Impact of COVID-19 on neurological patients attending a botulinum toxin service

Abstract

Sir, On January 30, 2020, the World Health Organization (WHO) declared the emergence of a novel coronavirus (here named COVID-19), firstly reported few weeks earlier in Wuhan, Hubei Province of China, as a public health emergency of international concern. Since then, drastic countermeasures including shutdowns of public services have been implemented worldwide to reduce virus transmission: on March 9, 2020, the Italian Prime Minister imposed a national lockdown and ordered all hospitals to stop all non-urgent medical procedures, further aiming to release medical capacities for the management of COVID-19-infected patients. Botulinum neurotoxin (BoNT) is a neurotoxic protein produced by the bacterium Clostridium botulinum, which is used in medical practice with a number of different indications including spasticity, dystonia, and chronic migraine [1]. As BoNT injections are usually given every 3 to 4 months, a large number of patients missed their scheduled treatment during the lockdown. Two initial reports described a significant worsening of this group of patients [2, 3], highlighting the importance of BoNT treatment in the management of these chronic conditions. However, these results arose from uncontrolled studies [2, 3]. We here report the results of a case-control study about the effects of the BoNT outpatient clinic shutdown on its patients and their health-related quality of life (HRQoL). Soon after the ease of the lockdown restrictions in Italy on May 4, 2020, our center offered one BoNT extra-clinic per week to reschedule all willing patients who had missed their appointment because of the service shutdown (from here on named "cases"). Patients attending the BoNT service with their usual schedule in the same period served as controls.

Effects of the onabotulinumtoxinA follow-up delay in migraine course during the COVID-19 lockdown

“…These results are supported by a recent study evaluating the effects of botulinumtoxin delay in patients with other pain conditions such as dystonia, spasticity, or hemifacial spasm, demonstrating the burden of neurological diseases during the lockdown [10]. Moreover, the botulinumtoxin delay in neurological patients has also been related to self-perceived worsening of their condition during the COVID-19 lockdown compared to controls [11]. In the same direction, our results demonstrate that onabotulinumtoxinA delay has also caused downside effects on patients with other chronic pain conditions such as chronic migraine.…”

Physical exercise effects on the brain during COVID-19 pandemic: links between mental and cardiovascular health

“…However, there are many possibilities for exercising at home during a quarantine. The WHO has declared the emergency of COVID-19 on January 30, 2020 [55], and due to the impact of this pandemic on social life and mental health, we suggest that doing a bit of physical exercise is better than doing nothing.…”

The effects of COVID-19 pandemic countermeasures on patients receiving botulinum toxin therapy and on their caregivers: a study from an Italian cohort

“…Erro et al [ 18 ] carried out a case-control study about the effects of the BT outpatient clinic interruption on spastic patients and their health-related quality of life (HRQoL). Soon after the beginning of lockdown’s countermeasures in Italy, 137 patients (94 cases and 43 controls) were asked to rate their perceived worsening from the time of their last treatment using a visual analog scale and a standardized, two-component tool to evaluate their health status.…”

“…They found that the case group reported a mean delay of therapy of about 73 days and a remarkable worsening of their condition than the control group (5.16 ± 3.09 vs 1.83 ± 3.34). Anyway, although the pandemic had important clinical consequences on neurological patients who suspended BT therapy, this evidence was not mirrored by a negative effect on HRQoL [ 18 ].…”