Accelerated Early Progression of Amyotrophic Lateral Sclerosis over the COVID-19 Pandemic

Abstract

During the COVID-19 pandemic and the related lockdowns, outpatient follow-up visits for patients with chronic neurological diseases have been suspended. Managing people affected by amyotrophic lateral sclerosis (ALS) has become highly complicated, leaving patients without the standard multidisciplinary follow-up. This study aimed to analyze the impact of the COVID-19 lockdown on ALS disease progression. We compared the clinical data and progression in the first year following diagnosis for patients who received ALS diagnosis during 2020 (G20, N = 34), comparing it with a group of diagnosed in 2018 (G18, N = 31). Both groups received a comparable multidisciplinary model of care in our Tertiary Expert ALS Centre, Novara, Italy. The monthly rate of ALSFRS-R decline during the lockdown was significantly increased in G20 compared to G18 (1.52 ± 2.69 vs. 0.76 ± 0.56; p-value: 0.005). In G20, 47% required non-invasive ventilation (vs. 32% of G18). Similarly, in G20, 35% of patients died vs. 19% of patients in G18 (p-value: 0.01). All results were corrected for gender, age, site of onset, and diagnostic delay. Several factors can be implicated in making ALS more severe, with a faster progression, such as reduced medical evaluations and the possibility of therapeutic changes, social isolation, and rehabilitation therapy suspension.

Keywords: ALSFRS-R; COVID-19; amyotrophic lateral sclerosis; motoneuron disease; pandemic; progression.

Figure 1

Respiratory support for ALS patients in G20 and G18 groups at one-year follow-up. G20: ALS patients with diagnosis in 2020; G18: ALS patients with diagnosis in 2018; NIV: non-invasive ventilation.

Figure 2

Nutritional support for ALS patients in G20 and G18 groups at one-year follow-up. G20: ALS patients with diagnosis in 2020; G18: ALS patients with diagnosis in 2018.

Figure 3

Survival in ALS patients in G20 and G18 groups for the first year of disease. G20: ALS patients with diagnosis in 2020; G18: ALS patients with diagnosis in 2018. Survival means death or tracheostomy. Chi-square test: 6.03, p-value = 0.01.