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Neurol Neuroimmunol Neuroinflamm ; 9(1)2022 01.
Article in English | MEDLINE | ID: covidwho-1928237


BACKGROUND AND OBJECTIVES: It is unclear how multiple sclerosis (MS) affects the severity of COVID-19. The aim of this study is to compare COVID-19-related outcomes collected in an Italian cohort of patients with MS with the outcomes expected in the age- and sex-matched Italian population. METHODS: Hospitalization, intensive care unit (ICU) admission, and death after COVID-19 diagnosis of 1,362 patients with MS were compared with the age- and sex-matched Italian population in a retrospective observational case-cohort study with population-based control. The observed vs the expected events were compared in the whole MS cohort and in different subgroups (higher risk: Expanded Disability Status Scale [EDSS] score > 3 or at least 1 comorbidity, lower risk: EDSS score ≤ 3 and no comorbidities) by the χ2 test, and the risk excess was quantified by risk ratios (RRs). RESULTS: The risk of severe events was about twice the risk in the age- and sex-matched Italian population: RR = 2.12 for hospitalization (p < 0.001), RR = 2.19 for ICU admission (p < 0.001), and RR = 2.43 for death (p < 0.001). The excess of risk was confined to the higher-risk group (n = 553). In lower-risk patients (n = 809), the rate of events was close to that of the Italian age- and sex-matched population (RR = 1.12 for hospitalization, RR = 1.52 for ICU admission, and RR = 1.19 for death). In the lower-risk group, an increased hospitalization risk was detected in patients on anti-CD20 (RR = 3.03, p = 0.005), whereas a decrease was detected in patients on interferon (0 observed vs 4 expected events, p = 0.04). DISCUSSION: Overall, the MS cohort had a risk of severe events that is twice the risk than the age- and sex-matched Italian population. This excess of risk is mainly explained by the EDSS score and comorbidities, whereas a residual increase of hospitalization risk was observed in patients on anti-CD20 therapies and a decrease in people on interferon.

COVID-19/epidemiology , COVID-19/physiopathology , Multiple Sclerosis/epidemiology , Adult , COVID-19/immunology , COVID-19/therapy , Cohort Studies , Comorbidity , Female , Hospitalization/statistics & numerical data , Humans , Intensive Care Units/statistics & numerical data , Italy/epidemiology , Male , Middle Aged , Multiple Sclerosis/immunology , Multiple Sclerosis/physiopathology , Retrospective Studies , Risk Factors , Severity of Illness Index
Biomed Res Int ; 2021: 2624860, 2021.
Article in English | MEDLINE | ID: covidwho-1484096


BACKGROUND: People with multiple sclerosis (MS) suffer from symptoms related to neural control, such as reduced central activation, lower muscle activity, and accentuated spasticity. A forced 9-week home confinement related to COVID-19 in Spain may have worsened these symptoms. However, no study has demonstrated the impact of home confinement on neuromuscular mechanisms in the MS population. This study was aimed at analyzing the effects of a 9-week home confinement on central activation, muscle activity, contractile function, and spasticity in MS patients. METHODS: Eighteen participants were enrolled in the study. Left and right knee extensor maximum voluntary isometric contraction (MVIC), maximal neural drive via peak surface electromyography (EMG) of the vastus lateralis, central activation ratio (CAR), and muscle contractile function via electrical stimulation of the knee extensor muscles, as well as spasticity using the pendulum test, were measured immediately before and after home confinement. RESULTS: Seventeen participants completed the study. CAR significantly decreased after lockdown (ES = 1.271, p < 0.001). Regarding spasticity, there was a trend to decrease in the number of oscillations (ES = 0.511, p = 0.059) and a significant decrease in the duration of oscillations (ES = 0.568, p = 0.038). Furthermore, in the left leg, there was a significant decrease in the first swing excursion (ES = 0.612, p = 0.027) and in the relaxation index (ES = 0.992, p = 0.001). Muscle contractile properties, MVIC, and EMG variables were not modified after confinement. CONCLUSIONS: The results suggest that a home confinement period of 9 weeks may lead to an increase in lower limb spasticity and a greater deficit in voluntary activation of the knee extensors.

COVID-19 , Multiple Sclerosis/physiopathology , Muscle, Skeletal/physiopathology , Communicable Disease Control , Electric Stimulation , Electromyography , Female , Humans , Isometric Contraction , Knee/physiology , Male , Middle Aged , Muscle Contraction , Muscle Spasticity , Muscle, Skeletal/physiology , Quadriceps Muscle/physiology
CNS Drugs ; 35(7): 743-767, 2021 07.
Article in English | MEDLINE | ID: covidwho-1296980


Recombinant interferon (IFN) ß-1b was approved by the US Food and Drug Administration as the first disease-modifying therapy (DMT) for multiple sclerosis (MS) in 1993. Since that time, clinical trials and real-world observational studies have demonstrated the effectiveness of IFN therapies. The pivotal intramuscular IFN ß-1a phase III trial published in 1996 was the first to demonstrate that a DMT could reduce accumulation of sustained disability in MS. Patient adherence to treatment is higher with intramuscular IFN ß-1a, given once weekly, than with subcutaneous formulations requiring multiple injections per week. Moreover, subcutaneous IFN ß-1a is associated with an increased incidence of injection-site reactions and neutralizing antibodies compared with intramuscular administration. In recent years, revisions to MS diagnostic criteria have improved clinicians' ability to identify patients with MS and have promoted the use of magnetic resonance imaging (MRI) for diagnosis and disease monitoring. MRI studies show that treatment with IFN ß-1a, relative to placebo, reduces T2 and gadolinium-enhancing lesions and gray matter atrophy. Since the approval of intramuscular IFN ß-1a, a number of high-efficacy therapies have been approved for MS, though the benefit of these high-efficacy therapies should be balanced against the increased risk of serious adverse events associated with their long-term use. For some subpopulations of patients, including pregnant women, the safety profile of IFN ß formulations may provide a particular benefit. In addition, the antiviral properties of IFNs may indicate potential therapeutic opportunities for IFN ß in reducing the risk of viral infections such as COVID-19.

Adjuvants, Immunologic/therapeutic use , Interferon beta-1a/therapeutic use , Multiple Sclerosis/drug therapy , Antiviral Agents/therapeutic use , COVID-19/drug therapy , Humans , Injections, Intramuscular , Multiple Sclerosis/diagnostic imaging , Multiple Sclerosis/physiopathology , SARS-CoV-2 , Treatment Outcome
Int J Mol Sci ; 22(8)2021 Apr 08.
Article in English | MEDLINE | ID: covidwho-1178285


Vaccines work by stimulating the immune system, and their immunogenicity is key in achieving protection against specific pathogens. Questions have been raised whether in Multiple Sclerosis (MS) patients they could induce disease exacerbation and whether vaccines could possibly act as a trigger in the onset of MS in susceptible populations. So far, no correlation has been found between the vaccinations against influenza, hepatitis B, tetanus, human papillomavirus, measles, mumps, rubella, varicella zoster, tuberculosis, yellow fever, or typhoid fever and the risk of MS. Further research is needed for the potential protective implications of the tetanus and Bacillus Calmette-Guerin vaccines in MS patients. Nowadays with the emerging coronavirus disease 2019 (COVID-19) and recent vaccinations approval and arrival, the risk-benefit in MS patients with regards to safety and efficacy of COVID-19 vaccination in those treated with immunosuppressive therapies is of paramount importance. In this manuscript, we demonstrate how different vaccine types could be related to the immunopathogenesis of MS and discuss the risks and benefits of different vaccinations in MS patients.

COVID-19 Vaccines/adverse effects , COVID-19 Vaccines/immunology , COVID-19/prevention & control , Multiple Sclerosis/immunology , Multiple Sclerosis/physiopathology , Vaccination/adverse effects , COVID-19/complications , Humans , Molecular Targeted Therapy/methods , Multiple Sclerosis/complications , Multiple Sclerosis/drug therapy , Vaccination/methods
Phys Med Rehabil Clin N Am ; 32(2): 239-251, 2021 05.
Article in English | MEDLINE | ID: covidwho-1057217


Amyotrophic lateral sclerosis and multiple sclerosis are neurodegenerative diseases requiring interdisciplinary rehabilitation services to maximize function, manage symptoms, prevent complications, and promote higher quality of life. Distance and disability may pose barriers to access of subspecialized care. Telehealth is one solution to facilitate access and was rapidly expanded during the COVID-19 pandemic. This article details the utility of telehealth services across the disease spectrum-including to establish a diagnosis, monitor progression for ongoing management, and identify and manage symptoms and provide therapy interventions. The challenges and promise of telehealth services for clinical care and research will be explored.

Amyotrophic Lateral Sclerosis/physiopathology , Amyotrophic Lateral Sclerosis/therapy , Multiple Sclerosis/physiopathology , Multiple Sclerosis/therapy , Telemedicine/methods , COVID-19/epidemiology , Health Services Accessibility , Humans , Pandemics , Patient Care Team , Physical Examination , SARS-CoV-2
Arq. neuropsiquiatr ; 78(9): 570-575, Sept. 2020. tab
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-808491


ABSTRACT Background: This study reported on a variety of psychological reactions related to anxiety, sleep quality, depression, fatigue, and quality of life in individuals with multiple sclerosis (MS), related to the Covid-19 quarantine experience. Objective: The aim of this study was to investigate the neuropsychiatric effects of the COVID-19 pandemic in MS patients and to analyze the risk factors contributing to psychological stress. Methods: The study was designed as a prospective, cross-sectional survey study. Multiple assessment tools that are used in neurological practice, including Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Fatigue Impact Scale (FIS), Pittsburgh Sleep Quality Index (PSQI), and Multiple Sclerosis Quality of Life-54 (MSQOL-54) were administered prospectively both during the early and the peak stages of COVID-19 outbreak (ESO and PSO, respectively). The survey forms were designed using SurveyMonkey and the participants were participating in the survey via a web link and QR code. Results: Fifty patients were included in the study. BDI scores, PSQI and FSI measurements, cognitive and social subscale scores and total FIS score, MSQOL-54 measurements, physical and mental subscale scores, and total MSQOL-54 score at PSO were significantly different than those at ESO. The body mass index values of the patients increased significantly at PSO compared to those measured at ESO. Conclusions: The results provide a basis for the development of psychological interventions that could minimize the prevalence of sleep disorders and depression and could improve patients' quality of life during the outbreak.

RESUMO Introdução: Este estudo relatou uma variedade de reações psicológicas relacionadas a ansiedade, qualidade do sono, depressão, fadiga e qualidade de vida em indivíduos com esclerose múltipla (EM), relacionadas à experiência de quarentena de COVID-19. Objetivo: O objetivo deste estudo foi investigar os efeitos neuropsiquiátricos da pandemia de Covid-19 em pacientes com EM e analisar os fatores de risco que contribuem para o estresse psicológico. Métodos: O estudo foi desenhado como um estudo prospectivo e transversal. Várias ferramentas de avaliação usadas na prática neurológica, incluindo Inventário de Depressão de Beck (Beck Depression Inventory - BDI), Inventário de Ansiedade de Beck (Beck Anxiety Inventory - BAI), Escala de Impacto de Fadiga (Fatigue Impact Scale - FIS), Índice de Qualidade de Sono de Pittsburgh (Pittsburgh Sleep Quality Index - PSQI) e Qualidade de Vida da Esclerose Múltipla-54 (Multiple Sclerosis Quality of Life-54 - MSQOL-54) foram administrados prospectivamente durante o estágio inicial do surto de COVID-19 (EIS) e o estágio de pico do surto de COVID-19 (EPS). Os formulários da pesquisa foram projetados usando o SurveyMonkey e os participantes participaram da pesquisa por meio de um link da web e código QR. Resultados: Foram incluídos 50 pacientes no estudo. Os escores BDI, PSQI, FSI, subescala cognitiva e social e escore total do FIS, MSQOL-54, subescala física e mental e MSQOL-54 total no PSO foram significativamente diferentes dos do EIS. Os valores do índice de massa corporal dos pacientes aumentaram significativamente na EPS em comparação com os medidos na EIS. Conclusões: Nossos resultados são uma base para o desenvolvimento de intervenções psicológicas que podem minimizar a prevalência de distúrbios do sono e depressão e melhorar a qualidade de vida dos pacientes durante o surto.

Humans , Pneumonia, Viral/psychology , Quality of Life/psychology , Social Isolation/psychology , Stress, Psychological , Coronavirus Infections/psychology , Depression/psychology , Multiple Sclerosis/psychology , Pneumonia, Viral/epidemiology , Cross-Sectional Studies , Prospective Studies , Coronavirus Infections , Coronavirus Infections/epidemiology , Depression/etiology , Pandemics , Betacoronavirus , Multiple Sclerosis/physiopathology