Table 2.

Summary of the impact of COVID-19 on chronic neurological conditions and recommendations for their management.

Non-acute neurological condition	Impact of COVID-19 infection/crisis	Recommendations/guidelines for management by professional bodies/health authorities	Recommendations by REPROGRAM consortium
Multiple sclerosis	Reduced availability of services in the COVID-19 crisis Risk due to an immunocompromised state	Guidelines by some Multiple Sclerosis associations released on disease-modifying treatments (DMTs)	Telemedicine Consider long-term association with brain atrophy
Neuromuscular disorders (including Motor Neuron Disease)	At higher risk due to bulbar or respiratory weakness, may already require breathing assistance Higher risk of pneumonia Clinical trials halted Loss of trust in caregivers	Maintenance of breathing equipment Adequate supply of medication, essential items, and feeding tube supplies Strict social distancing, avoiding non-essential travel Ensure continuity of care through communication with caregivers	Use online order facilities Neurologists should be cognizant of interruptions to clinical trials
Epilepsy	Overrepresentation in LMIC Risk of fever-triggered seizures Possible mobility and cognitive disabilities	Do not cease antiepileptic medications Discussions with physicians about any current immunosuppressants Epilepsy Foundation guidelines	Rationing of non-acute neurological testing including cancellation of elective epilepsy monitoring could be explored Individual case-mix and case-by-case approach preferred Government should consider allowing pharmacists to refill epilepsy scripts during COVID-19
Parkinson's Disease and other movement disorders	Often elderly, vulnerable population Possible bulbar and respiratory issues Cognitive impairments could impact compliance Infections may lead to sudden motor and behavioral changes	Healthcare workers must have knowledge on PD and be prepared for delirium Masks and eye protection should be worn during Botox® procedures	Physicians should recognize that anosmia is already a PD symptom Nursing and care homes need to ensure PD patients stay quarantined Elective procedures (PEG, FUT, and DBS) should be postponed IPG battery replacements should still be performed Tele-exercise and tele-physiotherapy should be utilized
Migraine and severe headache	Require frequent outpatient consultations	Use Telemedicine	Minimize all non-emergent procedures If physical consultation is required, ensure telephone, and front-desk screening for COVID-19
Stroke	Residual impairments including dysphagia May be elderly with the comorbid disease Pneumonia risk	FAST protocol Protected-code stroke	Medication regime needs no change Use of telemedicine Triage, rapid assessment, and infection screening REPROGRAM Acute Stroke Pathway for broad spectrum of acute neurological emergencies including stroke and transient ischemic attack
Guillain-Barré Syndrome	Possible parainfectious profile Post-infection complication Potential for life-long disability and CIDP Maybe immunosuppressed	GBS and CIDP patients are only deemed at higher risk if on immunosuppressants	Tight surveillance of any accelerated increases in GBS diagnosis after the COVID-19 crisis rests
Neuro-virological manifestations	Involvement of ACE2 receptor, neurological involvement	Limited or non-specific guidelines	Monitor inflammatory markers and signs of neuroinflammation Monitor COVID-19 patients for any neurological change Neurologists could consider COVID-19 infection as a risk factor when encountering patients with new neurological manifestations in future
Autism and pediatric neurological conditions	Disruption to daily life and managing children at home	Autism Speaks guidelines	Limit elective pediatric surgeries Proactively identify patients at risk of progressing from semi-urgent to urgent

Prepared by the authors based on the evidence from the studies discussed in the paper.

DMT, disease-modifying treatments; LMIC, low- and middle-income countries; CIDP, Chronic Inflammatory Demyelinating Polyneuropathy; COVID-19, severe acute respiratory syndrome coronavirus 2; ACE2, angiotensin-2 converting enzyme; PD, Parkinson's Disease.