% CI 1.5-1.8) as were individuals with neuromuscular disorders (OR 1.6, 95% CI 1.5-1.7). Self-reported racial and ethnic minority populations and those with highest social vulnerability had lower telemedicine participation rates (OR 0.8, 95% CI 0.8-0.8;OR 0.7, 95% CI 0.7-0.8). Interpretation(s): Telemedicine continued to be utilized even once in-person clinics were available. Pediatric epilepsy care can often be performed using telemedicine while young patients with neuromuscular disorders often require in-person assessment. Prominent barriers for socially vulnerable families and racial and ethnic minorities persist.Copyright © 2022 Mac Keith Press.
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Introduction: Over the last two years, the COVID-19 pandemic has negatively impacted the mental health of both COVID-19 patients and the general population. Adults with COVID-19 risked their lives, lost their loved ones, struggled with comorbid clinical conditions to manage, and have been unable to enjoy the physical presence of their families during the infection, quarantine, and lockdown periods. During hospitalization and discharge, family members often did not receive clinical updates from providers and patients, were unable to offer in-person assistance, and to receive psychological support. Incidence and prevalence of depression and anxiety among COVID- 19 older adults and their family members skyrocketed beyond the possibilities of any mental health system to address psychological aftermath of this pandemic and intervene with in-person services. In response to the urgent need for treatments that could be remotely delivered at a large scale, we designed DigiCOVID, a digital mental health approach that offered remote brief tele-psychotherapy to COVID-19 patients and/or their first-degree relatives. The main goal of this single arm, naturalistic study was to evaluate the feasibility, acceptability and usability of DigiCOVID. Additionally, we assessed the impact of DigiCOVID on psychopathology by means of self-report questionnaires. Method(s): Participants underwent an initial phonebased screening to of inclusion and exclusion criteria. Inclusion criteria were: 18-80 years old;positive nasopharyngeal swabs or serology to COVID-19 (for the patients' subgroup);absence of visual/ motor deficits that might interfere with study participation;good level of Italian;and adequate tech literacy. Participants were excluded if they had a previous or actual DSM-5 diagnosis of bipolar disorder, psychotic disorder, or substance use disorder;if they had a diagnosis of dementia;or if they presented suicidal ideation assessed through the Columbia Suicide Severity Rating Scale. Next, they completed a neuropsychological test over video to assess IQ (if lower than 70 participants were excluded), and filled out online gold-standard selfreports for depression (PHQ-9), anxiety (GAD-7), insomnia (ISI), post traumatic symptoms (IES-R) and general wellbeing (GHQ-12). Participants were then assigned to a psychotherapist who remotely conducted eight remote tele-psychotherapy sessions. After treatment, online questionnaires were filled out again to collect data on preliminary efficacy. Result(s): Since November 2021, 138 patients were recruited, 83 completed the intervention (57 patients, 26 fist-degree relatives), and 55 dropped out. At a group level, participants showed significant improvements on all clinical outcomes (PHQ-9: R2=0.12, p=.0019;ISI: R2=0.15, p=.0004;IES-R: R2=0.11, p=.0003;GHQ- 12: R2=0.23, p<.0001;GAD-7: R2=0.12, p=.0011). Given the high heterogeneity in illness severity and psychopathology, we conducted clustering on baseline data coming from the five online questionnaires: 55% of the whole sample had no psychopathology (Cluster 1), whereas 45% showed severe psychopathology (Cluster 2). When clustering was conducted on post-treatment data, three clusters emerged: no psychopathology, residual psychopathology and severe psychopathology. 71% of Cluster 1 participants remained asymptomatic;25% of Cluster 2 participants showed full symptom remission, while 48% and 28% of Cluster 2 participants showed partial symptom remission and no significant effect of treatment, respectively. Conclusion(s): Remote brief tele-psychotherapy for COVID-19 patients and their first-degree relatives is feasible and preliminary efficacious at reducing COVID-related psychopathology. Further research is needed to investigate distinct profiles of treatment response.
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Introduction It is well recognised that patients with Parkinson's disease (PD) have significant symptom burden in advanced stages of their disease. Integration of movement disorder and palliative care services has been limited by concerns about resource and sustainability. We present our experience of establishing a movement disorders palliative care multidisciplinary meeting. Method In 2019 we established a multidisciplinary virtual bimonthly meeting between movement disorders and palliative care specialists. Referrals were accepted from movement disorder specialists, community Parkinson's practitioners and palliative care specialists. Referring clinicians all actively applied primary palliative care approaches within their existing services. Aims of the meeting were to facilitate holistic management of complex needs, support advance care planning (ACP) and consider referral to specialist palliative care services. Result 37 patients in total were discussed over a 2-year period (although the service was limited for a time due to COVID pressures). On average 3 new patients were discussed per meeting. Reasons for referral included motor and non-motor symptoms, support with ACP, medication advice, caregiver concerns and emotional distress. Meeting outcomes included medication adjustments, expediting reviews, hospice support, carer support, and referral to other services. Since the meetings started 23 (62%) patients have died. Of these, 30% died in hospital compared with the national average of 43.4%. The average between discussion at the meeting and death was 139 days. The meeting has generated education opportunities, triggered joint assessments and a professionals' framework for the palliative management of patients with a movement disorder. Conclusions We present the experience of an MDT embedded within an early integrated palliative care service for movement disorders. The MDT has strengthened partnership working and findings suggest that alongside active primary palliative care, specialist palliative care for PD can be sustainable and resource efficient in a UK setting.
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There is a critical need for therapeutic interventions for Post-Acute Sequelae (PASC) of SARS-CoV-2 infection patients worldwide. tDCS has the potential for therapeutic targeting of these PASC symptoms, with devices that can be portable and wearable for home-based access. At-home tDCS access is highly relevant to complete the necessary clinical trials for PASC and has the potential to provide patients with an immediate treatment option. We have led the field in rigorous, reliable, and standardized home-based brain stimulation with the development of the remotely supervised or RS-tDCS platform. Participants are provided with remotely-controlled devices, trained in safe and effective operation, and then supervised for daily use through live videoconference. Extensively tested over >8 years (>12,000 at-home tDCS sessions in >500 patients to date), the feasibility of our RS-tDCS procedures has been verified for use across all ages (18-80 years), including those with advanced cognitive or motor disabilities and/or limited technical experience, and also reaching those at socioeconomic healthcare disadvantage for inclusion in RCTs. The RS-tDCS platform has allowed for the continued enrollment in ongoing RCTs during the COVID-19 onsite clinical research pause (with >100 participants by completing all study procedures from home). The telehealth delivery of the intervention results in rapid enrollment and high retention and adherence for repeated and extended sessions (e.g., >97% completion rates across RCTs to date). While tDCS remains under investigational status in the U.S., in 2019, we also launched tDCS as a clinical telehealth service as innovative care. In this at-home service, tDCS is delivered to patients at home and stimulation parameters can be individualized to be paired with interventions such as physical exercise, online adaptive computerized cognitive training, and guided mindfulness meditation. Patients with PASC, seen through our tDCS program, will be presented as examples of the at-home tDCS treatment approach. Research Category and Technology and Methods Clinical Research: 9. Transcranial Direct Current Stimulation (tDCS) Keywords: tDCS, Telehealth Intervention, PASC, SARS-CoV-2Copyright © 2023
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SARS-CoV-2 infection has been associated with multiple neurological manifestations. One such manifestation, which has been described since the early stages of the COVID-19 pandemic and is relevant for current neurological practice, is Guillain-Barre syndrome (GBS). The literature describes neurotoxic mechanisms of the virus itself and the possible pathways by which it may affect the peripheral nerves in experimental studies;however, we still lack information on the mechanisms causing the immune response that gives rise to GBS in the context of SARS-CoV-2 infection. Colombia is one of the Latin American countries worst affected by the pandemic, with the third-highest number of cases in the region;thus, it is essential to recognise GBS, as this potential postinfectious complication may severely compromise the patient's functional status in the absence of timely diagnosis and treatment. We present a series of 12 cases of GBS associated with SARS-CoV-2 infection from hospitals in 4 different Colombian cities and describe the clinical presentation, laboratory and electrophysiological study findings, and treatment.Copyright © 2022 Sociedad Espanola de Neurologia
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Introduction: Since the declaration of COVID-19 pandemic, several cases of demyelination of both peripheral and central nervous systems have been reported. The association of viral infection and the development of CNS demyelination has long been studied, and this link has recently been reported following SARS-CoV-2 infection as well. Case report: We report a case of a 36-year-old male who developed CNS demyelinating disease, that fulfilled the diagnostic criteria of multiple sclerosis (MS), 2 months after laboratory-confirmed infection with SARS-CoV-2. Conclusion(s): To our knowledge, this is the second published case report of MS in association with COVID-19 infection, and the first case from Middle East and North Africa (MENA) region, adding to the growing literature of a probable causal relationship between SARS-CoV-2 infection and the development of MS.Copyright © 2021 The Author(s)
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Background and Aims Sarcopenia can be defined as loss of muscle mass, strength and function and has been shown to be associated with increased morbidity and mortality in the adult population. Sarcopenia has been assessed by decreased psoas muscle surface area (PMSA) on Computer tomography (CT) and has been validated in paediatric studies. The impact of Sarcopenia in children with end stage liver disease and oncological conditions is now being recognised. There is scarce literature on the effect of sarcopenia on motor function. CT imaging exposes children to radiation and hence is done in a select group of children at the time of transplant assessment. The aim of this audit was to assess the prevalence of Sarcopenia in children undergoing liver transplant assessment and its relationship on laboratory variables, functional activity and clinical outcomes. Methods Retrospective single centre case review of patients with liver disease undergoing transplant assessment and CT imaging between 2018-2020. Psoas muscle was analysed at the level of L4/L5. The z-Scores were calculated using ageand gender-specific reference values. Sarcopenia was defined as tPMA z score less than -2. We assessed the relationship of Sarcopenia to the biochemical parameters, nutritional status, effect on motor delay/physical abilities (assessed by a range of age appropriate standardised developmental and physical assessments due to COVID pandemic isolation restrictions) and post-transplant complications. Results Thirty one children that met the inclusion criteria were included. Sarcopenia was prevalent in 17 children (6 males: 11 females), with a median age of 3.5 years (SD = 4.9). The common conditions were biliary atresia (n= 11, 35%), hepatoblastoma (n=6, 19%), Autoimmune hepatitis (n=3) etc. Twenty- four patients required additional nutritional support (77% nasogastric feeding, 13% PN and 6% oral supplementation). Mean tPMA z-score was -2.27. Data for the assessment of physical abilities/functional activity was available in 21 children. Impairment of motor skills/physical abilities was overall noted in 14/21 children (67%);9/13 (69%) in the sarcopenic group (6 significant impairment) vs 5/8 (63%) in non sarcopenic group (4 significant impairment). Sarcopenia was associated with increased complications (27 vs 7, p = 0.005) and hypoalbuminaemia (p=0.01), but was not statistically significant (p> 0.05) for the overall length of stay (total and intensive care). Discussion Sarcopenia was commonly identified in children with liver diseases undergoing transplant assessment. Reduction in physical abilities/functional activity was observed in both groups which may be a consequence of loss of muscle mass in children secondary to liver diseases or underlying oncological conditions leading to delay in gross motor skills. Although there was no statistical difference in the duration of stay or impairment of motor skills, complications were higher in the sarcopenic group. Conclusion In this pilot study, sarcopenia is prevalent in children being assessed for liver transplantation and was associated with increased complications. Better non-invasive methods (aside from CT scan) of assessing sarcopenia needs to be developed and validated for the paediatric age group, which would help to better characterise the true incidence and prevalence of sarcopenia in children with chronic liver disease. There is a need to offer nutritional support and assess physical function early in the pre transplant period in order to initiate appropriate physiotherapy interventions to halt and even reverse the progression of sarcopenia.
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Caregivers are especially likely to be more psychologically affected during the social and health care system constraints generated by the COVID-19 pandemic. Caregivers of children with neurodevelopmental disorders (i.e., autism, intellectual disability, attention deficit, hyperactivity, motor disability) have a more essential role than caregivers of healthy children. A quantitative cross-sectional study was designed, using descriptive, comparative and correlational statistical techniques to analyze health-related quality of life, emotional distress and overload in four subgroups of caregivers, classified according to the child's diagnosis. A total of 132 caregivers (86.4% women) were included. In group 1 (cognitive disability), 28 caregivers participated;in group 2 (ADHD), 51 were included;in group 3 (autism spectrum disorder), 33 caregivers participated, and in group 4 (motor disability), 20 were included. The main findings of this study were: i) alterations in physical role, bodily pain, general health and vitality;ii) very low percentages of depression, anxiety, stress and overload symptomatology;iii) differences in social functioning between the motor disability and ADHD groups;and in stress and overload between the autism and motor disability groups;and iv) moderate correlations between the dimensions of bodily pain and emotional role and depression, anxiety, stress and overload. It was concluded that there is more impairment in variables associated with physical health than with mental health. Copyright © 2023