Disruptions of neurological services, its causes and mitigation strategies during COVID-19: a global review

David García-Azorín, Katrin M. Seeher, Charles R. Newton, Njideka U. Okubadejo, Andrea Pilotto, Deanna Saylor, Andrea Sylvia Winkler, Chahnez Charfi Triki, Matilde Leonardi

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations


Background: The COVID-19 pandemic leads to disruptions of health services worldwide. To evaluate the particular impact on neurological services a rapid review was conducted. Methods: Studies reporting the provision of neurological services during the pandemic and/or adopted mitigation strategies were included in this review. PubMed and World Health Organization’s (WHO) COVID-19 database were searched. Data extraction followed categories used by WHO COVID-19 pulse surveys and operational guidelines on maintaining essential health services during COVID-19. Findings: The search yielded 1101 articles, of which 369 fulfilled eligibility criteria, describing data from 210,419 participants, being adults (81%), children (11.4%) or both (7.3%). Included articles reported data from 105 countries and territories covering all WHO regions and World Bank income levels (low income: 1.9%, lower middle: 24.7%, upper middle: 29.5% and high income; 44.8%). Cross-sectoral services for neurological disorders were most frequently disrupted (62.9%), followed by emergency/acute care (47.1%). The degree of disruption was at least moderate for 75% of studies. Travel restrictions due to lockdowns (81.7%) and regulatory closure of services (65.4%) were the most commonly reported causes of disruption. Authors most frequently described telemedicine (82.1%) and novel dispensing approaches for medicines (51.8%) as mitigation strategies. Evidence for the effectiveness of these measures is largely missing. Interpretation: The COVID-19 pandemic affects all aspects of neurological care. Given the worldwide prevalence of neurological disorders and the potential long-term neurological consequences of COVID-19, service disruptions are devastating. Different strategies such as telemedicine might mitigate the negative effects of the pandemic, but their efficacy and acceptability remain to be seen.

Original languageEnglish (US)
Pages (from-to)3947-3960
Number of pages14
JournalJournal of neurology
Issue number11
StatePublished - Nov 2021


  • COVID-19
  • Health services administration
  • Nervous system diseases
  • Neurology
  • Telemedicine

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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