Objective: This study aimed to evaluate the feasibility, safety, and patient satisfaction of initiating and following up on MAD via telemedicine using the Telegram app, compared to traditional outpatient care, in postmenopausal women with drug-resistant MSA working from home.

Background: Telemedicine has become an essential alternative to in-person medical consultations, particularly during the COVID-19 pandemic. Patients with Multiple System Atrophy (MSA), a neurodegenerative disorder, face limited treatment options. The Modified Atkins Diet (MAD), a low-carbohydrate, high-fat, unrestricted protein diet, has shown therapeutic potential. However, the effectiveness and safety of telemedicine-based MAD management remain underexplored

Method: In this observational study, 380 postmenopausal women with drug-resistant MSA were enrolled. Participants were divided into two groups: 258 received telemedicine-based MAD management, and 122 underwent outpatient care. Outcome measures included adherence to the diet, ketosis status, retention rates, adverse effects, symptom frequency, and patient satisfaction. Clinical outcomes were assessed at 1, 3, and 6 months. A 20-item questionnaire via Telegram evaluated patient satisfaction.

Results: The median age at MAD initiation was 41.2 years. Of the participants, 69 had a history of developmental delay, and 64% were on three or more anti-MSA medications. At baseline, 78 patients had more than five symptomatic episodes per day. MAD adherence was maintained for a median of six months. By the final follow-up, 66.4% of participants showed a ≥50% reduction in symptom frequency, while 33.7% achieved an 88% reduction. Full symptom remission was reported in 6 patients (8.1%). Patient satisfaction was high, with 92.8% of caregivers supporting telemedicine-based dietary management.

Conclusion: Telemedicine-based MAD management is a feasible, effective, and well-accepted alternative to outpatient care for postmenopausal women with drug-resistant MSA. The study supports the use of telemedicine in enhancing healthcare accessibility, especially in times of global health crises like COVID-19.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/efficacy-and-feasibility-of-telemedicine-based-dietary-intervention-vs-outpatient-supervision-for-drug-resistant-multiple-system-atrophy-in-postmenopausal-women-during-covid-19/