An Italian Neurology Outpatient Clinic Facing SARS-CoV-2 Pandemic: Data From 2,167 Patients

Abstract

Neurological sequelae of SARS-CoV-2 infection have already been reported, but there is insufficient data about the impact of the pandemic on the management of the patients with chronic neurological diseases. We aim to analyze the effect of COVID-19 pandemic and social restriction rules on these fragile patients. Methods: Patients with chronic neurologic diseases routinely followed at the outpatient clinic of Gemelli University Hospital, Rome, were assessed for symptoms suggestive of SARS-CoV-2 infection in the pandemic period, consequences of social restrictions, and neurological disease features, concomitant medical conditions, current medical and disease-specific treatments. Data source: a dedicated telephone survey designed to encompass questions on COVID-19 symptoms and on pandemic effects in chronic neurologic conditions. Results: Overall, 2,167 individuals were analyzed: 63 patients reported contact with COVID-19 positive cases, 41 performed the swab, and 2 symptomatic patients tested positive for COVID-19 (0.09%). One hundred fifty-eight individuals (7%) needed urgent neurological care, deferred due to the pandemic; 641 patients (30%) suspended hospital treatments, physiotherapy or other support interventions; 405 individuals (19%) reported a subjective worsening of neurological symptoms. Conclusions: In our population, the presence of neurological chronic diseases did not increase the prevalence of COVID-19 infection. Nevertheless, the burden of neurological disorders has been worsened by the lockdown.

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“… Regione Puglia and from Italian Ministry of Health (Ricerca Corrente), and Regione Puglia and CNR for Tecnomed Puglia per la Medicina di Precisione 4 Chronic neurological diseases Piano et al. (2020) 30 Italy An Italian Neurology Outpatient Clinic Facing SARS-CoV-2 Pandemic: Data From 2167 Patients Cross-sectional study Analyze the effect of COVID-19 pandemic and social restriction rules on patients with chronic neurological diseases. 2167 patients with chronic neurological diseases, such as ALS (4%), dystonia (5%), multiple sclerosis (9%), myopathies (17%), Parkinson’s disease (12%), stroke (11%) … Patients experienced subjective worsening of neurological condition (19%; 48% for ALS patients), suspension of hospital treatments or physiotherapy (30%; 97% for dystonia patients), difficulty finding medications (4%; 8% for Parkinson and Huntington patients) and a need for urgent consultation (7%; 14% for ALS patients), at different degrees depending on their disease.…”

“…Nine of the eleven selected studies were cross-sectional studies, 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 one was a prospective study 37 and one was a retrospective descriptive study. 38 Six studies were conducted in Europe, 28 , 30 , 31 , 33 , 35 , 37 one worldwide, 29 one in China, 38 one in the United States and Canada, 32 one in Serbia 34 and one in Montenegro.…”

“…Nine of the eleven selected studies were cross-sectional studies, 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 one was a prospective study 37 and one was a retrospective descriptive study. 38 Six studies were conducted in Europe, 28 , 30 , 31 , 33 , 35 , 37 one worldwide, 29 one in China, 38 one in the United States and Canada, 32 one in Serbia 34 and one in Montenegro. 36 Regarding the diagnosis of the included populations, three studies included stroke survivors, 29 , 31 , 38 one included individuals with amyotrophic lateral sclerosis (ALS), 28 four included individuals with multiple sclerosis, 32 , 34 , 36 , 37 one included individuals with chronic neurological diseases, 30 one included individuals with chronic pain 35 and one included individuals with neuromuscular disease.…”

“…38 Six studies were conducted in Europe, 28 , 30 , 31 , 33 , 35 , 37 one worldwide, 29 one in China, 38 one in the United States and Canada, 32 one in Serbia 34 and one in Montenegro. 36 Regarding the diagnosis of the included populations, three studies included stroke survivors, 29 , 31 , 38 one included individuals with amyotrophic lateral sclerosis (ALS), 28 four included individuals with multiple sclerosis, 32 , 34 , 36 , 37 one included individuals with chronic neurological diseases, 30 one included individuals with chronic pain 35 and one included individuals with neuromuscular disease. 29 , 31 , 32 , 33 Four studies were focussed on the perception of healthcare workers and health centers.…”

“… Outcomes Population Reported by ICF components Description Environmental factors Transportation services, systems and policies Insufficient ambulance resources were a potential reason for decreased stroke admission Stroke 38 Stroke centers Insufficient public transportation was a potential reason for decreased stroke admission Stroke 38 Stroke centers Health services, systems and policies Discontinuation of physiotherapy because of Covid-19 pandemic restrictions Amyotrophic Lateral Sclerosis 28 and chronic neurological diseases 30 Patients 28 , 30 and caregivers 28 Suspension of hospital treatments Chronic neurological diseases 30 Patients Need for urgent consultation Chronic neurological diseases 30 Patients Concerned they could not go to the hospital as usual. Relapsing-remitting multiple sclerosis (RRMS) 34 Patients Fear of coming to regular check-ups with their doctors because of the COVID-19 pandemic RMMS 36 Patients Not all patients were receiving their usual care in their centers Stroke 31 Stroke professionals The areas of stroke care considered as being the most affected by the current situation were rehabilitation and acute stroke care Stroke 31 Stroke professionals 1% of respondents said that, within chronic diseases, the st...…”