In Multiple Sclerosis (MS), time is of the essence as it is an active disease. With the onset of the first symptoms, patients start a life-long race against time, which determines how their life will go and whether and how quickly they will have to face the progressive disability.
Dr hab. n. med. Monika Adamczyk-Sowa, Prof. SUM Head of the Department and Clinic of Neurology, Medical Faculty in Zabrze, Silesian Medical University in Katowice, President of the Multiple Sclerosis and Neuroimmunology Section of the Polish Neurological Society
Some patients, fearing a possible infection, feel that their disease will “wait” for the end of the pandemic. What are the negative consequences of such conduct?
Both patients and doctors found themselves in a difficult position. Regarding this question, we must distinguish between two groups of patients – those who are undiagnosed and those who are already undergoing treatment. As for the first group, in the event of the appearance of typical symptoms of multiple sclerosis, they should immediately consult a neurologist to confirm the diagnosis. If the diagnosis is delayed, and thus the appropriate treatment is implemented, irreversible neurological damage may occur. The second group of patients are patients who already have a diagnosis, but have not yet been included in the immunomodulating therapy, or are already in the drug program, but are afraid of treatment or hospital stay. It is obvious that they should receive treatment as soon as possible, otherwise the symptoms of the disease will get worse. It should be noted that if the therapy is discontinued in patients who, especially in the 2nd line, are treated with more active drugs, the disease may worsen and develop more dramatic symptoms than those that occurred before the start of treatment. Also, definitely in multiple sclerosis, medications must be used regularly. Time in this disease is of great importance – the pandemic will probably stay with us for a long time, and the neurological condition of patients will not wait, but will only worsen.
Multiple sclerosis is said to be a disease with a hundred faces. What symptoms should worry the patient?
Multiple sclerosis is called the Hundred-Faced Disease precisely because symptoms can vary depending on what part of the brain or spinal cord it is occupying. One of the first common symptoms that may be evidence of MS is retrobulbar inflammation of the optic nerve with blurred, blurred vision. Other common symptoms include numbness of the face, limbs, dizziness, balance disorders, and paresis. It is important that in the event of their occurrence, the patient immediately sees a specialist in order to make a proper diagnosis.
Are there medications that can be effective in slowing atrophy?
Brain atrophy is the process of loss of brain tissue and the spinal cord. It occurs with age in everyone, even healthy people, but it progresses much faster in MS patients. Fortunately, there are drugs that effectively inhibit this process. It is important because brain atrophy correlates with the clinical picture, in the form of sphincter disorders, cognitive disorders, or deterioration of gait efficiency. Therefore, the sooner the correct diagnosis is made and the treatment is started, the greater the chance of stabilizing the clinical condition and inhibiting the disease activity.
What are the most serious problems facing patients with MS during the COVID-19 pandemic?
Unfortunately, with the outbreak of the pandemic, patients have limited access to doctors and health care centers, and thus – difficult access to diagnostics. In addition, they have to face difficulties related to moving to appointments or receiving medications. They also do not always have access to information – I think this problem occurs in most centers. In our company in Zabrze, we have it quite well organized, because at the beginning of the pandemic we launched an additional e-mail address and telephone number for patients. As the Multiple Sclerosis and Neuroimmunology Section of the Polish Neurological Society, we also try to disseminate important information, such as what drugs patients can be treated with or what to do in the event of an infection. I think that reaching patients with information is important, and that is what patients need.
The teleports that have been introduced, among others, are of great help in the care of patients. to run drug programs – it made the work of doctors much easier. You should be aware that TV visits will not replace direct contact between the patient and the specialist, however, the use of such a remote option allows the patient to be led in the drug program in a hybrid form.
Prof. dr hab. n. med. Konrad Rejdak, President of the Elect of the Polish Neurological Society
Multiple sclerosis (MS) patients, i.e. people at risk, fear the severe course of coronavirus infection. And they will be afraid more and more as infections increase. What can be advised to such patients?
From the information we have so far, it does not appear that MS patients are more susceptible to SARS-CoV-2 infection. Yes, it is necessary to take into account the increased risk of complications related to brain damage, lower motor activity or coexisting infections, mainly in the urinary tract, which appear in the course of the disease. Therefore, these patients should strictly follow the principles of SARS-CoV-2 infection prophylaxis. It is worth emphasizing, however, that patients with MS are a very disciplined patient group and follow the recommendations quite rigorously. Thanks to this, we do not note an increased incidence of COVID-19 among them.
Another issue is exposure to the drug that MS patients are taking. Here, too, the concerns that immunosuppressive or immunomodulatory drugs may in some way increase the susceptibility to SARS-CoV-2 infection have not been confirmed. The observations show that patients who are actively treated have COVID-19 relatively mildly. It should be noted that neglect of treatment may lead to psychophysical disability, therefore patients should not delay both the initiation and the continuation of treatment.
How important is the time of patient enrollment in the therapeutic process and individualization of treatment in the case of multiple sclerosis?
In the era of the COVID-19 pandemic, there have been signals that many patients postpone treatment on their own or do not want to enter drug programs. It is also a fact that the availability of services has decreased due to the epidemic threat and the closure of many wards. Unfortunately, time is the brain in neurology and treatment should be started as soon as possible after the diagnosis of MS. The more that the therapeutic possibilities are quite wide. Thanks to drugs available to Polish patients, we can not only effectively control the disease, but also stop its progress. Of course, the preparation must be appropriately selected to the patient’s profile and the course of the disease – the greater the disease activity, shown by relapses or changes in magnetic resonance imaging, the stronger the drugs should be used. The patient’s preferences as to the formula of the drug taken are also important – patients have access to both injection and oral preparations, which many patients prefer due to the ease of administration.
The SARS-CoV-2 coronavirus pandemic has proven that telemedicine solutions are an indispensable tool in the treatment of chronically ill patients. Online consultations can also be useful in monitoring patients with multiple sclerosis. What about people who have not yet been diagnosed?
TV shows have their advantages and disadvantages. On the one hand, a neurological patient cannot be consulted only through telemedicine solutions. Often it has to be physically examined – reflexes checked, symptoms confirmed. This is especially true of people who develop new symptoms. In such a situation, the doctor should also perform or order additional tests. That is why it is so important that people with MS symptoms report to a specialist doctor, as in their case viewing is not a sufficient solution. On the other hand, telemedicine can be an extremely valuable supporting method and a good solution in the case of monitoring the effectiveness of therapy, i.e. where we already have a diagnosis and want to reduce the frequency of patient visits without losing sight of him.
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