
==== Front
Basic Clin Neurosci
Basic Clin Neurosci
BCN
Basic and Clinical Neuroscience
2008-126X
2228-7442
Iranian Neuroscience Society

BCN-15-131
10.32598/bcn.2022.2736.1
Letter to the Editor
Progressive Multiple Sclerosis Patients Requiring Special Attention as a Group at Risk for Coronavirus Infection
Naser Moghadasi Abdorreza 1 https://orcid.org/0000-0002-8598-0911

Sahraian Mohammad Ali 1 https://orcid.org/0000-0002-3224-8807

Eskandarieh Sharareh 1 * https://orcid.org/0000-0002-8942-9983

1. Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
* Corresponding Author: Sharareh Eskandarieh, PhD., Address: Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. Tel: +98 (912) 5163975, E-mail: sh_eskandarieh@yahoo.com
Mar-Apr 2024
01 3 2024
15 2 131132
Copyright© 2024 Iranian Neuroscience Society
2024
https://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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pmcDear Editor

In January 2020, a novel coronavirus was identified by the Chinese Center for Disease Control and Prevention (CDC) and was subsequently named 2019 nCoV (Li et al., 2020). Coronavirus disease 2019 (COVID-19) has spread to many countries in 2020.

Several studies have discussed COVID-19 epidemiology and risk factors. Most affected patients have had mild symptoms and good prognosis, but some develop severe pneumonia or multiple organ failure that cause death.

A study has reported that most adult patients were between 35 and 55 years old. According to a study on early transmission dynamics of the virus, most (59%) patients were male, and their median age was 59 years (Chen et al., 2020).

Overall, half of the patients infected by COVID-19 had chronic diseases, primarily cardiovascular diseases, cerebrovascular diseases, and diabetes. Many results suggest that this disease mostly infects males and older people with chronic comorbidities as a result of a weak immune system (Chen et al., 2020). The majority of deaths were observed among middle-aged and elderly patients with comorbidities, including coronary heart disease, diabetes, hypertension, Parkinson disease, tumor surgery, and cirrhosis (Chen et al., 2020).

Given the global COVID-19 epidemic condition, it is vital to identify and take care of high-risk groups or people with underlying medical conditions, as the mortality could be higher in these groups.

Multiple sclerosis (MS) is a chronic neurologic disease with a progressive nature that is manifested mainly among males and older people, creating a substantial burden on the individual, society, and healthcare system (Marrie et al., 2015).

Although MS is present in all regions of the world, it is more prevalent in Caucasians. The global estimated number of MS patients has increased from 2.1 million in 2008 to 2.3 million in 2013.

Comorbidities such as hypertension, diabetes, hyperlipidemia, ischemic heart disease, chronic lung disease, migraine, epilepsy, and mood and anxiety disorders are common in the MS population. They can affect an individual’s disease course and prognosis, resulting in more disability, increased healthcare requirements, and a higher risk of hospitalization and mortality (Marrie et al., 2015).

Among all individual comorbidities, chronic lung disease, hypertension, and diabetes mellitus were the most common diseases among MS patients, which can increase the risk of COVID-19 infection (Marrie et al., 2015).

On the other hand, the status of MS (progressive vs a relapsing onset course), sex, and age are among the variables associated with higher EDSS (disability and expanded disability status scale) that can increase the risk of infection in MS patients, hence increasing the need for taking more care of these people (Celius, 2017).

Even though there is no treatment for MS, disease-modifying therapies can reduce the number of attacks and decrease the progression of MS (Al-Sakran et al., 2020).

Many immune modulatory drugs prescribed for MS patients do their function by altering the immune system. Subsequently, a significant number of older and disabled MS cases need support from caregivers or their family members through whom COVID-19 might infect them and be at risk of infection with the virus.

Moreover, some MS patients who use second- or third-line drugs that are primarily immunosuppressives might be more at risk of COVID-19 infection (Al-Sakran et al., 2020).

Since MS patients are more at risk of COVID-19 infection, the specific health precautions that may prevent or slow down the transmission of the disease should be considered, including telephone follow-up and home visits; identification, isolation, and follow-up of contacts; training environmental disinfection; and equipping at-risk individuals with personal protective equipment.
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References

Al-Sakran L. Marrie R. A. Blackburn D. Knox K. Evans C. (2020). Impact of comorbidity on hospitalizations in individuals newly diagnosed with multiple sclerosis: A longitudinal population-based study. Multiple Sclerosis and Related Disorders, 40 , 101955. [DOI:10.1016/j.msard.2020.101955]32000120
Celius E. G. (2017). Infections in patients with multiple sclerosis: Implications for disease-modifying therapy. Acta Neurologica Scandinavica, 136 (Suppl 201 ), 34–36. [DOI:10.1111/ane.12835]29068490
Chen N. Zhou M. Dong X. Qu J. Gong F. Han Y. (2020). Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet, 395 (10223 ), 507–513. [DOI:10.1016/S0140-6736(20)30211-7]32007143
Li Q. Guan X. Wu P. Wang X. Zhou L. Tong Y. (2020). Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. The New England Journal of Medicine, 382 (13 ), 1199–1207. [DOI:10.1056/NEJMoa2001316]31995857
Marrie R. A. Cohen J. Stuve O. Trojano M. Sørensen P. S. Reingold S. (2015). A systematic review of the incidence and prevalence of comorbidity in multiple sclerosis: Overview. Multiple Sclerosis, 21 (3 ), 263–281. [DOI:10.1177/1352458514564491]25623244
