| Abstract [eng] |
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is able to invade the human nervous system and can cause headache, nausea, vomiting, febrile seizures, encephalopathy, encephalitis, ataxia or psychiatric disorders, as well as quantitative disturbances of smell and taste which are observed both during the course of Parkinson’s disease and other alpha-synucleinopathies, only in slowly progressive and irreversible manner. The penetration of SARS-CoV-2 into the brain damaged by Parkinson’s disease can enhance the clinical burden of movement disorder and increase the deficit for substitutional dopaminergic therapy. To date, there are no randomised controlled trials of COVID-19 outcomes in cases of Parkinson’s disease and other movement disorders though patients of this category can be more vulnerable because of rigidity or dissinergy of respiratory musculature, diminished cough reflex, impaired swallowing, and chronic dyspnea. Indirect aggravating factors during the pandemic include stress, self-isolation, anxiety, and prolonged hypomobility which have a negative impact on the clinical burden of movement disorder and predispose weakened immune reactions. The compulsory limitations of contacts with physicians and relatives make cognitively impaired patients more prone to violations of medication regimen. In this case teleneurology is a perspective mode of medical care for patients with movement disorders during the pandemic. Amantadine and memantine are presumed to have some anti-SARS-CoV-2 potential but this assumption should be confirmed in clinical trials. International Parkinson Disease and Movement Disorders Society has published recommendations and priorities for patients with Parkinson’s disease and other movement disorders during the COVID-19 pandemic which state that all measures of social distancing currently in place for the general population almost globally must be strictly and carefully practiced, direct consultations must be held in exceptional cases (e.g., for adjusting or checking deep brain stimulation programming, battery failure, levodopa duodenal pump treatments, botulinum toxin therapy), and patients should be encouraged to use sports equipment available at home and /or play virtual reality games. In case COVID-19 is diagnosed, the physician must ensure the maintenance of previous medications, especially adequate doses of levodopa/peripheral decarboxylase inhibitor to avoid rigidity with contractures and respiratory impairment with reduced vital capacity and peak expiratory flow. |
