Guidance for the care of neuromuscular patients during the COVID-19 pandemic outbreak from the French Rare Health Care for Neuromuscular Diseases Network

Rev Neurol (Paris). 2020 Jun;176(6):507-515. doi: 10.1016/j.neurol.2020.04.004. Epub 2020 Apr 20.

Abstract

In France, the epidemic phase of COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began in February 2020 and resulted in the implementation of emergency measures and a degradation in the organization of neuromuscular reference centers. In this special context, the French Rare Health Care for Neuromuscular Diseases Network (FILNEMUS) has established guidance in an attempt to homogenize the management of neuromuscular (NM) patients within the French territory. Hospitalization should be reserved for emergencies, the conduct of treatments that cannot be postponed, check-ups for which the diagnostic delay may result in a loss of survival chance, and cardiorespiratory assessments for which the delay could be detrimental to the patient. A national strategy was adopted during a period of 1 to 2months concerning treatments usually administered in hospitalization. NM patients treated with steroid/immunosuppressants for a dysimmune pathology should continue all of their treatments in the absence of any manifestations suggestive of COVID-19. A frequently asked questions (FAQ) sheet has been compiled and updated on the FILNEMUS website. Various support systems for self-rehabilitation and guided exercises have been also provided on the website. In the context of NM diseases, particular attention must be paid to two experimental COVID-19 treatments, hydroxycholoroquine and azithromycin: risk of exacerbation of myasthenia gravis and QT prolongation in patients with pre-existing cardiac involvement. The unfavorable emergency context related to COVID-19 may specially affect the potential for intensive care admission (ICU) for people with NMD. In order to preserve the fairest medical decision, a multidisciplinary working group has listed the neuromuscular diseases with a good prognosis, usually eligible for resuscitation admission in ICU and, for other NM conditions, the positive criteria suggesting a good prognosis. Adaptation of the use of noninvasive ventilation (NIV) make it possible to limit nebulization and continue using NIV in ventilator-dependent patients.

Keywords: COVID-19; Guidelines; Management; Neuromuscular; Treatment.

Publication types

  • Practice Guideline

MeSH terms

  • Angiotensin Receptor Antagonists / therapeutic use
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Anti-Bacterial Agents / therapeutic use
  • Antimalarials / therapeutic use
  • Azithromycin / therapeutic use
  • Betacoronavirus*
  • COVID-19
  • Cardiorespiratory Fitness
  • Coronavirus Infections / drug therapy
  • Coronavirus Infections / epidemiology*
  • Emergency Treatment
  • France / epidemiology
  • Glycogen Storage Disease Type II / therapy
  • Hospitalization
  • Humans
  • Hydroxychloroquine / therapeutic use
  • Immune System Diseases / therapy
  • Immunoglobulins, Intravenous / therapeutic use
  • Immunosuppressive Agents / therapeutic use
  • Muscular Atrophy, Spinal / drug therapy
  • Neuromuscular Diseases / therapy*
  • Oligonucleotides / therapeutic use
  • Pandemics*
  • Physical Therapy Modalities
  • Pneumonia, Viral / drug therapy
  • Pneumonia, Viral / epidemiology*
  • Prognosis
  • RNA, Small Interfering / therapeutic use
  • SARS-CoV-2
  • Steroids / therapeutic use
  • Withholding Treatment
  • alpha-Glucosidases / therapeutic use

Substances

  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Anti-Bacterial Agents
  • Antimalarials
  • Immunoglobulins, Intravenous
  • Immunosuppressive Agents
  • Oligonucleotides
  • RNA, Small Interfering
  • Steroids
  • Hydroxychloroquine
  • patisiran
  • nusinersen
  • Azithromycin
  • GAA protein, human
  • alpha-Glucosidases