Background:
Epidemiologic studies on coronavirus disease 2019 (COVID-19) in patients with multiple sclerosis (pwMS) have focused on the first waves of the pandemic until early 2021.
Objectives:
We ...aimed to extend these data from the onset of the pandemic to the global coverage by vaccination in summer 2022.
Methods:
This retrospective, multicenter observational study analyzed COVISEP registry data on reported COVID-19 cases in pwMS between January 2020 and July 2022. Severe COVID-19 was defined as hospitalization or higher severity.
Results:
Among 2584 pwMS with confirmed/highly suspected COVID-19, severe infection rates declined from 14.6% preomicron wave to 5.7% during omicron wave (p < 0.001). Multivariate analysis identified age (odds ratio (OR) = 1.43, 95% confidence interval (CI) = 1.25–1.64 per 10 years), male sex (OR = 2.01, 95% CI = 1.51–2.67), obesity (OR = 2.36, 95% CI = 1.52–3.68), cardiac comorbidities (OR = 2.36, 95% CI = 1.46–3.83), higher Expanded Disability Status Scale (EDSS) scores (OR = 2.09, 95% CI = 1.43–3.06 for EDSS 3–5.5 and OR = 4.53, 95% CI = 3.04–6.75 for EDSS ⩾6), and anti-CD20 therapies (OR = 2.67, 95% CI = 1.85–3.87) as risk factors for COVID-19 severity. Vaccinated individuals experienced less severe COVID-19, whether on (risk ratio (RR) = 0.64, 95% CI = 0.60–0.69) or off (RR = 0.32, 95% CI = 0.30–0.33) anti-CD20.
Discussion:
In pwMS, consistent risk factors were anti-CD20 therapies and neurological disability, emerging as vital drivers of COVID-19 severity regardless of wave, period, or vaccination status.
IMPORTANCE: Risk factors associated with the severity of coronavirus disease 2019 (COVID-19) in patients with multiple sclerosis (MS) are unknown. Disease-modifying therapies (DMTs) may modify the ...risk of developing a severe COVID-19 infection, beside identified risk factors such as age and comorbidities. OBJECTIVE: To describe the clinical characteristics and outcomes in patients with MS and COVID-19 and identify factors associated with COVID-19 severity. DESIGN, SETTING, AND PARTICIPANTS: The Covisep registry is a multicenter, retrospective, observational cohort study conducted in MS expert centers and general hospitals and with neurologists collaborating with MS expert centers and members of the Société Francophone de la Sclérose en Plaques. The study included patients with MS presenting with a confirmed or highly suspected diagnosis of COVID-19 between March 1, 2020, and May 21, 2020. EXPOSURES: COVID-19 diagnosed with a polymerase chain reaction test on a nasopharyngeal swab, thoracic computed tomography, or typical symptoms. MAIN OUTCOMES AND MEASURES: The main outcome was COVID-19 severity assessed on a 7-point ordinal scale (ranging from 1 not hospitalized with no limitations on activities to 7 death) with a cutoff at 3 (hospitalized and not requiring supplemental oxygen). We collected demographics, neurological history, Expanded Disability Severity Scale score (EDSS; ranging from 0 to 10, with cutoffs at 3 and 6), comorbidities, COVID-19 characteristics, and outcomes. Univariate and multivariate logistic regression models were used to estimate the association of collected variables with COVID-19 outcomes. RESULTS: A total of 347 patients (mean SD age, 44.6 12.8 years, 249 women; mean SD disease duration, 13.5 10.0 years) were analyzed. Seventy-three patients (21.0%) had a COVID-19 severity score of 3 or more, and 12 patients (3.5%) died of COVID-19. The median EDSS was 2.0 (range, 0-9.5), and 284 patients (81.8%) were receiving DMT. There was a higher proportion of patients with a COVID-19 severity score of 3 or more among patients with no DMT relative to patients receiving DMTs (46.0% vs 15.5%; P < .001). Multivariate logistic regression models determined that age (odds ratio per 10 years: 1.9 95% CI, 1.4-2.5), EDSS (OR for EDSS ≥6, 6.3 95% CI. 2.8-14.4), and obesity (OR, 3.0 95% CI, 1.0-8.7) were independent risk factors for a COVID-19 severity score of 3 or more (indicating hospitalization or higher severity). The EDSS was associated with the highest variability of COVID-19 severe outcome (R2, 0.2), followed by age (R2, 0.06) and obesity (R2, 0.01). CONCLUSIONS AND RELEVANCE: In this registry-based cohort study of patients with MS, age, EDSS, and obesity were independent risk factors for severe COVID-19; there was no association found between DMTs exposure and COVID-19 severity. The identification of these risk factors should provide the rationale for an individual strategy regarding clinical management of patients with MS during the COVID-19 pandemic.
Les encéphalopathies auto-immunes (EAI) comptent parmi les diagnostics difficiles en neurologie. De découverte récente, elles ont vu leurs contours, sémiologiques et biologiques, évoluer ces ...dernières années, avec la découverte de nouveaux auto-anticorps ciblant spécifiquement des épitopes du système nerveux central. Ainsi une nouvelle classification a été proposée, reposant sur la localisation neuronale de l’antigène ciblé et non plus sur l’existence potentielle d’un syndrome paranéoplasique. Le neurologue doit ainsi savoir amener dans sa démarche diagnostique cette hypothèse. Les auteurs, à partir d’observations didactiques d’EAI, avec participation du public, se proposent de partager leur expérience devant cette approche diagnostique délicate, laquelle inclura une démarche clinique et anamnestique, d’une part, iconographique et surtout immunologique, d’autre part.
Il n’y a pas à ce jour dans la littérature de recommandations sur la prise en charge des patients se présentant pour des céphalées non traumatiques en urgence.
Ce travail évalue l’intérêt d’un ...protocole de prise en charge diagnostique de patients adultes admis dans un service d’urgences pour des céphalées non traumatiques comme motif principal d’admission.
Cent vingt-trois dossiers ont été recueillis aux urgences de l’hôpital d’instruction des armées Desgenettes du 01/02/013 au 30/01/2014. L’étude a comporté deux périodes successives de six mois, la première sans intervention spéciale sur cette thématique (P1), la seconde après mise en application d’un protocole de prise en charge (P2). Les trois paramètres étudiés pour juger de l’apport du protocole étaient le nombre de scanners cérébraux effectués, le nombre d’hospitalisations et le nombre d’avis spécialisés demandés.
Le nombre de scanners a augmenté après protocole (de 21,5 % à 33,5 % : p=0,15), mais son utilisation semble plus pertinente (23,5 % anormaux avant ; 33,5 % après : p=0,72). Le recours à l’examen complémentaire utile semble améliorer en cas de céphalée secondaire vitale. Le nombre d’avis spécialisés n’a pas diminué (16,5 % à 14,5 % : p=0,73) mais avec moins d’avis neurologiques. Le nombre d’hospitalisations n’a pas été modifié (11,5 % contre 12,5 % après, p=0,86).
L’utilisation d’un protocole diagnostique pour la prise en charge des céphalées non traumatiques de l’adulte aux urgences d’un CHG dans Lyon n’a pas mis en évidence une différence statistiquement significative sur le nombre de scanners cérébraux réalisés, d’avis spécialisés demandés ou d’hospitalisations. Mais des tendances sont observées et un effectif de patients plus important aurait permis de les rendre significatives.
L’application d’un protocole, qui à terme pourrait devenir score prédictif, a permis d’augmenter la sensibilité diagnostique des céphalées secondaires vitales, redoutées par l’urgentiste sans augmenter significativement le recours aux scanners.
Post-traumatic stress disorder is an adjustment disorder combining psychological and physical symptoms. Faced with the pain associated with post-traumatic stress disorder, it is important to know how ...to differentiate between the pain linked to the physical injury at the time of the traumatic event and the psychogenic pain. Identifying these pains and studying their aetiology, combined with an assessment of the patient's psychological state and life history, enables multi-disciplinary care to be put in place to improve the patient's prognosis and can help to improve recognition of these disorders.
PDF
