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01-12-2021 | Myasthenia Gravis | COVID-19

Myasthenia gravis and telemedicine: a lesson from COVID-19 pandemic

Authors: Dario Ricciardi, Silvia Casagrande, Francesco Iodice, Bianca Orlando, Francesca Trojsi, Giovanni Cirillo, Marinella Clerico, Marco Bozzali, Letizia Leocani, Gianmarco Abbadessa, Giuseppina Miele, Gioacchino Tedeschi, Simona Bonavita, Luigi Lavorgna, on behalf of the Digital Technologies, Web, Social Media Study Group of the Italian Society of Neurology

Published in: Neurological Sciences | Issue 12/2021

Abstract

COVID-19 pandemic has induced an urgent reorganization of the healthcare system to ensure continuity of care for patients affected by chronic neurological diseases including myasthenia gravis (MG). Due to the fluctuating nature of the disease, early detection of disease worsening, adverse events, and possibly life-threatening complications is mandatory. This work analyzes the main unresolved issues in the management of the myasthenic patient, the possibilities offered so far by digital technologies, and proposes an online evaluation protocol based on 4 simple tests to improve MG management. Telemedicine and Digital Technology might help neurologists in the clinical decision-making process of MG management, avoiding unnecessary in presence consultations and allowing a rational use of the time and space reduced by the pandemic.

WHO Director-General’s opening remarks at the media briefing on COVID-19 - 11 March 2020. https://www.who.int/directorgeneral/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020

Buonsenso D, Iodice F, Sorba Biala J, Goletti D (2021) COVID-19 effects on tuberculosis care in Sierra Leone. Pulmonology 27:67–69. https://doi.org/10.1016/j.pulmoe.2020.05.013

Brigo F, Bonavita S, Leocani L et al (2020) Telemedicine and the challenge of epilepsy management at the time of COVID-19 pandemic. Epilepsy Behav 110:107164. https://doi.org/10.1016/j.yebeh.2020.107164CrossRefPubMedPubMedCentral

Moccia M, Lanzillo R, Brescia Morra V et al (2020) Assessing disability and relapses in multiple sclerosis on tele-neurology. Neurol Sci 41:1369–1371. https://doi.org/10.1007/s10072-020-04470-xCrossRefPubMed

Bonavita S, Tedeschi G, Atreja A, Lavorgna L (2020) Digital triage for people with multiple sclerosis in the age of COVID-19 pandemic. Neurol Sci 41:1007–1009. https://doi.org/10.1007/s10072-020-04391-9CrossRefPubMed

International MG/COVID-19 Working Group, Jacob S, Muppidi S et al (2020) Guidance for the management of myasthenia gravis (MG) and Lambert-Eaton myasthenic syndrome (LEMS) during the COVID-19 pandemic. J Neurol Sci 412:116803. https://doi.org/10.1016/j.jns.2020.116803CrossRefPubMedCentral

Anand P, Slama MCC, Kaku M et al (2020) COVID-19 in patients with myasthenia gravis. Muscle Nerve. https://doi.org/10.1002/mus.26918

Rein N, Haham N, Orenbuch-Harroch E et al (2020) Description of 3 patients with myasthenia gravis and COVID-19. J NeurolSci 417. https://doi.org/10.1016/j.jns.2020.117053

Hübers A, Lascano AM, Lalive PH (2020) Management of patients with generalised myasthenia gravis and COVID-19: four case reports. J Neurol Neurosurg Psychiatry 91:1124–1125. https://doi.org/10.1136/jnnp-2020-323565CrossRefPubMed

10.

Ramaswamy SB, Govindarajan R (2020) COVID-19 in refractory myasthenia gravis—a case report of successful outcome. J Neuromuscul Dis 7:361–364. https://doi.org/10.3233/JND-200520CrossRefPubMedPubMedCentral

11.

Gummi RR, Kukulka NA, Deroche CB, Govindarajan R (2019) Factors associated with acute exacerbations of myasthenia gravis. Muscle Nerve 60:693–699. https://doi.org/10.1002/mus.26689CrossRefPubMed

12.

Narayanaswami P, Sanders DB, Wolfe G et al (2021) International consensus guidance for management of myasthenia gravis: 2020 update. Neurology 96:114–122. https://doi.org/10.1212/WNL.0000000000011124CrossRefPubMedPubMedCentral

13.

Meng L, Qiu H, Wan L et al (2020) Intubation and ventilation amid the COVID-19 outbreak: Wuhan’s experience. Anesthesiology 132:1317–1332. https://doi.org/10.1097/ALN.0000000000003296CrossRefPubMed

14.

Kovvuru S, Nalleballe K, Onteddu SR et al (2021) Immunosuppression in chronic autoimmune neurological disorders during the COVID-19 pandemic. J Neurol Sci 420.https://doi.org/10.1016/j.jns.2020.117230

15.

Andersen KM, Mehta HB, Palamuttam N et al (2021) Association between chronic use of immunosuppresive drugs and clinical outcomes from coronavirus disease 2019 (COVID-19) hospitalization: a retrospective cohort study in a large US health system. Clin Infect Dis.https://doi.org/10.1093/cid/ciaa1488

16.

Li Y, Emmett CD, Cobbaert M et al (2021) Knowledge and perceptions of the COVID-19 pandemic among patients with myasthenia gravis. Muscle Nerve 63:357–364. https://doi.org/10.1002/mus.27130CrossRefPubMed

17.

Delly F, Syed MJ, Lisak RP, Zutshi D (2020) Myasthenic crisis in COVID-19. J Neurol Sci 414:116888. https://doi.org/10.1016/j.jns.2020.116888CrossRefPubMedPubMedCentral

18.

Camelo-Filho AE, Silva AMS, Estephan EP et al (2020) Myasthenia gravis and COVID-19: clinical characteristics and outcomes. Front Neurol 11:1053. https://doi.org/10.3389/fneur.2020.01053CrossRefPubMedPubMedCentral

19.

Roy B, Nowak RJ, Roda R et al (2020) Teleneurology during the COVID-19 pandemic: a step forward in modernizing medical care. J Neurol Sci 414:116930. https://doi.org/10.1016/j.jns.2020.116930CrossRefPubMedPubMedCentral

20.

Telehealth and Remote Care. https://www.aan.com/tools-and-resources/practicing-neurologists-administrators/telemedicine-and-remote-care/. Accessed 7 Feb 2021

21.

Guidon AC, Amato AA (2020) COVID-19 and neuromuscular disorders. Neurology 94:959–969. https://doi.org/10.1212/WNL.0000000000009566CrossRefPubMed

22.

Bedlack RS, Simel DL, Bosworth H et al (2005) Quantitative myasthenia gravis score: assessment of responsiveness and longitudinal validity. Neurology 64:1968–1970. https://doi.org/10.1212/01.WNL.0000163988.28892.79CrossRefPubMed

23.

Wolfe GI, Herbelin L, Nations SP et al (1999) Myasthenia gravis activities of daily living profile. Neurology 52:1487–1489. https://doi.org/10.1212/wnl.52.7.1487

24.

Ward EC, Sharma S, Burns C et al (2012) Validity of conducting clinical dysphagia assessments for patients with normal to mild cognitive impairment via telerehabilitation. Dysphagia 27:460–472. https://doi.org/10.1007/s00455-011-9390-9CrossRefPubMed

25.

Morelli N, Rota E, Terracciano C et al (2020) The baffling case of ischemic stroke disappearance from the casualty department in the COVID-19 era. ENE 1–3.https://doi.org/10.1159/000507666

26.

Penner JL, McClement SE, Sawatzky J-AV (2007) Management of dysphagia in advanced oropharyngeal cancer. Int J Palliat Nurs 13:206–212. https://doi.org/10.12968/ijpn.2007.13.5.23498CrossRefPubMed

27.

Guidon AC, Muppidi S, Nowak RJ et al (2021) Telemedicine visits in myasthenia gravis: expert guidance and the Myasthenia Gravis Core Exam (MG-CE). Muscle Nerve.https://doi.org/10.1002/mus.27260

28.

Kukulka K, Gummi RR, Govindarajan R (2020) A telephonic single breath count test for screening of exacerbations of myasthenia gravis: a pilot study. Muscle Nerve 62:258–261. https://doi.org/10.1002/mus.26987CrossRefPubMed

29.

Larson ST, Wilbur J (2020) Muscle weakness in adults: evaluation and differential diagnosis. Am Fam Physician 101:95–108PubMed

30.

Sih M, Soliven B, Mathenia N et al (2017) Head-drop: a frequent feature of late-onset myasthenia gravis. Muscle Nerve 56:441–444. https://doi.org/10.1002/mus.25526CrossRefPubMed

31.

Suiter DM, Leder SB (2008) Clinical utility of the 3-ounce water swallow test. Dysphagia 23:244–250. https://doi.org/10.1007/s00455-007-9127-yCrossRefPubMed

Title: Myasthenia gravis and telemedicine: a lesson from COVID-19 pandemic
Authors: Dario Ricciardi
Silvia Casagrande
Francesco Iodice
Bianca Orlando
Francesca Trojsi
Giovanni Cirillo
Marinella Clerico
Marco Bozzali
Letizia Leocani
Gianmarco Abbadessa
Giuseppina Miele
Gioacchino Tedeschi
Simona Bonavita
Luigi Lavorgna
on behalf of the Digital Technologies, Web, Social Media Study Group of the Italian Society of Neurology
Publication date: 01-12-2021
Publisher: Springer International Publishing
Keywords: Myasthenia Gravis
COVID-19
Telemedicine
Published in: Neurological Sciences / Issue 12/2021
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI: https://doi.org/10.1007/s10072-021-05566-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Myasthenia gravis and telemedicine: a lesson from COVID-19 pandemic

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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