Abstract
The COVID-19 pandemic has pushed health systems to their limit and forced readjustment of standards of care for different pathologies. Management of neuromuscular diseases becomes a challenge since most of them are chronic, disabling, progressive, and/or require immunosuppressive drugs. There are three main aspects of COVID-19 that affect neuromuscular diseases care. The first one relates to how SARS-CoV2 directly affects different neuromuscular pathologies. Respiratory weakness, as seen in myasthenia gravis, amyotrophic lateral sclerosis, and myopathies, and the use of immunomodulatory drugs (Myasthenia Gravis and Chronic Inflammatory Demyelinating Polyneuropathy) make this group of patients potentially more vulnerable. Secondly, safety measures also affect proper care, limiting care continuity, and physical rehabilitation (one of the essential aspects of myopathies treatment). Telemedicine can partially solve the problem allowing for a continuum of close care, avoiding unnecessary visits, and even guaranteeing the attention of professionals from tertiary care centers. However, one of the crucial steps in neuromuscular diseases is diagnosis, and in most scenarios, more than one face-to-face visit is needed. Lastly, the global COVID-19 situation will also have an economic impact on patients and their families. This situation is of particular concern given that neuromuscular diseases already present difficulties due to the scarcity of resources in terms of public healthcare and research.
Highlights
The global pandemic situation due to COVID-19 has led to restructuring the management of different diseases
We know that specific functional scales or aspects of physical examination can be performed telematically with strong correlation with their equivalents in face-to-face visits performed by health professionals [47]
NMD patients are a group at risk, either because of respiratory affectation or their condition of immunosuppression
Summary
The global pandemic situation due to COVID-19 has led to restructuring the management of different diseases. Long term corticosteroids is the drug that increase most the risk of infections (20–50%) [23, 24] and are often administered in various NMDs: MG, chronic dysimmune neuropathies, Duchenne/Becker Muscular Dystrophy (DMD/BMD) and patients with spinal muscular atrophy (SMA) treated with Onasemnogene abeparvovec-xioi (steroids must be administered for the first 2 months since the administration of the gene therapy). Prada et al, reported a cohort of 196 patients affected by immune-mediated neuromuscular diseases, with 0.6% laboratory-confirmed COVID-19 infection in those receiving IVIG or subcutaneous immunoglobulins, and 6.4% confirmed infection in those with other immunosuppressive treatment or no treatment This could suggest a protective effect of chronic immunoglobulin therapy in the risk of COVID-19 infection.
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