Objective To report initial results of a planned multicenter year‐long prospective study examining the risk and impact of COVID‐19 among persons with neuroinflammatory disorders (NID), particularly multiple sclerosis (MS). Methods In April 2020, we deployed online questionnaires to individuals in their home environment to assess the prevalence and potential risk factors of suspected COVID‐19 in persons with NID (PwNID) and change in their neurological care. Results Our cohort included 1115 participants (630 NID, 98% MS; 485 reference) as of 30 April 2020. 202 (18%) participants, residing in areas with high COVID‐19 case prevalence, met the April 2020 CDC symptom criteria for suspected COVID‐19, but only 4% of all participants received testing given testing shortages. Among all participants, those with suspected COVID‐19 were younger, more racially diverse, and reported more depression and liver disease. PwNID had the same rate of suspected COVID‐19 as the reference group. Early changes in disease management included telemedicine visits in 21% and treatment changes in 9% of PwNID. After adjusting for potential confounders, increasing neurological disability was associated with a greater likelihood of suspected COVID‐19 (OR adj = 1.45, 1.17–1.84). Interpretations Our study of real‐time, patient‐reported experience during the COVID‐19 pandemic complements physician‐reported MS case registries which capture an excess of severe cases. Overall, PwNID seem to have a risk of suspected COVID‐19 similar to the reference population.

We report a fatal case of COVID-19 in a 51-year-old African American woman with multiple sclerosis on natalizumab. She had multiple risk factors for severe COVID-19 disease including race, obesity, hypertension, and elevated inflammatory markers, but the contribution of natalizumab to her poor outcome remains unknown. We consider whether altered dynamics of peripheral immune cells in the context of natalizumab treatment could worsen the cytokine storm syndrome associated with severe COVID-19. We discuss extended interval dosing as a risk-reduction strategy for multiple sclerosis patients on natalizumab, and the use of interleukin-6 inhibitors in such patients who contract COVID-19.

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The WHO Model List of Essential Medicines is a recommended formulary for high-priority diseases based on public health trends and epidemiology patterns. The biennial publication serves as a guide for countries, particularly low-and lower-middle-income countries, to develop their own national essential medicines list (EML), and many nongovernmental organizations base their medication supplies on the WHO EML. Over the last 40 years, WHO has expanded the EML in response to treatment gaps for infectious diseases, pediatrics, palliative care, and cancer. In contrast, neurotherapeutics are poorly represented on the Model List despite the global burden of neurologic disorders, which have continued to increase in the last decade. It is imperative that the neurology community advocate for more evidence-based neurologic medicines on the WHO EML. Equitable access to essential neurologic medicines is a crucial step toward reducing the treatment gap for high-burden neurologic disorders worldwide. Neurology ® 2017;88:e87-e91 GLOSSARY EML 5 essential medicines list; LMIC 5 low-and lower-middle-income countries; NGO 5 nongovernmental organization.The burden of neurologic disorders on the global population continues to increase, particularly in low-and lower-middle-income countries (LMICs).1 The most recent estimates from the Global Burden of Disease Study show that stroke is the second highest cause of mortality and morbidity worldwide.1,2 Migraine, meningitis, and dementia rank in the top 30 causes of disability-adjusted life-years, and epilepsy in the top 50, of 315 diseases and injuries studied. Numerous treatment gaps exist for high-burden neurologic disorders in LMICs, 3 and improved access to essential neurologic medicines deserves prioritization.The WHO publishes its Model List of Essential Medicines in order to guide developing countries in their national drug policies, ensure equitable access to essential medicines, and promote rational use of medicines. The essential medicines concept has inspired over 110 countries to generate a national essential medicines list (EML). In addition, many nongovernmental organizations (NGOs) that facilitate health care in resource-poor settings (e.g., United Nations High Commissioner for Refugees, Médecins Sans Frontières, and International Federation of Red Cross and Red Crescent Societies) accept donations and distribute medicines in accordance with the WHO EML. 4 Medicines selected for the Model List are associated with increased global availability in both the public and private sectors when compared to nonessential medicines. 5 The Model List has grown from 208 medicines in 1977 to over 400 medicines in the 2015 edition. It includes a core list of efficacious, safe, and cost-effective medicines relevant to a basic health care system, and a complementary list of medicines for which specialized diagnostic or monitoring facilities, specialist medical care, or specialist training are needed.6 While the WHO EML has expanded in response to treatment gaps for infectious diseases,...