Cardiac conduction and/or rhythm abnormalities (CCRA) are the most frequent and life-threatening complications in DM1. In order to determine prevalence, incidence, characteristics, age of onset and predictors of CCRA, CCRA progression and sudden cardiac death (SCD) in DM1, we collected ECG/24hECG-Holter data from a yearly updated 34-year database of a cohort of 103 DM1 patients without cardiac abnormalities at baseline, followed for at least 1 year. Fifty-five patients developed CCRA [39 developed conduction abnormalities (CCA) and 16 rhythm abnormalities (CRA)], which progressed in 22. Nine had SCD. Risk and incidence of CCRA amounted to 53.4 and 6.83% person-years (CCA: 37.9 and 4.8%; CRA 15.5 and 2%), respectively; risk and incidence of SCD amounted to 8.74 and 0.67% person-years, respectively. CTG expansion represented a predictor of CCRA incidence (HR 1.10, p = 0.04), CCRA progression (HR 1.28, p = 0.001) and SCD (HR 1.39, p = 0.002). MIRS progression during follow-up was associated with CCRA prevalence (OR 5.82, p = 0.004); older age and larger CTG expansion to SCD prevalence (OR 2.67, p = 0.012; OR 1.54, p = 0.005). Age of CCRA onset and CCRA progression was significantly lower in patients with larger CTG expansion and in those with MIRS progression. Age when SCD occurred was significantly lower in patients with larger CTG expansion. Amongst recorded cardiac abnormalities, both atrial flutter (OR 8.70; p = 0.031) and paroxysmal supraventricular tachycardia (OR 8.67; p = 0.040) were associated with SCD. Although all DM1patients may develop cardiac abnormalities at any time in their life, patients older than 30 years with larger CTG expansion and MIRS progression in particular should be carefully monitored via periodical ECG.

There was no funding for this study. SECTION 1On March 2020, a 49-year-old white Caucasian man was admitted in our emergency department due to a one-week history of fever (39-40 °C) and cough. His past medical history included arterial hypertension and a testicular seminoma in 2011 treated with surgery and platinum-based chemotherapy. Laboratory tests revealed increased C-reactive protein, mild lymphopenia and thrombocytopenia. Chest CT showed multifocal ground-glass opacities and nasopharyngeal swab was positive for severe acute respiratory coronavirus 2 (SARS-COV-2), leading to a diagnosis of Coronavirus Disease 2019 . The patient was hospitalized and treatment with hydroxychloroquine, lopinavir/ritonavir and ceftriaxone was started.Four days later, his respiratory function rapidly worsened, requiring transfer to intensive care unit (ICU) and mechanical ventilation (MV). Despite early clinical stabilization, attempts of

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Objective To estimate the incidence and describe clinical characteristics and outcome of GBS in COVID-19 patients (COVID19-GBS) in one of the most hit regions during the first pandemic wave, Lombardia. Methods Adult patients admitted to 20 Neurological Units between 1/3–30/4/2020 with COVID19-GBS were included as part of a multi-center study organized by the Italian society of Hospital Neuroscience (SNO). Results Thirty-eight COVID19-GBS patients had a mean age of 60.7 years and male frequency of 86.8%. CSF albuminocytological dissociation was detected in 71.4%, and PCR for SARS-CoV-2 was negative in 19 tested patients. Based on neurophysiology, 81.8% of patients had a diagnosis of AIDP, 12.1% of AMSAN, and 6.1% of AMAN. The course was favorable in 76.3% of patients, stable in 10.5%, while 13.2% worsened, of which 3 died. The estimated occurrence rate in Lombardia ranges from 0.5 to 0.05 GBS cases per 1000 COVID-19 infections depending on whether you consider positive cases or estimated seropositive cases. When we compared GBS cases with the pre-pandemic period, we found a reduction of cases from 165 to 135 cases in the 2-month study period in Lombardia. Conclusions We detected an increased incidence of GBS in COVID-19 patients which can reflect a higher risk of GBS in COVID-19 patients and a reduction of GBS events during the pandemic period possibly due to a lower spread of more common respiratory infectious diseases determined by an increased use of preventive measures.

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A wide range of neurological manifestations have been reported during the COVID-19 pandemic, including a variety of Parkinsonian cases. The association of numerous viruses with the development of persistent or transient Parkinsonism has been well-documented. We observed a patient who developed a levodopa non-responsive Parkinsonian syndrome with dysautonomia during a prolonged stay at home for COVID-19. Although the temporal proximity of the emerging Parkinsonian features with a COVID-19 diagnosis suggested a causal relationship, we considered the possibility of a coincidental occurrence of multiple system atrophy. We discuss the patient's clinical features in relation to the established clinical diagnostic criteria and review differential diagnoses as well as the role of SARS-CoV-2 infection.