ABSTRACT BACKGROUND: Respiratory failure is the most common cause of death in patients with amyotrophic lateral sclerosis (ALS), and morbidity is related to poor quality of life (QOL). Non-invasive ventilation (NIV) may be associated with prolonged survival and QOL in patients with ALS. OBJECTIVES: To assess whether NIV is effective and safe for patients with ALS in terms of survival and QOL, alerting the health system. DESIGN AND SETTING: Systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting standards using population, intervention, comparison, and outcome strategies. METHODS: The Cochrane Library, CENTRAL, MEDLINE, LILACS, EMBASE, and CRD databases were searched based on the eligibility criteria for all types of studies on NIV use in patients with ALS published up to January 2022. Data were extracted from the included studies, and the findings were presented using a narrative synthesis. RESULTS: Of the 120 papers identified, only 14 were related to systematic reviews. After thorough reading, only one meta-analysis was considered eligible. In the second stage, 248 studies were included; however, only one systematic review was included. The results demonstrated that NIV provided relief from the symptoms of chronic hypoventilation, increased survival, and improved QOL compared to standard care. These results varied according to clinical phenotype. CONCLUSIONS: NIV in patients with ALS improves the outcome and can delay the indication for tracheostomy, reducing expenditure on hospitalization and occupancy of intensive care unit beds. SYSTEMATIC REVIEW REGISTRATION: PROSPERO database: CRD42021279910 — https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=279910.

RESUMO Antecedentes: Considerando a Emergência em Saúde Pública de Importância Nacional em decorrência da infecção pelo coronavírus, o governo federal brasileiro temporariamente regulamentou o uso da telemedicina diretamente entre médico e paciente, para consulta, monitorização e diagnóstico. Há mais de uma década os neurologistas reconhecem os benefícios da telemedicina no tratamento do AVC agudo. Entretanto, como o uso da telemedicina no país era restrito até a pandemia da COVID-19, a magnitude do envolvimento dos neurologistas brasileiros com a telemedicina não é conhecida. Métodos: Todos os membros da Academia Brasileira de Neurologia foram convidados por e-mail a responder voluntariamente um questionário sobre seu envolvimento pessoal com telemedicina antes e durante a pandemia. Resultados: 162 neurologistas, representando todas as regiões do Brasil, responderam o questionário. A pesquisa mostrou que 18,5% dos respondedores trabalhavam com telemedicina antes da pandemia da COVID-19, enquanto 63,6% afirmaram trabalhar com telemedicina durante a pandemia. As principais modalidades de telemedicina utilizadas durante a pandemia são a teleorientação e a teleconsulta. Discussão: De acordo com esses resultados, a pandemia da COVID-19 influenciou profundamente o comportamento dos neurologistas brasileiros, que passaram a demonstrar uma ideia mais favorável sobre telemedicina, e determinou uma busca ativa de informações sobre teleneurologia. Há necessidade de maior capacitação nesta área em nosso país. Universidades e sociedades médicas devem se esforçar para melhorar a educação em telemedicina. A expansão do uso da teleneurologia com alta qualidade contribuirá para um melhor cuidado dos pacientes com doenças neurológicas no Brasil.

ABSTRACT Background: After the public health emergency due to COVID-19 was declared in Brazil, the federal government temporarily regulated and authorized the use of telemedicine services for patient consultation, monitoring, and diagnosis. For more than a decade, neurologists have recognized the benefits of telemedicine in the acute management of stroke patients. However, as the use of telemedicine was restricted until the COVID-19 pandemic, the view of Brazilian neurologists about telemedicine is unknown. Methods: All neurologists registered at the Brazilian Academy of Neurology were invited by e-mail to participate in a survey about personal perceptions on telemedicine use. Results: One hundred sixty-two neurologists from all regions of Brazil answered the online questionnaire. The survey showed that 18.5% of participants worked with telemedicine before the pandemic, while 63.6% reported working with telemedicine during the pandemic. The main telemedicine modalities used during the pandemic were teleorientation and teleconsultation. Discussion: According to our data, the COVID-19 pandemic deeply influenced the behavior of Brazilian neurologists, who developed a more favorable view about telemedicine and actively searched for information about telemedicine. As there is a need for more training in this area in Brazil, universities and medical societies must strive to improve telemedicine education. Expanding the use of high-quality teleneurology can contribute to a better care for patients with neurological diseases in Brazil.

RESUMO Introdução: A telemedicina surge pela primeira vez na neurologia como uma ferramenta para facilitar o acesso ao tratamento do acidente vascular cerebral (AVC) Agudo. Mais recentemente, inúmeras evidências têm surgido acerca da eficácia e da segurança do uso da telemedicina em várias outras áreas da neurologia. Com o advento da pandemia de COVID-19 e a necessidade de isolamento social, as autoridades brasileiras flexibilizaram a regulamentação da telemedicina, permitindo assim que inúmeros pacientes com doenças neurológicas possam ter acesso ao tratamento, com menor risco de exposição à contaminação pelo SARS-CoV-2. Objetivo: O objetivo deste artigo foi avaliar criticamente as evidências correntes acerca da segurança e eficácia do uso da telemedicina em diversas áreas da neurologia. Métodos: Este artigo foi uma revisão de artigos indexados no PubMed, buscando os termos telemedicina, cefaleias, esclerose múltipla, doenças vestibulares, doenças cerebrovasculares, epilepsia, doenças neuromusculares, demência e desordens do movimento. Os artigos mais relevantes em cada uma das áreas foram criticamente analisados. Resultados: Diversos artigos foram identificados e analisados em todas as áreas anteriormente citadas. Os principais achados quanto às contribuições da telemedicina, para o diagnóstico e tratamento das condições, foram apresentados, indicando potenciais benefícios da telemedicina em todas as áreas buscadas. Conclusão: As evidências atuais indicam que a teleneurologia é uma potencial ferramenta para ampliar o acesso ao cuidado em inúmeras áreas da neurologia.

ABSTRACT Background: Telemedicine was first introduced in Neurology as a tool to facilitate access to acute stroke treatment. More recently, evidence has emerged of the use of telemedicine in several other areas of Neurology. With the advent of the COVID-19 pandemic and the need for social isolation, Brazilian authorities have expanded the regulation of the use of telemedicine, thus allowing the treatment of many patients with neurological diseases to be conducted with less risk of SARS-CoV-2 contamination. Objective: This study aimed to critically review the current evidence of the use, efficacy, safety, and usefulness of telemedicine in Neurology. Methods: A review of PubMed indexed articles was carried out by searching for the terms “telemedicine AND”: “headache”, “multiple sclerosis”, “vestibular disorders”, “cerebrovascular diseases”, “epilepsy”, “neuromuscular diseases”, “dementia”, and “movement disorders”. The more relevant studies in each of these areas were critically analyzed. Results: Several articles were found and analyzed in each of these areas of Neurology. The main described contributions of telemedicine in the diagnosis and treatment of such neurological conditions were presented, indicating a great potential of use of this type of assistance in all these fields. Conclusion: Current evidence supports that teleneurology can be a tool to increase care for patients suffering from neurological diseases.