Review on multiple sclerosis management in times of SARS-CoV-2 pandemic

Georgiana Serban,Rodica Balasa

doi:10.37897/rjn.2020.2.3

Abstract

The emergence of the novel coronavirus, SARS-CoV-2, has startled the entire world and created a genuine chaos inside the medical system. As the infection is spreading, the manifestations are becoming more diverse. The number of SARS-CoV-2-induced neurological cases described in the literature is increasing and the neurologists are experi-encing disturbing times in managing their patients, especially those diagnosed with autoimmune diseases, namely multiple sclerosis (MS). Disease-modifying therapies (DMTs) seem to enhance the susceptibility of MS patients to develop severe form of infections. Therefore, their utilization during COVID-19 pandemic is controversial. This review aims to summarise the available recommendations regarding the neurological management of MS patients, with an emphasis on the changes this pandemic has brought in the MS treatment.

Highlights

The year 2020 will be remembered for a long time as a global challenge to survive SARS-CoV-2 invasion, which has brought a wave of huge changes inside the medical system in each country and unified the entire medical community in a battle against a unique enemy.Coronavirus is a positive-sense RNA virus which has a crown-like appearance under electron microscopy [1]
Two main concerns have emerged during SARSCoV-2 pandemic: first of all, the protection of the elderly who make up the majority of stroke or dementia patients and who are at risk of developing the severe form of infection, and secondly, the treatment of auto-immune diseases, such as multiple sclerosis, which might interfere with the evolution of infection [7]
COVID-19 pandemic has raised a series of uncertainties regarding the management of neurological patients, especially of those diagnosed with

Summary

INTRODUCTION

The year 2020 will be remembered for a long time as a global challenge to survive SARS-CoV-2 invasion, which has brought a wave of huge changes inside the medical system in each country and unified the entire medical community in a battle against a unique enemy. The previous SARS-CoV and MERS-CoV epidemics have allowed the researchers [19,20,21] to analyse the neurological involvement of coronavirus. Coronavirus targets the receptor for angiotensin-converting enzyme 2 (R-ACE2) which is largely expressed throughout the body, including on the endothelium of the blood vessels in the brain This would allow the virus to damage the blood-brain barrier and penetrate the central nervous system [23]. It is yet to be proven if this contributes to respiratory failure in SARS-CoV-2 infections Another important asset of coronavirus is its ability to activate the immune cells and trigger a powerful systemic inflammatory response syndrome which can eventually provoke multiple organs failure. By invading and activating the glial cells, the virus induces an inflammatory state inside the brain, which results in neurological manifestations [23]

VIRAL INFECTIONS IN MS

CONCLUSIONS