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Multiple sclerosis during the COVID-19 pandemic

Editorial Note: Currently, data limitations and our lack of understanding about the pathogenesis of COVID-19 present challenges for all clinicians, especially those caring for patients with underlying or comorbid conditions. Across the US, the total number of COVID-19 cases has risen to 32,946 confirmed cases and 417 deaths, as of March 23, 2020, at 9:13 am.1

Q. Based on our current knowledge of COVID-19, are patients with multiple sclerosis (MS) at increased risk for neurological complications due to infection with COVID-19?

Answer

A diagnosis of MS alone does not suggest greater risk for either the virus or neurological complications. And we don’t necessarily think of MS patients as more neurologically vulnerable, at this time. However, some patients living with MS are more vulnerable to infection, such as those living with MS-associated disability (eg, those who rely on wheelchairs) along with individuals who have other known risk factors of advanced age, poorer health, and certain comorbid conditions that apply to the general population. We also know that in some cases, some patients experience an amplification or pseudoexacerbation of their MS symptoms during the course of an infection. However, as far as we know this does not lead to new lesions or otherwise alter the overall MS disease course.

The other considerations for risk in MS are decisions related to the disease-modifying therapies (DMTs) used to treat the disease. Some but not all of these medications may result in immunosuppression. If a patient’s current DMT regimen is altered or delayed to minimize risk of infection, then in some cases, there could be an increased risk for relapse.

Otherwise, there is no information at this time to anticipate that the virus would influence disease course or progression or otherwise lead to unforeseen neurological complications.

Q. As the number of COVID-19 cases globally continues to grow, so does the risk to the most vulnerable patient populations. Furthermore, neither a treatment nor a cure is available at this time. What precautionary and preventive strategies are recommended to reduce the risk of infection in this patient group?

Answer:

As noted, an MS diagnosis itself is not thought to confer high risk. Vulnerable populations that need to be especially cautious and reduce their risk of exposure include individuals who have general risk factors, which include patients who are older, have a higher level of disability, and have certain comorbid conditions. These patients should be sure to carefully follow self-isolation procedures. MS providers are also considering their patients’ DMT regimens and timing of dosing for optimal protection both from the disease and the virus.

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The author has reported no commercial interests occurring within the past 2 years.