Disruptions of neurological services, its causes and mitigation strategies during COVID-19: a global review

• Published in: Journal of neurology Vol. 268; no. 11; pp. 3947 - 3960
• Main Authors: García-Azorín, David, Seeher, Katrin M., Newton, Charles R., Okubadejo, Njideka U., Pilotto, Andrea, Saylor, Deanna, Winkler, Andrea Sylvia, Charfi Triki, Chahnez, Leonardi, Matilde
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2021; Springer Nature B.V
• Subjects: Adult; Child; Communicable Disease Control; Coronaviruses; COVID-19; Health services; Humans; Medicine; Medicine & Public Health; Neurological diseases; Neurological disorders; Neurology; Neuroradiology; Neurosciences; Pandemics; Review; Reviews; SARS-CoV-2; Telemedicine; COVID-19; Neurology; Health services administration; Nervous system diseases; Telemedicine
• ISSN: 0340-5354; 1432-1459; 1432-1459
• DOI: 10.1007/s00415-021-10588-5

Background The COVID-19 pandemic leads to disruptions of health services worldwide. To evaluate the particular impact on neurological services a rapid review was conducted. Methods Studies reporting the provision of neurological services during the pandemic and/or adopted mitigation strategies were included in this review. PubMed and World Health Organization’s (WHO) COVID-19 database were searched. Data extraction followed categories used by WHO COVID-19 pulse surveys and operational guidelines on maintaining essential health services during COVID-19. Findings The search yielded 1101 articles, of which 369 fulfilled eligibility criteria, describing data from 210,419 participants, being adults (81%), children (11.4%) or both (7.3%). Included articles reported data from 105 countries and territories covering all WHO regions and World Bank income levels (low income: 1.9%, lower middle: 24.7%, upper middle: 29.5% and high income; 44.8%). Cross-sectoral services for neurological disorders were most frequently disrupted (62.9%), followed by emergency/acute care (47.1%). The degree of disruption was at least moderate for 75% of studies. Travel restrictions due to lockdowns (81.7%) and regulatory closure of services (65.4%) were the most commonly reported causes of disruption. Authors most frequently described telemedicine (82.1%) and novel dispensing approaches for medicines (51.8%) as mitigation strategies. Evidence for the effectiveness of these measures is largely missing. Interpretation The COVID-19 pandemic affects all aspects of neurological care. Given the worldwide prevalence of neurological disorders and the potential long-term neurological consequences of COVID-19, service disruptions are devastating. Different strategies such as telemedicine might mitigate the negative effects of the pandemic, but their efficacy and acceptability remain to be seen.