Care for Patients With Neuromuscular Disorders in the COVID-19 Pandemic Era

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has prompted a rapid and unprecedented reorganization of medical institutions, affecting clinical care for patients with chronic neurological diseases. Although there is no evidence that patients with neuromuscular disorders (NMD) confer a higher infection risk of COVID-19, NMD and its associated therapies may affect the patient's ability to cope with infection or its systemic effects. Moreover, there is a concern that patients with chronic NMD may be at increased risk of manifesting severe symptoms of COVID-19. In particular, as respiratory compromises account for the major cause of mortality and morbidity in NMD patients, newly emerging data also show that the risk of exacerbation caused by COVID-19 accumulates in this particular patient group. For example, patients with motor neuron disease and dystrophinopathies often have ventilatory muscle weakness or cardiomyopathy, which may increase the risk of severe COVID-19 infection. Thus, the COVID-19 pandemic may severely affect NMD patients. Several neurological associations and neuromuscular networks have recently guided the impact of COVID-19 on patients with NMD, especially in managing cardiopulmonary involvements. It is recommended that patients with moderate- to high-risk NMD be sophisticatedly monitored to reduce the risk of rapid decline in cardiopulmonary function or potential deterioration of the underlying NMD. However, limited neuromuscular-specific recommendations for NMD patients who contract COVID-19 and outcome data are lacking. There is an urgent need to properly modify the respiratory care method for NMD patients, especially during the COVID-19 pandemic. Conclusively, COVID-19 is a rapidly evolving field, and the practical guidelines for the management of NMD patients are frequently revised. There must be a close collaboration in a multidisciplinary care team that should support their hospital to define a standardized care method for NMD patients during the COVID pandemic. This article reviews evidence-based practical guidelines regarding care delivery, modification, and education, highlighting the need for team-based and interspecialty collaboration.

Clinical and Virological Features of Patients Hospitalized with Different Types of COVID-19 Vaccination in Mexico City

“…The impact of vaccination can be observed in lowering mortality despite having comorbidities [ 35 ]. One example is neuromuscular disorders such as myasthenia gravis, which has a high mortality percentage (44%) in patients with COVID-19—a percentage that was lowered with vaccination with a low risk of adverse events [ 36 , 37 ].…”

Facing Muscular Dystrophy During Covid-19 Pandemic: The Role of Support Associations and Spirituality

“…In contrast with what has just been reported, the participants of this research affirmed they have not encountered specific difficulties in the management of their illness from the point of view of the assistance, since the presence of assistants remained constant during the whole quarantine; only some participants have complained about some problems concerning physiotherapy: this aspect is in line with the existent literature (Gitkind et al, 2020 ). Many patients affected by neuromuscular illnesses have suffered home isolation and the temporary interruption of a part of their medical appointments and ambulatory exams, finding it difficult to receive standard therapies and rehabilitation sessions and facing the risk to see a worsening of their illness or an exacerbation of their symptoms (Bertran Recasens & Rubio, 2020 ; Tseng & Chen, 2021 ).…”

A Comprehensive Review of Neuromuscular Manifestations of COVID-19 and Management of Pre-Existing Neuromuscular Disorders in Children

“…Exacerbations of existing myasthenia gravis have likewise been described in adult patients with COVID-19 [57][58][59]. Additionally, chronic immunosuppressive therapy may increase the risk of infection [37].…”

“…While not universal, pediatric neuromuscular diseases often carry comorbidities that may put patients at risk of severe disease, including cardiomyopathy, restrictive lung disease, impaired cough function, aspiration risk, sleep-disordered breathing, and immunosuppressive drug use [6,37].…”