These are challenging times. As I write this column in mid-March, I am struck by the mix of articles in this issue—and those in the news—both sobering and hopeful. Our cover feature describes a special story of love, friendship, and devotion between Hollywood publicist Nanci Ryder, who has amyotrophic lateral sclerosis (ALS), and actresses Courteney Cox and Renee Zellweger, who have supported her efforts to spread awareness and raise funds for ALS research.
As we go to press, we are in the early stages of learning about COVID-19. To understand more, I asked my friend and colleague Ken L. Tyler, MD, FAAN, a virology expert and chair of neurology at the University of Colorado School of Medicine, to share some information and advice with our readers based on what we know at this time.
Dr. Tyler notes that the US Centers for Disease Control and Prevention (CDC) has identified older adults and people with serious chronic medical conditions, like heart disease, lung disease, and diabetes, as at especially high-risk of getting very sick. So too are people with chronic neurologic conditions, such as multiple sclerosis (MS), Parkinson's disease, Alzheimer's disease, ALS, myasthenia gravis, and other disorders. The CDC has advised people at high risk for COVID-19 to prepare for a possible outbreak in their community.
Who else is at risk: Other vulnerable demographics are people over the age of 60 and those with underlying medical conditions, which might diminish their ability to fight infections. Also at higher risk are people who take immunosuppressant drugs, including corticosteroids like prednisone, and biological immunomodulatory agents, such as natalizumab (Tysabri), rituximab (Truxima), ocrelizumab (Ocrevus), azathioprine (Imuran), mycophenolate mofetil (CellCept), and mycophenolate sodium (Myfortic), for conditions such as MS and myasthenia gravis.
How to stay safe: Don't travel on cruise ships or airplanes, and avoid large public gatherings. Steer clear of people who are sick, and wash your hands often with soap and hot water for at least 20 seconds. If you don't have access to soap and water, clean your hands with a hand sanitizer that has at least 60 percent alcohol.
Prepare in advance: Make sure you have an adequate amount of groceries and household supplies to stay home for a period of time. Keep medical supplies (tissues and alcohol wipes, for example) and over-the-counter medications to treat fever and other symptoms handy, and ask health care providers about prescribing extra necessary medications.
For people with MS: The National MS Society's National Medical Advisory Committee recommends that patients continue to take their disease-modifying therapy (DMT); anyone who wishes to discontinue such a therapy should talk to their neurologist first. Patients contemplating starting a DMT that depletes cells or carries warnings of a severe increase in disability after stopping should discuss the risks and benefits with their doctors.
By the time you read this, we will know more about COVID-19 and how to stay safe. Look for updated advisories from our experts on our website, BrainandLife.org, and at BrainandLife.org/COVID19.
As always, let us know what you think about the stories in this issue. We look forward to hearing from you.
Orly Avitzur, MD, MBA, FAAN, Editor-in-Chief
