COVID 19 in patients with Neurological Disorders. What to remember ?




In this exceptional time, when the whole world is suffering with the pandemic of COVID 19 and mankind is suffering, it is of utmost importance that we take adequate precautions and try not to get the infection ourselves or transmit it to others. Having a neurological disorder might not actually increase the risk of catching COVID 19 infection for all the patients. But there are few subgroups of patients who are at increased risk of catching infection and might suffer severe outcomes of the disease. The virus does not differentiate between individuals but having a weak immune system or pre-existing comorbidities might create worse outcomes in a patient.

Let us answer the questions that might be coming to your mind pertaining to the disease and the risk categorisation of anyone with a prior neurological disorder.

Q. Are patients with neurological problems at increased risk for catching the infections?

A. Not all patients with neurological disorders are at increased risk of catching COVID 19 disease.

Rather most patients would be at the same risk as the general population. Factors that increase the risk of catching and worsening the outcome of the infection are :

  1. Patient who are elderly > 60 years of age

  2. Patients who have previous comorbidities like Hypertension and Diabetes

  3. Patient who has previous respiratory conditions

  4. Neurological Patients who are frail, bedridden , unable to take care of themselves and their personal hygiene

  5. Patients who have disability esp in terms of swallowing and respiratory muscle weakness

  6. Patients with autoimmune disorders Multiple sclerosis / Demyelinating diseases/ inflammatory myositis, Inflammatory neuropathies, Myasthenia gravis especially who are on immunosuppressive medicines like steroids or Disease modifying therapies

  7. Patients who have certain Muscle disorders like myopathies, Dystrophies due to weakness in the respiratory muscle and coexisting cardiac diseases that are quite Prevalent in them

  8. Patient who recently had Hematopoietic Stem cell transplantation

  9. Patient who have acute exacerbation or acute episode of their primary neurological problem

  10. Patients with seizure disorder/ epilepsy may have a recurrence in case of high fever.

Q. Would the medicines that I am taking affect my immune system ?

A. Most of the medicine would not affect the risk for COVID 19 disease or its outcomes. But patients who have autoimmune disorder ( diseases where patients have auto antibodies ) are on immune modulating medicines like steroids, Interferons, monoclonal antibodies. These medicines might increase the risk of catching viral infections. However, please do not leave/change your medication on your own. Discuss with your doctor and take all due precautions.

Q. Is Coronavirus likely to trigger neurological diseases ?

A. All viruses are known to create changes in the body and may trigger a number of problems that may affect us. Corona virus is similar to other viruses in that aspect. There have been unconfirmed reports of coronavirus infection precipitating stroke, but there are only few cases like that.

Q. How can we manage Coronavirus Infection ?

A. Prevention is the best way to manage viral infections. Patients who are at high risk of catching infection should take all the precautions to avoid catching the infection. All patients should follow social distancing. Association of British Neurologists recommend patients who come under the high risk category of catching the infection and facing its outcomes should follow self-isolation. ( Ref :

Self isolation is a concept that you should behave as if you already have the infection. Staying in isolation and segregating from the rest of the family, not sharing your bed-sheets, towel, bathrooms, utensils, adequate and repeated hand washing are vital components of self isolation. It is recommended that you should self isolate for 12 weeks at least at this point of time.

Management is supportive at present and includes management of the respiratory symptoms. A lot of clinical trials are underway for antiviral medicines but no proven therapy is available at present. In case you catch the infection, you should consult your primary care giver for all management strategies that are available. And please self isolate your self if you catch infection.

Q. What should I do if I have symptoms ?

A. If you start having any loss of smell, fever, sore throat, difficulty in breathing, bodyache, headache, please consult your physician or a respiratory physician . He/ She might order some imaging of the lung and some blood tests and throat swab to check whether you have COVID 19. At home, self isolate yourself. Do not expose others to the disease. Most of the patients have mild flu like illness but caution and isolation is still needed. Stay in touch with your physician who would need to follow you up for any deterioration.

Q. Should I stop my regular medicines ?

A. At any point of time, consult your primary healthcare provider for managing your ongoing medicines. Do not stop medicines after reading from online websites and forums. That might do more harm as the context of giving you medicine might not be available on these websites.

Q. Is there any medication that would interact with COVID 19 management ?

A. There are significant interactions of the medicine that are being given for COVID 19 and other medicines, especially cardiac side effects might increase with few medicines. Please share the information of the medicines that you are taking with your healthcare provider who is managing you for COVID 19.



Author :

Dr Sweta Singla

Consultant Neurology

Kalpavriksh Superspeciality Center

Dwarka

Delhi


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