COVID-19 and neuromuscular disorders
Abstract
The coronavirus 2019 (COVID-19) pandemic has potential to disproportionately and severely affect patients with neuromuscular disorders. In a short period of time, it has already caused reorganization of neuromuscular clinical care delivery and education, which will likely have lasting effects on the field. This article reviews (1) potential neuromuscular complications of COVID-19, (2) assessment and mitigation of COVID-19-related risk for patients with preexisting neuromuscular disease, (3) guidance for management of immunosuppressive and immunomodulatory therapies, (4) practical guidance regarding neuromuscular care delivery, telemedicine, and education, and (5) effect on neuromuscular research. We outline key unanswered clinical questions and highlight the need for team-based and interspecialty collaboration. Primary goals of clinical research during this time are to develop evidence-based best practices and to minimize morbidity and mortality related to COVID-19 for patients with neuromuscular disorders.
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© 2020 American Academy of Neurology.
Publication History
Received: April 5, 2020
Accepted: April 9, 2020
Published online: April 13, 2020
Published in issue: June 2, 2020
Disclosure
A.C. Guidon has served as a consultant or on a medical advisory board for Alexion, Momenta, and Ra Pharma; has received royalties from Oakstone Publishing; and receives grant funding from the Myasthenia Gravis Foundation of America. A.A. Amato is Associate Editor for Neurology and received royalties from Oakstone Publishing, Neuromuscular Disorders, Harrison's Principles of Internal Medicine, and Up-to-Date, and has served as a consultant or on medical advisory board for Alexion and Argenx. Go to Neurology.org/N for full disclosures.
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We read with interest the comprehensive review by Guidon et al.1 It is given that respiratory compromises cause primary mortality of patients with neuromuscular disorders (NMD); however, we have not seen a more in-depth discussion regarding specific consideration for respiratory management of NMD patients with COVID-19 infection. Recently, the World Muscle Society advised features of NMD patients conferring a higher risk of severe COVID-19, mostly belonging to the pulmonary aspects.2
Modifications of respiratory care in NMD patients during the COVID-19 pandemic are urgently needed. Non-invasive ventilation (NIV) has been proposed as the first-line intervention of acute respiratory failure in NMD patients to avert intubation, shorter ICU stays, and improved survival.3 However, recent studies have restricted the NIV use during the COVID-19 pandemic for the concern of spreading the aerosolized virus.4 The design of a tight-fitting face mask with a viral-proof filter might be a solution. Several innovative designs have been proposed and applied clinically.5
Furthermore, periodic prone positioning is beneficial to improve the oxygenation of patients with COVID-19 complicated with acute respiratory distress syndrome (ARDS).4 However, this position might be challenging for NMD patients who are frequently associated with kyphoscoliosis.2
Nevertheless, COVID-19 is a rapidly evolving field, and the opinion of respiratory management in NMD patients is subject to frequent revision.
Disclosure
The authors report no relevant disclosures. Contact [email protected] for full disclosures.
References