A position statement from the American Academy of Neurology (AAN) recommends teleneurology for nonemergent care of people with chronic neurologic conditions during the COVID-19 pandemic. Published in the May 15, 2020 issue of Neurology, this new ethical guidance recommends use of teleneurology whenever possible to reduce the risk of exposure to the Sars-COV-2 virus.
The AAN also states that for patients with neurologic disease severe enough to warrant hospitalization, such as those with stroke or epilepsy, neurologists must try to maintain the customary standard of care in this complex, new environment.
According to the guidance, some neurologic medications may weaken a person’s immune system, putting them at greater risk of COVID-19. For example, those taking corticosteroids or immunomodulating therapies for multiple sclerosis or myasthenia gravis may be more susceptible to COVID-19.
For times when resources are scarce, the position statement lists criteria for determining how resources should be allocated. Decisions should be based on need, prospect of benefit, best medical evidence, and the balance of personal freedoms with the interests of the entire community.
“People should be counseled by their neurologists on how their nonemergency neurologic condition may change their risk of hospitalization and death due to a COVID-19 infection,” said Michael A. Rubin, MD, University of Texas Southwestern Medical Center. “In the event that hospitals have to triage limited resources, it’s possible that people with advanced neurologic disease may not be offered certain elements of lifesaving care, such as ventilators and ICU beds. To ensure more control in the treatments they receive, people with advanced disease and their loved ones should discuss with their neurologist how reduced resources may impact their care and communicate their care preferences if they were to become seriously ill.”
Tzu-Ying Chuang, MD, PhD, and Dhanashri Miskin, MD
Barbara C. Jobst, MD
Magdalena Szaflarski, PhD