Impact and Challenges of the COVID-19 Pandemic on Patients Requiring Botulinum Toxin A Treatment

Pajo, Azalea T.; Espiritu, Adrian I.; Jamora, Roland Dominic G.

doi:10.14802/jmd.20088

Cited by 3 publications

(4 citation statements)

References 21 publications

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“…[9][10][11] In some cases, a bridging therapy may be offered, while awaiting face to face consultations, such as those done in movement disorders. 12 Corollary to teleneurology and teleconsultation, the government has allowed the use of electronic prescriptions, where a PDF/JPEG file of the prescription may be used by the patient when buying their medicines. 13 This proved helpful for patients for which continuity of medications are essential such as those with epilepsy, dystonia, stroke, dementia, and Parkinson's disease.…”

Section: Discussionmentioning

confidence: 99%

Impact and Challenges to the Neurology Residency Training in The Medical City During the COVID-19 Pandemic

Geronimo¹,

Maylem²,

Maria³

et al. 2021

Acta Med Philipp

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Introduction. The COVID-19 pandemic presented an extraordinary challenge to the operations of private hospitals involved in neurological residency training. Numerous adaptations were made to restructure the hospital, including the special units and diagnostic centers. Teaching and training activities were swiftly transitioned to online platforms and research activities were streamlined. Manpower allocation into teams with active duties followed by mandatory quarantine periods became the norm.Objective. To evaluate the effect of the COVID-19 pandemic on the neurology training program by comparing two periods: pre-pandemic and pandemic periods.Methods. We reviewed the changes implemented by the hospital in response to the pandemic. We also looked into our residency training program pre-pandemic and the subsequent changes instituted to adapt to the pandemic.Results. Due to the community quarantine imposed by the government, there was a drastic drop by as much as 70.5% in the out-patient census, 38.4% in the in-patient census, and 46.9% in neurodiagnostic (electroencephalography and electrodiagnostic medicine). The residents were reorganized into three teams of 4 residents, further divided into COVID and non-COVID rotations for 5 days straight duty. Consultants were also stratified into high-risk (on-call for emergency referrals in a work-from-home scheme) and non-high-risk (COVID patient rounds). Teleconsultation was likewise utilized. Academic activities were shifted to blended online learning. Conclusion.There was a need to reorganize resident staffing brought about by the hospital changes as well, to ensure safety during the pandemic. The pandemic has forced us to shift to alternative methods of teaching and examination, such as teleneurology. Regular assessments and adjustments to the training program will need to be done to adapt to an evolving situation.

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Section: Discussionmentioning

confidence: 99%

Impact and Challenges to the Neurology Residency Training in The Medical City During the COVID-19 Pandemic

Geronimo¹,

Maylem²,

Maria³

et al. 2021

Acta Med Philipp

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“…This survey shows how strongly the closure of a botulinum toxin outpatient clinic in Austria and thereby prolonged interinjection intervals affected patients’ symptom reoccurrence and their QoL. Case reports and surveys from Italy, the USA, Germany, and the Philippines have already shown the negative influence of COVID-19-related delays of BoNT-A injections on patients suffering from dystonia, spasticity, or migraine (Dressler and Adib Saberi 2020 ; Ali 2020 ; Ranza et al 2020 ; Erro et al 2021 ; Santamato et al 2021 ; Tarantino et al 2021 ; Samadzadeh et al 2021 ; Pajo et al 2021 ). This is underlined by 75–91% of patients perceiving the security of long-term BoNT-A therapy as very important and 76–98% which felt their patient rights not respected by COVID-19 counter measures (this study, Dressler and Adib Saberi 2020 ; Tarantino et al 2021 ).…”

Section: Discussionmentioning

confidence: 99%

“…Our results emphasize the importance of ensuring the individual BoNT-A interinjection intervals for these patients. This has to be guaranteed even in circumstances such as the COVID-19 pandemic and can be achieved with security measures minimizing the risk of infection (Pajo et al 2021 ; Baricich et al 2020 ).…”

Section: Discussionmentioning

confidence: 99%

COVID-19-related delays of botulinum toxin injections have a negative impact on the quality of life of patients with dystonia and spasticity: a single-center ambulatory care study

et al. 2021

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Background Botulinum toxin A (BoNT-A) is considered a safe and effective treatment for spasticity and dystonia. Individual interinjection intervals are critical for the maintenance of the effect. In Austria, BoNT outpatient clinics were shutdown from November to December 2020 during COVID-19 control measures, leading to rescheduling of BoNT-A injections. This survey aimed at investigating the influence of injection delays on symptoms, physical functioning, and quality of life (QoL) of the affected patients. Methods Between April and July 2021, 32 outpatients (21 females, mean age: 63.4 ± 12.1 years) treated ≥ 12 months at the BoNT outpatient clinic Horn-Allentsteig (Austria) and experienced ≥ 2 week injection delays, completed a structured face-to-face questionnaire. Results Indications were dystonia (34%), spasticity (63%), and hyperhidrosis (3%). Injections were delayed by 10 weeks (median, range: 2–15). Muscle cramps increased in 95% of patients with spasticity, muscle twitches in 91% of those with dystonia, and pain in 9% and 60% for dystonia and spasticity, respectively. Overall, 75% reported functional worsening, and deterioration in QoL by 62.6% ± 16.8 (mean ± SD). The impact on QoL correlated with the subjective global improvement induced by BoNT-A (Rs: 0.625; p < 0.001). For 75%, long-term assurance of BoNT-A therapy was very important, and 81% felt their patient rights not respected. Conclusions COVID-19-related delays in BoNT-A injections illustrate the importance of this therapy for symptom relief, functional outcome, and QoL in patients suffering from involuntary muscle hyperactivity. BoNT-A therapy is essential and has to be guaranteed even in circumstances such as the COVID-19 pandemic.

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“…7 BoNT treatment sessions have been postponed during the ECQ, and most of these patients received treatment sessions beyond the efficacy window for BoNT injections. [8][9][10] As the government started easing the quarantine, outpatient clinics gradually resumed with guidelines in place. 11,12 However, in-hospital clinics that provide services requiring face-to-face consult, such as the movement disorders clinic, continue to operate with a lean workforce.…”

Section: Introductionmentioning

confidence: 99%

Botulinum Toxin Treatment Practice Recommendations for Movement Disorders Clinics During the COVID-19 Pandemic

2021

Acta Med Philipp

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Background. Due to the Coronavirus disease 2019 (COVID-19) pandemic, non-emergency services like botulinum toxin A (BoNT) injections were temporarily discontinued.Objective. We aimed to create standard practices that optimize the management of patients needing BoNT injections while ensuring both patients' and healthcare professionals' safety.Methods. We evaluated published guidelines and best practices to determine their applicability for BoNT injection during this pandemic. We then devised a decision tree algorithm for use in our hospital. Results.A decision tree algorithm has been formulated based on patient evaluation and risk stratification, triaging, the urgency of the procedure, and proper precautions on personal protective wear as appropriate for the procedure's risk stratification. Conclusion.The algorithm is in place to ensure the safety of both the patient and healthcare professional. It can be adopted and revised by other centers to suit their clinic needs.

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Impact and Challenges of the COVID-19 Pandemic on Patients Requiring Botulinum Toxin A Treatment

Cited by 3 publications

References 21 publications

Impact and Challenges to the Neurology Residency Training in The Medical City During the COVID-19 Pandemic

Impact and Challenges to the Neurology Residency Training in The Medical City During the COVID-19 Pandemic

COVID-19-related delays of botulinum toxin injections have a negative impact on the quality of life of patients with dystonia and spasticity: a single-center ambulatory care study

Botulinum Toxin Treatment Practice Recommendations for Movement Disorders Clinics During the COVID-19 Pandemic

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