Feedback from neurology residents and neuroimmunology fellows about the practical training in multiple sclerosis.

OBJECTIVE: To obtain feedback from Neurology residents and Neuroimmunology fellows about the practical training in multiple sclerosis (MS). METHODS: A survey was developed and administered electronically to Neurology residents or Neuroimmunology fellows that received training in eight large MS outpatient clinics in Brazil, from 2018 to 2021. We evaluated their beliefs on: (1) the optimal number of MS patients evaluated in a 4-hour outpatient clinic session, (2) the quality of dedicated MS medical records, (3) the training of the neurological exam in MS patients, (4) the teaching discussion with the attending neuroimmunologist and (5) the prescription of MS disease-modifying drugs (DMDs). RESULTS: The response rate was 57% (43/76). We found that 4 or 5 MS patients would be optimal during a 4-hour outpatient clinic session. Optimal MS medical records were considered structured and presented in a timeline of disease activity and the history of DMDs. 18 in 43 (42%) respondents felt insecure in performing clinical scales used in MS patients. Discussion with the attending neurologist specialized in Neuroimmunology was considered adequate in only half of the respondents, suggesting a need for improvement in teaching strategies. Almost a quarter of the respondents (11/43, 26%) felt that the prescription of DMDs was complex and challenging. Some respondents suggested that readymade templates could be helpful. CONCLUSION: The number of patients, medical records, use of MS clinical scales, discussion with attending neurologist specialized in MS care, and the prescription of DMDs present room for improvement in MS training for Neurology residents and Neuroimmunology fellows.

Guillain-Barre syndrome following COVID-19 vaccines: A scoping review.

Guillain-Barre syndrome following COVID-19 vaccines (GBSfCV19v) is a reported adverse effect that remains unclear. We present a structured review based on two case reports of GBSfCV19v, a systematic review, and Vaccine Adverse Event Reporting System (VAERS) analysis to estimate the risk and describe the clinical characteristics (CC) of these events. We've searched on MEDLINE and Embase, from the inception to May 20, 2021, using the keywords: "Guillain barre syndrome" and cross-referenced with "covid-19 vaccines." We estimated the risk of GBSfCV19v, comparing it with the risk of GBS following the influenza vaccine (GBSfIv), considering the VAERS sensitivity. The clinical characteristics included: age, sex, comorbidities, type of vaccine, administered dose, clinical onset, deaths, cerebrospinal fluid (CSF), and electromyography (EMG) pattern. We found 43 cases, considering the risk of GBSfCV19v lower than GBSfIv (160-320 cases). The patients had a mean age of 54 years and 23 (56%) were male. The types of vaccines used: Pfizer (22), Moderna (9), AstraZeneca (3), Janssen (3), and Johnson & Johnson (1). 24 cases of GBS occurred after the first dose, with clinical onset of 7 days. CSF albuminocytological dissociation was reported in 7 patients, and EMG revealed a predominant demyelinating pattern. GBSfCV19v risk appears to be lower than what was expected from other respiratory virus vaccines. Most cases of GBS were middle-aged males within a week following the first dose of the COVID-19 vaccine, showing a typical demyelinating neuropathy with albuminocytological dissociation.

Clinical Features of COVID-19 on Patients With Neuromyelitis Optica Spectrum Disorders.

BACKGROUND AND OBJECTIVES: To describe the clinical features and disease outcomes of coronavirus disease 2019 (COVID-19) in patients with neuromyelitis optica spectrum disorder (NMOSD). METHODS: The Neuroimmunology Brazilian Study Group has set up the report of severe acute respiratory syndrome (SARS-CoV2) cases in patients with NMOSD (pwNMOSD) using a designed web-based case report form. All neuroimmunology outpatient centers and individual neurologists were invited to register their patients across the country. Data collected between March 19 and July 25, 2020, were uploaded at the REDONE.br platform. Inclusion criteria were as follows: (1) NMOSD diagnosis according to the 2015 International Panel Criteria and (2) confirmed SARS-CoV2 infection (reverse transcription-polymerase chain reaction or serology) or clinical suspicion of COVID-19, diagnosed according to Center for Disease Control / Council of State and Territorial Epidemiologists (CDC/CSTE) case definition. Demographic and NMOSD-related clinical data, comorbidities, disease-modifying therapy (DMT), COVID-19 clinical features, and severity were described. RESULTS: Among the 2,061 pwNMOSD followed up by Brazilian neurologists involved on the registry of COVID-19 in pwNMOSD at the REDONE.br platform, 34 patients (29 women) aged 37 years (range 8-77), with disease onset at 31 years (range 4-69) and disease duration of 6 years (range 0.2-20.5), developed COVID-19 (18 confirmed and 16 probable cases). Most patients exhibited mild disease, being treated at home (77%); 4 patients required admission at intensive care units (severe cases); and 1 patient died. Five of 34 (15%) presented neurologic manifestations (relapse or pseudoexacerbation) during or after SARS-CoV2 infection. DISCUSSION: Most NMOSD patients with COVID-19 presented mild disease forms. However, pwNMOSD had much higher odds of hospitalization and intensive care unit admission comparing with the general Brazilian population. The frequency of death was not clearly different. NMOSD disability, DMT type, and comorbidities were not associated with COVID-19 outcome. SARS-CoV2 infection was demonstrated as a risk factor for NMOSD relapses. Collaborative studies using shared NMOSD data are needed to suitably define factors related to COVID-19 severity and neurologic manifestations.