Bardia Nourbakhsh, MAS, MD, on Managing MS During the Pandemic: DMTs, Telemedicine, and More

In this video, Bardia Nourbakhsh, MAS, MD, gives an overview of how COVID-19 has changed how he and his colleagues see and treat multiple sclerosis patients in their tertiary specialty care center, and the challenges that have arisen throughout the pandemic.

Additional Resource:

• National MS Society. MS treatment guidelines during coronavirus. Accessed September 2, 2020. https://www.nationalmssociety.org/coronavirus-covid-19-information/multiple-sclerosis-and-coronavirus/ms-treatment-guidelines-during-coronavirus

Bardia Nourbakhsh, MAS, MD, is a board-certified neurologist and an assistant professor of neurology at Johns Hopkins Medicine in Baltimore, Maryland.

TRANSCRIPT:

I'm Bardia Nourbakhsh. I'm an assistant professor of neurology at Johns Hopkins University. Today, I'm going to talk a little bit about the effect of COVID-19 pandemic on our practice as a tertiary specialty MS center.

As you can imagine, since the beginning of the pandemic, many of our patient encounters have changed to telemedicine. So, before the pandemic, a very small proportion of our visits were through telemedicine, and it changed to almost be exclusively telemedicine in the first few months after the beginning of the pandemic. And now, I and many of my colleagues–we have a combination of in-person visits and telemedicine, depending on multiple factors–for example, if this is a new patient who needs evaluation or is it a follow-up, if we think that an in-person neurological examination is an important part of evaluation or not.

Also, regulatory and legal issues play a role. For example, despite relaxation of regulation about seeing patients across state lines, still there are many states that we are not able to see patients through telemedicine, If the patient is located in those states. So, we still need to see them in person. Fortunately, I have to say that it has worked really well, and we have been able to provide high-quality care to most of our patients during the pandemic and despite all these difficulties.

I also wanted to talk a little bit about the effect of the pandemic on our MS patients. So, I would say, one of the direct effects that I've seen very commonly has been the effect of isolation and lack of access to care, including physical therapy, that has led to deconditioning and apparent worsening of the disease of many patients with more advanced disease. Also, as you can imagine, MS being an autoimmune disease and many patients receiving immunomodulatory or immunosuppressive treatments, it was a big question for all patients if MS or the medication they are taking for MS affects their risk regarding contracting COVID-19 or experiencing more severe disease.

This has been difficult question to answer, but based on mostly expert opinion and several observational studies, I can tell that having MS by itself does not seem to increase the risk of contracting COVID-19 or having more severe course of the disease. However, patients who have more severe disability due to MS or patients who have comorbid conditions associated with MS might be at increased risk for the disease or experiencing a more severe course of the disease.

Also, the effect of DMTS are extremely valuable. And, I do not have high-quality evidence to speak about a specific type of DMT, but as you can imagine, probably more immunosuppressive disease-modifying treatments may, and again I have to emphasize, only may increase the risk of the disease or having a more severe course. On the other hand, some medications like interferons which have been tested or are being tested as treatments for COVID-19 may in fact have prophylactic effects or reduce the risk of having more severe disease. Again, all these statements are based on expert opinions or relatively small observational studies, and we do not have high-quality evidence at this point to make a firm statement.

Another point I wanted to make was the effect of the pandemic on delaying care. So, I have had several patients since the beginning of the pandemic that–they didn't seek medical attention when they experienced a multiple sclerosis relapse or, several patients that developed MS symptoms for the first time, and because of the concern of coming to medical facilities, they delayed their diagnostic testing or seeking medical attention at the first time. You can imagine, probably, those issues resulted in more severe disability that would not have happened if we were not dealing with the pandemic.