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J Res Med Sci 2021,  26:68

Managing anxiety among multiple sclerosis patients during COVID-19 pandemic

Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Date of Submission30-May-2020
Date of Acceptance30-Dec-2020
Date of Web Publication30-Aug-2021

Correspondence Address:
Prof. Vahid Shaygannejad
Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jrms.JRMS_633_20

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How to cite this article:
Adibi I, Mirmosayyeb O, Ramezani N, Shaygannejad V. Managing anxiety among multiple sclerosis patients during COVID-19 pandemic. J Res Med Sci 2021;26:68

How to cite this URL:
Adibi I, Mirmosayyeb O, Ramezani N, Shaygannejad V. Managing anxiety among multiple sclerosis patients during COVID-19 pandemic. J Res Med Sci [serial online] 2021 [cited 2022 Dec 8];26:68. Available from: https://www.jmsjournal.net/text.asp?2021/26/1/68/325066

In a few months after the global outbreak of coronavirus 19(COVID-19), >109,000 patients in Iran, were confirmed to be infected by this new emerging virus.[1] This rapid global and national spread, in conjunction with described mortalities of the disease, have brought about fear and stress in the community. People with chronic disease are more vulnerable to stress and experience more anxiety in reaction to stress, because of their health condition, medication use, disabilities, or altered immune status.

Patients with multiple sclerosis (MS) are nearly 6–10 times as likely as the normal population to experience anxiety and depression.[2] The prevalence of MS in Iran and especially in Isfahan province is high,[3] so that the consequences of the COVID-19 pandemic for these patients have become a challenging issue.[2]

Anxiety is considered a triggering factor for MS relapse.[2] On the other hand, there are concerns about the effect of MS treatments on the immune system and the consequent risk of COVID-19 infection. These concerns are more important in patients under treatment with anti-CD20 antibodies, lymphopenic drugs, and corticosteroids.[4] Hence, ambivalence may occur when MS patients and their physicians confront clinical issues regarding start, stop, or switching MS treatments during the COVID-19 pandemic. The role of Vitamin D status in the pathogenesis of MS and in the severity of COVID-19 infection[5] may indicate another area of ambiguity in this field.

In this newly arisen public health issue, COVID-19 pandemic, every clinical decision-making for MS patients should respect patients' fears and anxiety. To elude ambiguity and controversies we need explicit guidelines. Furthermore, individualized decision-making and involvement of the patient in this process reduce patients' anxiety and stress. The patient should be informed of the side effects of switching or arbitrarily discontinuing their medications.

Neurologists and nurses should address patients' anxiety to choose an effective strategy for stress management in MS patients. Reassurance about the immunocompetence of most MS patients, regardless of mild to moderate treatment-induced lymphopenia, may be helpful. Providing thorough information about each treatment, side effects, as well as the risk of infection, will warrant more adherence during the time of the pandemic. Stress and anxiety should not hinder medical care and consultation. This becomes more crucial if administrating or switching to new drugs is indicated.

In patients under immunosuppressive treatments, the treatment plan should be evaluated based on the course of treatment, disease activity, and patient preference. Convenient access to telehealth services for mental and medical care should be provided. Patients should be encouraged to plan regular exercise, keeping social and emotional contacts (despite physical distancing), healthy diet, adequate sleep, and stress-reducing activities (i.e., Yoga and meditation)[2] are recommended. Obsessively checking and searching for updates on the COVID-19 may aggravate anxiety and should be avoided.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Organization WH. Coronavirus Disease (COVID-19) Outbreak. Organization WH; 2020. Available from: https://wwwwhoint/emergencies/diseases/novel-coronavirus-2019.2020. [Last accessed on 2021 Jan 01].  Back to cited text no. 1
Seyed Ahadi M, Sahraian MA, Rezaeimanesh N, Naser Moghadasi A. Psychiatric Advice During COVID-19 Pandemic for Patients with Multiple Sclerosis, Iran J Psychiatry Behav Sci. 2020;14(2):e103243.   Back to cited text no. 2
Ashtari F, Karimi A, Delpisheh A, Meamar R, Sayehmiri K, Daliri S. Estimated incidence rate of multiple sclerosis and its relationship with geographical factors in Isfahan Province between the years 2001 and 2014. Int J Prev Med 2018;9:103.  Back to cited text no. 3
[PUBMED]  [Full text]  
Wijnands JM, Zhu F, Kingwell E, Fisk JD, Evans C, Marrie RA, et al. Disease-modifying drugs for multiple sclerosis and infection risk: A cohort study. J Neurol Neurosurg Psychiatry 2018;89:1050-6.  Back to cited text no. 4
Daneshkhah A, Agrawal V, Eshein A, et al. The Possible Role of Vitamin D in Suppressing Cytokine Storm and Associated Mortality in COVID-19 Patients. medRxiv; 2020. DOI: 10.1101/2020.04.08.20058578.  Back to cited text no. 5


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