Management of patients with amyotrophic lateral sclerosis (ALS) has changed significantly during the COVID-19 pandemic. Telemedicine has become an effective tool to monitor ALS patients during the pandemic without exposing them to the risk of infection due to close contact [9]. This approach does not benefit only patients, but it also benefits healthcare professionals and decreases economic burden of the pandemic on the entire healthcare system which has to deal with the increasing number of COVID-19 patients.
The current study is the first study discussing the importance of telemedicine encounters with ALS patients in Egypt and in North Africa during the pandemic. This study included 43 patients who are already registered in the specialized ALS clinic in Egypt. These encounters were free of charge and were offered to all patients in the period between July 1, 2020, and February 6, 2021, via WhatsApp texts +/− phone calls. All patients and caregivers were satisfied with telemedicine encounters because of decreased financial burden of the disease (by eliminating the cost of transport and follow-up visits) and avoidance of unnecessary contact. Depressive symptoms were detected in 8 patients, and antidepressants were prescribed. Patients who showed decline in ALSFRS-R experienced intercurrent events as motor, bulbar, and respiratory functions which required intervention with invasive (gastrostomy and Botox injection) and non-invasive (NIV) measures. None of the patients showed symptoms suggestive of COVID-19 infection.
Participating patients and their caregivers did not feel comfortable with video calls, which also has been seen in Italy in a previous study by Capozzo and his colleagues [3], and this could be attributed to cultural reasons shared by some Mediterranean regions. Some studies have shown that the rate of depression and anxiety has increased in population [10, 11] especially among chronically ill patients [11, [12]]; in the current study, I detected depressive symptoms in some of the ALS patients, which has been also found in some Italian studies [4, 13].
One of the limitation of this study is being unable to re-assess all patients face to face with ALSFRS-R after telemedicine encounters to validate their ALSFRS-R scale results; only patients who reported decline in ALSFRS-R sale were brought to the office and re-assessed, which limits the detection of worsening of symptoms. However, ALSFRS-R was sensitive in detecting disease progression which mandated intervention.
The importance of this study comes from being the first study showing the efficacy of telemedicine in the field of ALS in Egypt and North Africa, which was not well developed before the pandemic. ALSFRS-R which was validated in Arabic previously [5] showed feasibility and was easy to administer to patients and their caregivers in telemedicine encounters, and helped in detecting disease progression which mandated intervention.