Abstract
The spread of the COVID-19 pandemic has imposed significant challenges on healthcare provision, requiring changes in the conventional patient management, particularly in chronic diseases like multiple sclerosis (MS). To increase patient safety and reduce the risk of infection, while ensuring an appropriate and regular follow-up, tele-medicine gained prominence as a valid alternative to face-to-face appointments. However, the urgency of the implementation and the lack of experience in most MS centers led to “ad hoc” and extremely diverse approaches, which now merit to be standardized and refined. Indeed, while tele-consultation cannot fully replace face-to-face visits, it certainly can, and will, be incorporated as part of the routine care of MS patients in the near future. Bearing this in mind, the Portuguese Multiple Sclerosis Study Group (GEEM) has developed a set of recommendations for the usage of tele-medicine in the management of MS patients, both during the pandemic and in the future. The consensus was obtained through a two-step modified Delphi methodology, resulting in 15 recommendations, which are detailed in the manuscript.
Highlights
Multiple sclerosis (MS) is a chronic degenerative disorder of the central nervous system of auto-immune origin [1] that affects 2.8 million persons worldwide and 0.142% of Europeans [2]
In Portugal, the first case was registered on March 2, and 14 days later, the Ministry of Health determined that all nonurgent care provision should be canceled, redirecting all efforts to fight COVID-19 [7]
The set of recommendations reflects the experience of relevant physicians in multiple sclerosis (MS) management in Portugal
Summary
Multiple sclerosis (MS) is a chronic degenerative disorder of the central nervous system of auto-immune origin [1] that affects 2.8 million persons worldwide and 0.142% of Europeans [2]. MS Management Recommendations During Pandemic symptoms, adverse events and relapses, a neurological examination, and a review and discussion of any ancillary examinations performed [4] Given their importance for the optimal control of the disease, patient education regarding diet, physical exercise, smoking, and other lifestyle factors should take place at each visit [4]. This document is a collection of best practices developed by neurologists with strong expertise in MS and was developed bearing in mind that tele-medicine will inevitably be, to a greater or lesser extent, incorporated in the routine care of MS patients in the near future This is not a formal and exhaustive guideline document, it is expected that this expert consensus may provide some guidance to physicians in the best approach to use telemedicine in MS patients. Patient monitoring changes Disease dashboards Self-reporting monitoring tools Relapse procedure
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