key: cord-1011282-t5gi8byw
authors: Garibaldi, Matteo; Siciliano, Gabriele; Antonini, Giovanni
title: Telemedicine for neuromuscular disorders during the COVID-19 outbreak
date: 2020-07-10
journal: J Neurol
DOI: 10.1007/s00415-020-10063-7
sha: 5e1f30823753573244d7d58df07616c026b84cd2
doc_id: 1011282
cord_uid: t5gi8byw

nan

in outpatient care services, which makes these disorders particularly suitable for TM. However, remote clinical evaluation can have some important limitations. First of all, while TM assessment appears appropriate for NMD patients with known diagnosis and fairly stable clinical condition, it loses power when used for diagnostic purposes, given the difficulties to appreciate subtle neurological signs, such as mild weakness or sensory deficits. Furthermore, patient's difficulties to access the teleconsultation and the necessity of a caregiver for TM evaluation for some patients should be considered. Finally, clinical data obtained by TM could not be easily compared to those recorded during ambulatory visits. In this scenario, the use of clinical scales suitable to be administered via TM could help in NMD patient follow-up. An ideal scale for TM should be concise, easy to be administered, reproducible, comprehensive enough in capturing the wide range of different clinical manifestations and informative in remote evaluation of functions without direct clinical examination.

Facing the problem of TM consulting for NMD during COVID-19 outbreak, we suggest, as suitable for that, the following scales: ALSFR-R for motor neuron diseases [7] , MG-ADL for neuromuscular junction diseases [8] , Myo-FRS for myopathies and Nerve-FRS (N-FRS) for neuropathies. ALSFR-R and MG-ADL are disease-specific scales validated for amyotrophic lateral sclerosis and myasthenia gravis, respectively; they appear the most reliable scales for a remote evaluation in these two disorders, as they satisfy the aforementioned prerogatives required in a TM context and in addition, they allow to compare the score obtained by TM with those previously obtained. Their use could be also extended to other motor neuron diseases and myasthenic syndromes, for which, other disease-specific scales could have some limitations by TM. Validated scales for myopathies and neuropathies are quite disease-specific and difficult to use in remote consultation due to a number of predominantly examiner-dependent items. Accordingly, we conceived the Myo-FRS and the N-FRS, two functional scales, which, rather than explore too much disease-specific tasks, are aimed to capture, basically through a functional questionnaire, the overall characteristics of neuromuscular performance, both in myopathies and in neuropathies (Table 1) . MYO-FRS and N-FRS have never been used before, and do not allow a comparison with formerly collected clinical data. However, they provide a practical and useful tool to assign a functional score, which reflects the overall neuromuscular impairment along the disease course. Certainly, time has to come for their validation, but in this historical moment, implementation of routine tests is urgently needed for a homogeneous and effective approach to NMD through TM.

Conflicts of interest All authors report no relevant disclosures and conflict of interest for this study.

Ethical standard This study has been performed in accordance with the ethical stadards requirements Myo-FRS score from 0 (severe disability) to 44 (normal functions), Nerve-FRS score from 0 (severe disability) to 44 (normal functions), NRS numerical rating score (0 = absent, 10 = worst imaginable)

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