Letter: Evaluation and Surgical Treatment of Functional Neurosurgery Patients With Implanted Deep Brain Stimulation and Vagus Nerve Stimulation Pulse Generators During the COVID-19 Pandemic

Gross, Robert E.; Buetefisch, Cathrin M.; Miocinovic, Svjetlana; Bullinger, Katie L.; Okun, Michael S.; Ostrem, Jill L.; Foote, Kelly D.; Starr, Phillip A.

doi:10.1093/neuros/nyaa185

Cited by 8 publications

(9 citation statements)

References 17 publications

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“…Changes to programming should be deferred and urgent replacement of batteries should only be considered in those experiencing an increase in generalised seizures. 13…”

Section: Chronic Epilepsymentioning

confidence: 99%

Epilepsy care in the COVID-19 era

2020

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The COVID-19 pandemic will impact on how care for chronic conditions is delivered. We use epilepsy to exemplify how care for patients will be affected, and suggest ways in which healthcare systems can respond to deliver the most effective care. Where face-to-face outpatient appointments have been cancelled, telemedicine can facilitate remote clinical consultations for new and follow-up epilepsy clinic patients while reducing the risk of infection to both patients and healthcare staff. First-seizure patients will need investigation pathways rationalised, while those with chronic epilepsy will need to have reliable alternative avenues to access clinical advice. At the same time, neurologists should support emergency departments and acute medical units, advising on appropriate management of seizures and other acute neurological presentations. Ultimately, the revolution in our clinical practice is unlikely to cease after this pandemic, with reconfiguration of services likely to bring improvements in efficiency and convenience, and a reduced environmental impact.

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“…Changes to programming should be deferred and urgent replacement of batteries should only be considered in those experiencing an increase in generalised seizures. 13…”

Section: Chronic Epilepsymentioning

confidence: 99%

Epilepsy care in the COVID-19 era

2020

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“…Considering the significantly lower frequency of EP carried out due to radicular pain during the first wave of the pandemic, there is obviously a demand for sufficient conservative pain management as a valid treatment alternative for patients with degenerative diseases of the spine suffering from radicular pain. Regular follow-up visits for patients with incidentalomas, optimized treatment plans for patients eligible to receive functional neurosurgery [ 17 ], and early initiation of measures to promote timely discharge of patients, such as individualized discharge planning, and transitional care interventions [ 18 ], may become increasingly relevant as the pandemic proceeds. In particular, timely discharge of patients may help to have more beds available for COVID-19 patients during the pandemic [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

The Demand for Elective Neurosurgery at a German University Hospital during the First Wave of COVID-19

et al. 2020

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Background: Patients’ fear of the coronavirus disease 2019 (COVID-19) may delay inevitable treatment, putting potential benefits at risk. This single-center retrospective study aims to analyze temporal relationships of the first wave of the COVID-19 pandemic in Germany with the number of patients who sought and received elective neurosurgical treatment at a German university hospital. Methods: Daily outpatient numbers (ON) and elective procedures (EP) were recorded at our department between 1 January 2020 and 30 June 2020 (baseline: between 1 January 2019 and 30 June 2019). In patients who received EP, we recorded indication, outcome, and length of stay (LOS). Moving averages of ON (MAON) and of EP were calculated. Data on governmental action taken in response to the pandemic and on coronavirus-positive cases in Germany (CPCG) were superimposed. Exponential and arc tangent curves (ATC) were fitted to the absolute numbers of CPCG. Phase shifts were estimated, and Spearman’s rank correlation coefficient, rho, was calculated between the 2020 MAON and the derivative function of the fitted ATC (DFATC). Wilcoxon rank sum served as statistical test. Significance was assumed with p values of less than 0.05. Results: ON were significantly decreased in April 2020 as compared to April 2019 (p = 0.010). A phase shift between the German lockdown, the DFATC, and the decrease in MAON was not detected, while a phase shift of 10 days between the DFATC and the subsequent increase in MAON was detected. The DFATC was significantly negatively correlated (rho = −0.92, p < 0.0001) to the MAON until 31 March 2020, and, when shifted by 10 days, the DFATC was significantly negatively correlated (rho = −0.87, p < 0.0001) to the MAON from 01 April 2020. EP (p = 0.023), including the subset of non-oncological EP (p = 0.032), were significantly less performed in the first half of 2020 as compared to the first half of 2019. In March and April 2020, we conducted significantly more EP due to motor deficits (p = 0.0267, and less), visual disturbances (p = 0.0488), and spinal instability (p = 0.0012), and significantly less EP due to radicular pain (p = 0.0489), as compared to March and April 2019. LOS ranked significantly higher in patients who received cranial or spinal EP in March and April 2020 as compared to March and April 2019 (p = 0.0497). Significant differences in outcome were not observed. Conclusion: The beginning of the COVID-19 pandemic was correlated to an immediate and significant decrease in ON, and to a significant decrease in the number of EP performed. The subsequent increase in ON was delayed. Adequate measures to promote timely discharge of patients may become increasingly relevant as the pandemic proceeds. Although we observed a shift in the range of indications towards significantly more EP in patients with neurological deficiencies, care should be taken to avoid potentially deleterious delays of necessary elective treatment in future pandemic situations.

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“…While deep brain stimulation procedures were initially delayed at the onset of the pandemic given their elective status, this has shifted as safety protocols for elective procedures were implemented. Gross et al [10] provide recommendations for addressing potential neurosurgical risks during COVID-19 and as such, will not be reviewed here. Patients receiving DBS are carefully selected given symptom severity and ability to adhere to the treatment protocol.…”

Section: Deep Brain Stimulationmentioning

confidence: 99%

Expert opinion in obsessive-compulsive disorder: Treating patients with obsessive-compulsive disorder during the COVID-19 pandemic

Candelari

Wojcik

Wiese

et al. 2021

Personalized Medicine in Psychiatry

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This commentary outlines assessment and treatment of patients with OCD during the era of COVID-19. The ongoing COVID-19 pandemic has required providers to make important considerations in treatment, including how usual risk is defined, as well as the use of personal protective equipment and telehealth services. These considerations have allowed providers to continue using both reliable and valid assessment procedures, as well as previously established and efficacious interventions. These adjustments create a context in which patient care for OCD remains fundamentally unchanged; however, important considerations should still be made because of the COVID-19 pandemic.

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Letter: Evaluation and Surgical Treatment of Functional Neurosurgery Patients With Implanted Deep Brain Stimulation and Vagus Nerve Stimulation Pulse Generators During the COVID-19 Pandemic

Cited by 8 publications

References 17 publications

Epilepsy care in the COVID-19 era

Epilepsy care in the COVID-19 era

The Demand for Elective Neurosurgery at a German University Hospital during the First Wave of COVID-19

Expert opinion in obsessive-compulsive disorder: Treating patients with obsessive-compulsive disorder during the COVID-19 pandemic

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