Abstract

Background: Teleneurology is an effective tool for the rapid evaluation of patients in remote locations with a well-established use in stroke and epilepsy. To date its adoption for Amyotrophic Lateral Sclerosis (ALS) care is still in a preliminary stage. We evaluated the feasibility of multidisciplinary assessment of patients with ALS, using telememedicine during the emergency determined by the COVID-19 pandemic. Methods: All patients included in this survey had received a diagnosis of ALS according to international criteria after a complete clinical and paraclinical assessment during 2019. A structured questionnaire was used by the neurologist with the patient or the caregiver. A video interaction was offered but refused by all patients because they did not feel comfortable or did not have smartphone. Results: Out of 31 clinical interviews 8 were completed directly with the patients and 23 with patients’ caregivers. In a successive survey, most of patients were satisfied with the neurological interview (85%), the possibility to interact directly with the clinician being at home (85%) and reduction of economic and time costs because they avoided unnecessary travel to the clinic. Most of subjects expressed their willingness to continue to be included in remote evaluation programs (90%). Notably, none of the patients presented index symptoms of Covid-19 infection. Conclusion: Our study indicates that telemedicine is a valid tool to triage patients with ALS to increase practice outreach and efficiency. Delivery of care via telemedicine was effective and successful in people with ALS in the dramatic and sudden crisis determined by Covid-19 outbreak.

摘要

背景：远程神经病学是在中风和癫痫病中广泛使用的快速评估偏远地区患者的有效工具。迄今为止，其用于肌萎缩性侧索硬化症（ALS）的护理仍处于初步阶段。我们评估了在COVID-19大流行确定的紧急情况下，使用远程医疗对ALS患者进行多学科评估的可行性。方法：在2019年进行了全面的临床和临床前评估之后，本次调查所包括的所有患者均已根据国际标准诊断为ALS。神经科医生对患者或护理人员使用了结构化问卷。提供了视频互动，但所有患者都拒绝了，因为他们感到不舒服或没有智能手机。结果：在31项临床访谈中，有8项直接与患者完成，23项由患者护理人员完成。在连续的调查中，大多数患者对神经科面试感到满意（85％），可以与在家中的临床医生直接互动（85％），并且减少了经济和时间成本，因为他们避免了不必要的去诊所旅行，因此感到满意。大多数受试者表示愿意继续将其纳入远程评估程序中（90％）。值得注意的是，没有患者表现出Covid-19感染的指数症状。结论：我们的研究表明，远程医疗是对ALS患者进行分类的有效工具，以增加实践范围和效率。在Covid-19爆发所确定的剧烈而突然的危机中，通过远程医疗为ALS患者提供了有效而成功的服务。