COVID-19 Related to Parkinson's

Does COVID-19 affect the central nervous system?

Yes, 25% of hospitalized COVID-19 pts had central nervous system (CNS) symptoms:

  • Headache, dizziness, impaired consciousness
  • Seizures, strokes, brain hemorrhage
  • Cytokine storm: excess of pro-inflammatory molecules that cause blood clots

Does COVID-19 affect the peripheral nervous system?

Neuromuscular conditions with COVID-19

  • No evidence of direct viral invasion of motor neurons or peripheral nerves
  • Critical Illness Polyneuropathy
  • Myopathy (myalgias, elevated muscle enzymes or creatinekinase); viral myositis?
  • Guillian-Bare syndrome (GBS)

Are PD Patients more susceptible to COVID-19?

  • No evidence of increased susceptibility to getting infected with COVID-19 when exposed
  • But PD patients are considered high risk for more severe infection: they are elderly, impaired swallowing and clearing of secretions, impaired cough, weaker chest/respiratory muscles

COVID-19 can worsen PD?

Parkinsonism and Related Disorders (May 2020)
2 PD patients in France:

  • No evidence of direct viral invasion of motor neurons or peripheral nerves
  • Critical Illness Polyneuropathy
  • Myopathy (myalgias, elevated muscle enzymes or creatinekinase); viral myositis?
  • Guillian-Bare syndrome (GBS)

If a PD patient suddenly has a worsening in their PD symptoms, more falls or difficulty in their swallowing, that patient should be tested for COVID-19

Early COVID-19 symptoms may overlap with PD symptoms:

  • Fatigue
  • Loss of sense of smell
  • Myalgias
  • Weakness
  • Hot flushes

Can the drugs used for COVID-19 cause neurological damage?

Chloroquine or Hydroxychloroquine

  • Cause toxic neuromyopathy (with prolonged use of a year or more)
  • New onset or worsening Myasthenia Gravis
  • Some studies have shown it might benefit Parkinson's at least in animal models
  • Activates a protein called NURR1 (nuclear receptor related protein 1): critical for development & survival of dopamine neurons

Do PD patients need to take any extra precautions?

  • No more than the usual elderly precaution
  • Avoid crowds; stay home
  • Social distancing
  • Washing of hands
  • Use of alcohol-based hand sanitizers
  • Wearing a mask
  • Avoid touching eyes, nose and mouth with unclean hands

Vitamin D deficiency

If vitamin D deficient:

  • 2x greater risk of major complications from COVID-19
  • Vit D: plays a role in immunity; reduces inflammation
  • Vit D: dairy products, cereal, fatty fish (salmon, tuna, mackerel), sun dried mushrooms; sun exposure

PD patients:

  • 55%-84% are vitamin D deficient
  • Vitamin D deficiency predisposes to PD
  • Vitamin D affects motor & cognitive functions

Does COVID-19 predispose to Parkinson's?

Only time will tell
Report of Encephalitis (inflammation of the brain) with COVID-19

  • Affected 500 million people
  • Caused Encephalitis Lethargica
  • Caused acute parkinsonism and post-encephalitic chronic parkinsonism
  • More than a million cases of parkinsonism notes with the 1918 pandemic
  • Individuals born between 1888 and 1924: had a 2-3 times higher risk for developing Parkinson's

Other movements notes in the post-encephalitic phase

  • Dystonia (neck, eyes, jaw, limbs)
  • Chorea
  • Myoclonus
  • Tics ( including respiratory tics)

Is there any antiviral drug used for Parkinson's that potentially may have an impact on COVID-19?

  • Amantadine
  • Antiviral drug vs influenza A: it blocks viral replication
  • In COVID-19, it is proposed that amantadine blocks the viporine channel, preventing release of viral nucleus into the infected host cell