Basic principles for the management of neurological patients during the COVID-19 pandemic

S V Kopishinskaya,A S Arakelyan,A N Payudis,O V Petruchik,I A Velichko,V V Bucev,N O Zharinova,A A Gasanova,I V Korobejnikov,N G Zhukova

doi:10.17650/2222-8721-2020-10-1-31-42

Abstract

In a COVID-19 pandemic, a neurologist needs to be able to assess the risks of virus infection in patients with individual neurological diseases. The review presents categories of risk groups from the Association of British Neurologists for neuromuscular diseases, multiple sclerosis and other autoimmune diseases of the central nervous system, stroke, epilepsy and Parkinson’s disease. The risk of infection and the management of patients with neuromuscular diseases are analyzed in detail. The use of multiple sclerosis disease modifying drugs, the treatment of stroke patients are discussed. The data from the international guidelines for the management of patients with epilepsy and Parkinson’s disease are presented.

Highlights

ГАУ РО «Областной консультативно-диагностический центр»; Россия, 344010 Ростов-на-Дону, ул
In a COVID-19 pandemic, a neurologist needs to be able to assess the risks of virus infection in patients with individual neurological dise ases
The risk of infection and the mana gement of patients with neuromuscular diseases are analyzed in detail

Summary

Лекции и обзоры

Слабость дыхательных мышц наравне с сопутствующим интерстициальным поражением легких (часто при болезнях соединительной ткани); возможно проведение иммуносупрессии; при полиомиозите и дерматомиозите продолжать терапию кортикостероидами; иногда необходимо увеличить дозу стероидов при острой инфекции; при миозите с включениями противопоказан гидроксихлороквин, как вызывающий вакуолизацию мышечных волокон и усиливающий слабость мышц [3, 10] The active stage of the disease, respiratory muscle weakness along with concomitant interstitial lung damage (often with connective tissue diseases); immunosuppression is possible; with polymyositis and dermatomyositis, continue corticosteroid therapy; sometimes it is necessary to increase the dose of steroids in acute infections; in case of inclusion body myositis, hydroxychloroquine is contraindicated, as it causes vacuolization of muscle fibers and enhances muscle weakness [3, 10]. Дыхательная недостаточность, неинвазивная ИВЛ; гидроксихлороквин с осторожностью, как вызывающий вакуолизацию мышечных волокон и усиливающий слабость мышц [3, 11] Weak cough, respiratory insufficiency, non-invasive MV; hydroxychloroquin with caution, as causing vacuolization of muscle fibers and enhancing muscle weakness [3, 11].

Высокий риск High risk

Особенности использования при инсульте Features of stroke management

Тактика ведения Management

Atherothrombotic stroke and stroke of unknown cause