# Assessment of the Clinical and Functional Health Status of Patients with Amyotrophic Lateral Sclerosis during the COVID-19 Pandemic in Brazil Using Telemedicine

## TL;DR

This study used telemedicine to monitor ALS patients in Brazil during the pandemic, showing functional decline and increased use of ventilatory support.

## Contribution

Demonstrates the feasibility of telemedicine for ALS patient monitoring and ventilatory support adjustments during the pandemic.

## Key findings

- The ALSFRS-R total score and motor domain significantly declined during the pandemic.
- Non-invasive ventilation (NIV) prescription increased from 54.4% to 83.3%.
- Telemedicine proved effective for clinical and functional follow-up of ALS patients.

## Abstract

This study aimed to monitor the clinical and functional progression of patients with amyotrophic lateral sclerosis (ALS) and adjust ventilatory support during the COVID-19 pandemic in Brazil using telemedicine. This longitudinal case series included five evaluations from January 2019 to June 2021. The first and second assessments were performed in person and consisted of pulmonary function, respiratory muscle strength, functionality (ALS Functional Rating Scale—Revised [ALSFRS-R]) and disease staging (King’s College criteria). The use of non-invasive ventilation (NIV), ALSFRS-R, and disease staging were assessed in the third, fourth, and fifth assessments during the COVID-19 pandemic, using telemedicine. The rate of functional decline was calculated by the difference in the total score of ALSFRS-R between evaluations. A cutoff of 0.77 in the ALSFRS-R was used to characterize the speed of functional decline. Eleven patients (mean age of 51 years, eight males) were assessed. The total score of the ALSFRS-R (p < 0.01) and its motor domain (p < 0.01) reduced significantly during the pandemic. NIV prescription increased from 54.4% to 83.3%. Telemedicine helped with the clinical and functional follow-up of patients with ALS.