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Collection of Articles on COVID-19 and Movement Disorders

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  Overview / Review Articles

Moving Forward from the COVID-19 Pandemic: Needed Changes in Movement Disorders Care and Research
Valdovinos BY, Modica JS, Schneider RB. Current Neurology and Neuroscience Reports. 2022 Feb 2;1-10. 

Relationship between COVID-19 and movement disorders: A narrative review
Schneider SA, Hennig A, Martino D. European Journal of Neurology. 2021 Dec 16.


View description       A detailed review of the literature on movement disorders in the context of the COVID-19 pandemic discussing several aspects: First, the variety of transient movement disorders that may manifest in the acute phase of COVID-19, most often myoclonus, with more than 50 patients described in the literature. New-onset parkinsonism, chorea, and tic-like behaviours (the latter mostly as a manifestation of a functional disorder) are also reviewed. Second, movement disorders as a side effect after COVID-19 vaccination: these are rare, occurring with a frequency of 0.00002-0.0002 depending on the product used, mostly manifesting with tremor. Third, current evidence for potential long-term manifestations, including long COVID parkinsonism. Forth, the impact on patients with pre-existing movement disorder syndromes (i.e. negative effects on clinical status and overall well-being, and reduced access to medication and health care).
 
  COVID-19 Vaccine

 

How Does Severe Acute Respiratory Syndrome-Coronavirus-2 Affect the Brain and Its Implications for the Vaccines Currently in Use.
Oldfield PR, Hibberd J, Bridle BW. Vaccines (Basel). 2021 Dec 21;10(1):1.

Severe dyskinesia after administration of SARS-CoV2 mRNA vaccine in Parkinson Disease
Erro R, Buonomo AR, Barone P, Pellecchia MT. Movement Disorders. 2021 Oct;36(10):2219.

  Slideshow created by MDS SIC Committee

COVID-19 Vaccination for Persons with Parkinson’s Disease: Light at the End of the Tunnel?
Bloem, Bastiaan R.,Trenkwalder, Claudia, Sanchez-Ferro, Alvaroc, Kalia, Lorraine V., Alcalay, Roy, Chiang, Han-Linf, Kang, Un Jungg, Goetz, Christopher, Brundin, Patriki, Papa, Stella M. Journal of Parkinson's Disease, 2021;11(1):3-8.

View description The authors discuss COVID vaccines’ efficacy and safety in the specific context of PD. They find that the benefits and risks of COVID-19 vaccines do not appear to be different compared to the general population, and thus recommend COVID-19 vaccination with approved vaccines to persons with PD, unless there is a specific contraindication. However, some caution seems warranted in very frail and terminally ill elderly persons with PD living in long-term care facilities.


 


Transient akathisia after the SARS-Cov-2 vaccine
Salinas MR, Dieppa M. Clinical Parkinsonism and Related Disorders. 2021;4:100098. 

View description
The authors report a case of transient akathisia after the second dose of the Pfizer COVID-19 vaccinewhich may imply a potential vulnerability of the extrapyramidal system to the immune response against even a component of the virus.


 

  Overall Impact of COVID-19 on PD

 

Impact of COVID-19 Pandemic on (Health) Care Situation of People with Parkinson's Disease in Germany (Care4PD)
Fründt O, Hanff AM, Mai T, Kirchner C, Bouzanne des Mazery E, Amouzandeh A, Buhmann C, Krüger R, Südmeyer M. Brain Science. 2021 Dec 31;12(1):62

Outcome of Hospitalized Parkinson's Disease Patients with and without COVID-19
Parihar R, Ferastraoaru V, Galanopoulou AS, Geyer HL, Kaufman DM. Movement Disorders Clinical Practice. 2021 May 3:10.1002/mdc3.13231.

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Background: The Parkinson's disease (PD) patient population, with an already reduced life expectancy, is rendered particularly vulnerable by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2).  

Objectives: We determined the risk factors that increase the risk of death in patients with Parkinson's disease who are infected by SARS-CoV-2.  

Methods: Patients with a diagnosis of PD admitted to Montefiore Hospital (Bronx, New York) and tested for SARS-CoV-2 were identified. Retrospective review of electronic medical records confirmed the diagnosis; patients were classified by severity of PD. PD severity, demographic, socioeconomic factors, and co-morbidities were correlated with mortality rates in patients with SARS-CoV-2.  

Results: We identified 162 patients meeting criteria; chart review confirmed a diagnosis of PD in 70 patients. Of the 70 patients, 53 were positive for SARS-CoV-2 and 17 were negative. PD patients with SARS-CoV-2 infection had a higher mortality rate (35.8%) compared to PD patients without the infection (5.9%, P = 0.028). PD patients older than 70 years of age, those with advanced Parkinson's disease, those with reductions in their medications, and non-Hispanics (largely comprised of Black/African- Americans) had a statistically significant higher mortality rate, if infected.  

Conclusions: PD did not increase mortality rates from SARS-CoV-2 infection when age was controlled. However, certain unalterable factors (advanced disease and age greater than 70 years) and alterable ones (reductions in PD medications) placed PD patients at increased risk for mortality. Also several socioeconomic factors contributed to mortality, for example, non-Hispanic patients with SARS-CoV-2 infection fared worse, likely driven by poorer outcomes in the Black/African-American cohort.

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The impact of Parkinson's disease on manifestations and outcomes of Covid-19 patients: A systematic review and meta-analysis
El-Qushayri AE, Ghozy S, Reda A, Kamel AMA, Abbas AS, Dmytriw AA. Reviews in Medical Virology. 2021 Jul 14:e2278. 

View description

The authors provide a systematic review and meta-analysis to review the impact of PD on the prognosis of Covid-19 patients, including 13 papers. They found a pooled prevalence rate of Covid-19 of 2.12% (95%CI: 0.75-5.98). Fever, cough, fatigue and anorexia were the most common symptoms with a rate of 72.72% (95% CI: 57.3 - 92.29), 66.99% (95% CI: 49.08-91.42), 61.58% (95% CI: 46.69-81.21) and 52.55% (95% CI: 35.09-78.68), respectively. The pooled rates were 39.89% (95% CI: 27.09-58.73) for hospitalisation, 4.7% (95% CI: 1.56-14.16) for ICU admission and 25.1% (95%CI: 16.37-38.49) for mortality. Overall, there were no significant differences in hospitalisation and mortality rates among Covid-19 patients with and without PD. The authors conclude that the prevalence and prognosis of Covid-19 patients seem comparable in patients with PD and those without it.
 


Covid-19 and Parkinson's disease: an overview
Cartella SM, Terranova C, Rizzo V, Quartarone A, Girlanda P. Journal of Neurology. 2021 Dec;268(12):4415-4421. 

View description

The authors review the state of the art about the relationship between Covid-19 and Parkinson's disease, focusing on five points: 1) Covid-19's impact on Parkinson's disease (PD) based on their health and their risk of developing severe Covid-19; 2) the consequences of lockdown and restrictive measures on mental and cognitive health on both patients and caregivers; 3) patients' care and management; 4) the importance of continuity of exercise; and 5) potential causative links in that COVID may trigger parkinsonism.
 


A French survey on the lockdown consequences of COVID-19 pandemic in Parkinson's disease. The ERCOPARK study.
Fabbri M, Leung C, Baille G, Béreau M, Brefel Courbon C, Castelnovo G, Carriere N, Damier P, Defebvre L, Doe de Maindreville A, Fluchere F, Fuzzatti M, Grabli D, Maltete D, Rousseau V, Sommet A A, Thalamas C, Thiriez C, Rascol O, Ory-Magne F. Parkinsonism & Related Disorders. 2021 Jul 13;89:128-133.

View description

A standardized investigatation of the consequences of the first COVID-19 lockdown (mid-March - mid-April 2020) on motor and non-motor symptoms (NMS) including psycho-social aspects in a cohort of French people with Parkinson's disease (PwP).

2653 PD patients were included, enrolled through a patient community or as part of a hospital based PD Expert Center. The authors report that physiotherapy was interrupted among 88.6% of the patients. 40.9% referred a clinical modification of their symptoms. Pain (9.3%), rigidity (9.1%) and tremor (8.5%) were the most frequently new or worsened reported symptoms. The authors conclude that the COVID-19 lockdown had a negative impact on motor and NMS of PwP and that efforts should be allocated to avoid interruption of care, including physiotherapy and physical activities and implementation of telemedicine.
 


Physical Activity and Perceived Health in People With Parkinson Disease During the First Wave of Covid-19 Pandemic: A Cross-sectional Study From Sweden.
Leavy B, Hagströmer M, Conradsson DM, Franzén E. Journal of Neurologic Physical Therapy. 2021 Oct 1;45(4):266-272.

View description

An investigation of sensor-derived physical activity measured over 7 days using the Actigraph GT3x accelerometer and perceived health of people with PD during the first wave of the COVID-19 pandemic, as well as the factors associated with these outcomes in 89 participants.

Overall, this Swedish patient cohort was relatively physically active. However, women were less active at moderate-vigorous levels and were at greater risk of deterioration in perceived health during this time. To elaborate: The majority (67%, women more than men) reported a pandemic-related reduction in exercise habits. A pandemic-induced deterioration in health was reported by 42%, women being 5 times more likely than men to do so.
 


COVID-19: An Early Review of Its Global Impact and Considerations for Parkinson's Disease Patient Care.
Bhidayasiri R, Virameteekul S, Kim JM, Pal PK, Chung SJ. Journal of Movement Disorders. 2020 May;13(2):105-114.

View description

A review to explore the risk of COVID-19 in PD based on the susceptibility to severe disease, its impact on PD disease severity, potential long-term sequelae, and difficulties of PD management during this outbreak, where neurologists face various challenges on how to maintain effective care for PD patients without exposing them, or physicians, to the risk of infection.
 


Impact of Prolonged Lockdown due to COVID-19 in Patients with Parkinson's Disease.
Prasad S, Holla VV, Neeraja K, Surisetti BK, Kamble N, Yadav R, Pal PK.Prasad S, et al. Neurology India. 2020 Jul-Aug;68(4):792-795.

View description

A study to explore the effects of prolongation of lockdown in a sample of 100 PD patients. The authors found that patients faced a significantly increased number of problems due to this pandemic, specifically, the inability to access health care and difficulty procuring medication. Patients also reported worsening of motor symptoms.
 


The Impact of the COVID-19 Pandemic on Parkinson's Disease: Hidden Sorrows and Emerging Opportunities
Helmich R, Bolem B. Journal of Parkinson's Disease. 2020;10(2):351-354.

  Pathogenesis

The mechanisms of smell loss after SARS-CoV-2 infection.
Doty RL. The Lancet Neurology. 2021 Jul 30:S1474-4422(21)00202-7.

Gut Microbiome Imbalance and Neuroinflammation: Impact of COVID-19 on Parkinson's Disease.
Follmer C. Movement Disorders. 2020 Sep;35(9):1495-1496.

Neuropathologic features of four autopsied COVID-19 patients.
Kantonen J, Mahzabin S, Mäyränpää MI, Tynninen O, Paetau A, Andersson N, Sajantila A, Vapalahti O, Carpén O, Kekäläinen E, Kantele A, Myllykangas L.Kantonen J, et al. Brain Pathology. 2020 Aug 6:10.1111/bpa.12889.

Special Collection: COVID-19 Resources
Movement Disorders. 

COVID-19 and selective vulnerability to Parkinson's disease.
Pavel A, Murray DK, Stoessl AJ.Pavel A, et al. The Lancet Neurology. 2020 Sep;19(9):719.

COVID-19 and Parkinson's Disease: Shared Inflammatory Pathways Under Oxidative Stress
Chaudhry ZL, Klenja D, Janjua N, Cami-Kobeci G, Ahmed BY. Brain Sciences. 2020 Oct 31;10(11):807.

View description

Increasing evidence suggests an involvement of oxidative stress and contribution of NFκB in the development of both COVID-19 and PD. Although it is early to identify if SARS-CoV-2 led infection enhances PD complications, it is likely that oxidative stress may exacerbate PD progression in COVID-19 affected individuals and/or vice versa.

Using bioinformatics analysis, the authors investigate whether NFκB-associated inflammatory pathways following oxidative stress in SARS-CoV-2 and PD patients are correlated by searching for similarities of SARS-CoV-2 proteins against human proteome. In addition, a human cell model of PD was created in 6-hydroxydopamine (6OHDA)-induced differentiated dopamine-containing neurons (dDCNs) obtained from an immortalized human neural progenitor cell line derived from the ventral mesencephalon region of the brain (ReNVM). The authors find that SARS-CoV-2 infection and 6OHDA-induced toxicity triggered stimulation of caspases-2, -3 and -8 via the NFκB pathway, resulting in the death of dDCNs. Specific inhibitors for NFκB and certain caspases reduced the death of stressed dDCNs. Selective inhibition of caspases and NFκB activation may contribute to the development of potential therapeutic approaches for the treatment of COVID-19 and PD.
 


COVID-19 and Parkinson’s disease: Defects in neurogenesis as the potential cause of olfactory system impairments and anosmia
Rethinavel H, Ravichandran S, Radhakrishnan RK, Kandasamy M. Journal of Neurochemical Anatomy. 2021 Sep;115:101965.

Is COVID-19 a Perfect Storm for Parkinson's Disease?
Brundin P, Nath A, Beckham JD. Trends in Neurosciences. 2020 Dec;43(12):931-933.

View description

The description of the possible cellular and molecular mechanisms underlying the development of acute parkinsonism following coronavirus disease 2019 (COVID-19) and whether COVID-19 might be associated with elevated long-term risk of PD are discussed.
 


The Possible Protective Role of α-Synuclein Against Severe Acute Respiratory Syndrome Coronavirus 2 Infections in Patients with Parkinson's Disease.
Ait Wahmane S, Achbani A, Ouhaz Z, Elatiqi M, Belmouden A, Nejmeddine M.Ait Wahmane S, et al. Movement Disorders. 2020 Jun 9:10.1002/mds.28185.

May Parkinson's disease be a protective factor against CNS involvement by SARS-CoV2?
Spina Tensini F, Spina Tensini T, Franklin GL, Teive HAG. Parkinsonism & Related Disorders. 2020 Aug;77:20.

COVID-19 and possible links with Parkinson's disease and parkinsonism: from bench to bedside.
Sulzer D, Antonini A, Leta V, Nordvig A, Smeyne RJ, Goldman JE, Al-Dalahmah O, Zecca L, Sette A, Bubacco L, Meucci O, Moro E, Harms AS, Xu Y, Fahn S, Ray Chaudhuri K. NPJ Parkinson's Disease. 2020 Aug 20;6(1):18.

View description

An early viewpoint discussing insights from basic science and clinical perspectives of brain COVID-19. The authors interpret neuropathology studies and discuss the role of ACE2 expression in healthy and infected brains.
 

  New-Onset Parkinsonism After a COVID-19 Infection

 

Parkinson's disease after COVID-19.
Makhoul K, Jankovic J. Journal of Neurological Sciences. 2021 Mar 15;422:117331.

Acute hypokinetic-rigid syndrome following SARS-CoV-2 infection.
Méndez-Guerrero A, Laespada-García MI, Gómez-Grande A, Ruiz-Ortiz M, Blanco-Palmero VA, Azcarate-Diaz FJ, Rábano-Suárez P, Álvarez-Torres E, de Fuenmayor-Fernández de la Hoz CP, Vega Pérez D, Rodríguez-Montalbán R, Pérez-Rivilla A, Sayas Catalán J, Ramos-González A, González de la Aleja J. Neurology. 2020 Oct 13;95(15):e2109-e2118.

Coronavirus disease 2019 and parkinsonism: a non-post-encephalitic case.
Faber I, Brandão, PRP, Menegatti F, de Carvalho Bispo DD, Maluf FB, Cardoso F. Movement Disorders. 2020; 35: 1721-1722.

A case of probable Parkinson’s disease after SARS-CoV-2 infection.
Cohen ME, Eichel R, Steiner-Birmanns B, Janah A, Ioshpa M, Bar-Shalom R, Paul JJ, Gaber H, Skrahina V, Bornstein NM, Yahalom G. Lancet Neurology. 2020; 19: 804-805

  PD as Manifestation of Long-COVID

Can SARS-CoV-2 Infection Lead to Neurodegeneration and Parkinson's Disease?
Krey L, Huber MK, Höglinger GU, Wegner F. Brain Sciences. 2021 Dec 18;11(12):1654.

View description A review summarizing the interface between viral infection and neurodegeneration/PD. The authors discuss SARS-CoV-2 neurotropism, neuropathology and the suspected pathophysiological links between the COVID infection and neurodegeneration. The authors conclude that the current data are not sufficient to confirm that COVID-19 can trigger or accelerate neurodegenerative diseases.
 


Possible Link between SARS-CoV-2 Infection and Parkinson's Disease: The Role of Toll-Like Receptor 4.
Conte C. International Journal of Molecular Science. 2021 Jul 1;22(13):7135.

View description

A review article discussing the neurotropic potential of SARS-CoV-2 and its possible involvement in the pathogenesis of PD. Specifically, the involvement of the toll-like receptor 4 (TLR4) signaling pathway and the possible interaction between SARS-CoV-2 and α-SYN are explored.
 


Can COVID-19 accelerate neurodegeneration?
Salari M, Etemadifar M. Clinical Case Reports. 2021 Jul 9;9(7):e04433.

View description

The authors discuss how far COVID-19 may accelerate neurodegeneration in patients with neurodegenerative disease.
 


Parkinson's Disease in the Era of a Novel Respiratory Virus Pandemic
Otero-Losada M, Kobiec T, Udovin L, Chevalier G, Quarracino C, Menéndez Maissonave C, Bordet S, Capani F, Perez-Lloret S. Frontiers in Neurology. 2020 Sep 11;11:995.

Parkinsonism as a Third Wave of the COVID-19 Pandemic?
Beauchamp LC, Finkelstein DI, Bush AI, Evans AH, Barnham KJ.Beauchamp LC, et al. J Parkinsons Dis. 2020 Sep 22. Journal of Parkinson's Disease. 2020;10(4):1343-1353.

View description

Given the clinical overlap between COVID-19 and PD (e.g. hyposmia), the authors highlight the importance of monitoring convalescent individuals for potential long-term implications that may include neurodegenerative sequelae such as viral-associated parkinsonism. They call for a strategized health policy to ensure healthcare systems all over the world are prepared for a third wave of the virus in the form of parkinsonism.
 


A Post-COVID-19 Parkinsonism in the Future?
Boika AV. Movement Disorders. 2020 Jul;35(7):1094.

The Potential Role of SARS-COV-2 in the Pathogenesis of Parkinson's Disease.
Chaná-Cuevas P, Salles-Gándara P, Rojas-Fernandez A, Salinas-Rebolledo C, Milán-Solé A.Chaná-Cuevas P, et al. Frontiers in Neurology. 2020 Sep 17;11:1044.

View description

The authors discuss neurotropic properties and longevity of coronaviruses, with some selectively targeting the basal ganglia. The authors discuss that coronavirus is detected in brain autopsies and in CSF of affected patients and the role of marked inflammatory responses.
 


The cognitive consequences of the COVID-19 epidemic: collateral damage?
Ritchie K, Chan D, Watermeyer T. Brain Communications. 2020 May 28;2(2):fcaa069.

View description

A systematic search on previous viral epidemics regarding cognitive difficulties following the infection. The authors discuss how coronavirus infections may increase the probability of post-infection memory impairment, and acceleration of neurodegenerative disorders such as Alzheimer's disease.
 


Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Parkinsonism: Is There Evidence for Concern?
Monje MHG, Martínez-Fernández R. Movement Disorders. 2020 Oct;35(10):1725.

Can the 2019 Novel Coronavirus Cause Parkinson's Disease?
Achbani A, Sine H, Naciri A, Baba MA, Kharbach A, Bouchriti Y, Nejmeddine M. Movement Disorders. 2020 Jul;35(7):1102-1103.

Alzheimer's and Parkinson's Diseases Predict Different COVID-19 Outcomes: A UK Biobank Study.
Yu Y, Travaglio M, Popovic R, Leal NS, Martins LM. Geriatrics (Basel, Switzerland). 2021 Jan 26;6(1):10.

View description

An investigation of the links between neurodegeneration and COVID-19. Primary health records of 13,338 UK individuals tested for COVID-19 between March and July 2020 were analyzed. While a pre-existing diagnosis of Alzheimer's disease predicted the highest risk of COVID-19 and mortality among elderly individuals, Parkinson's disease was also associated with a higher risk of SARS-CoV-2 infection but not mortality from COVID-19. The authors conclude that there are disease-specific differences in COVID-19 susceptibility among patients affected by neurodegenerative disorders.
 

  Clinical Outcome of Patients with Pre-Existing PD

COVID-19 manifestations in people with Parkinson's disease: A USA cohort
Yaqian Xu, Matthew Surface, Amanda K Chan, Joshua Halpern, Nora Vanegas-Arroyave, Blair Ford, Megan P Feeney, Kimberly T Kwei, Linn E Katus, Sheng-Han Kuo, Hiral Shah, Cheryl Waters, Linda M Winfield, James C Beck, Serge Przedborski, Stanley Fahn Roy N AlcalayJournal of Neurology. 2021 Sep 4. 

View description

The authors surveyed PD patients with self-reported COVID-19 for COVID-19 symptoms, general clinical outcomes and changes in motor and non-motor PD symptoms. In this cohort of 46, PD with COVID-19 manifestations of COVID-19 were similar to the general population, ranging from asymptomatic carriers (1/46) to death (6/46). The most common COVID-19 symptoms were fever/chills, fatigue, cough, weight loss, and muscle pain. Participants reported worsening and new onset of motor and non-motor PD symptoms during COVID-19 illness, including dyskinesia, rigidity, balance disturbances, anxiety, depression and insomnia.
 


Integrated multi-omics approach identified molecular mechanism and pathogenetic processes of COVID-19 that affect patient with Parkinson's disorder.
Zhao H, Zhang Q, Chen H, Rezanur Rahman M, Md Faruquee H. Saudi Journal of Biological Sciences. 2021 Dec;28(12):6939-6945.

View description

This study investigated the genetic impact or mechanisms that may induce Parkinsonism in COVID-19 patients or after COVID-19 by looking for commonly dysregulated genes, transcriptional regulators, and pathways between PD and COVID-19. The authors integrated genome-wide transcriptomic datasets from peripheral blood mononuclear cells (PBMC) samples from COVID-19 and PD and associated pathways. They found 81 upregulated and 48 downregulated differentially expressed genes (DEGs) shared between PD and COVID-19, which were involved in key pathways "mitochondrion structure organization," "cell activation in immune response," and "signaling by interleukins." Specifically, RELA, TP53 and SP1 TFs were identified that may regulate the upregulated DEGs.
 


Outcome of Parkinson's Disease Patients Affected by COVID-19.
Antonini A, Leta V, Teo J, Chaudhuri KR. Movement Disorders. 2020 Jun;35(6):905-908.

Predictors of COVID-19 outcome in Parkinson's disease.
Fasano A, Elia AE, Dallocchio C, Canesi M, Alimonti D, Sorbera C, Alonso-Canovas A, Pezzoli G.Fasano A, et al. Parkinsonism Relat Disord. 2020 Aug 13;78:134-137

View description

The authors report clinical findings in a cohort of 117 community-dwelling PD patients with COVID-19 followed in 21 tertiary centers in Italy, Iran, Spain and the UK. Overall mortality was 19.7%, with a significant effect of co-occurrence of dementia, hypertension and PD duration.
 


COVID-19 in Parkinson's disease: what holds the key?
Sainz-Amo R, Baena-Álvarez B, Pareés I, Sánchez-Díez G, Pérez-Torre P, López-Sendón JL, Fanjul-Arbos S, Monreal E, Corral-Corral I, García-Barragán N, Martínez-Castrillo JC, Fasano A, Alonso-Cánovas A. Parkinsonism & Related Disorders. 2020 Sep;78:134-137.

Effects of COVID-19 on Parkinson's disease clinical features: a community-based case-control study.
Cilia R, Bonvegna S, Straccia G, Nico GA, Elia AE, Romito LM, Devigili G, Cereda E, Eleopra R. Movement Disorders. 2020 May 25. doi: 10.1002/mds.28170.

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The impact of coronavirus disease 2019 (COVID-19) on clinical features of Parkinson's disease (PD) has been poorly characterized so far. Of 141 PD patients resident in Lombardy, we found 12 COVID-19 cases (8.5%), whose mean age and disease duration (65.5 and 6.3 years, respectively) were similar to controls. Changes in clinical features in the period January 2020 to April 2020 were compared with those of 36 PD controls matched for sex, age, and disease duration using the clinical impression of severity index for PD, the Movement Disorders Society Unified PD Rating Scale Parts II and IV, and the nonmotor symptoms scale. Motor and nonmotor symptoms significantly worsened in the COVID-19 group, requiring therapy adjustment in one third of cases. Clinical deterioration was explained by both infection-related mechanisms and impaired pharmacokinetics of dopaminergic therapy. Urinary issues and fatigue were the most prominent nonmotor issues. Cognitive functions were marginally involved, whereas none experienced autonomic failure. © 2020 International Parkinson and Movement Disorder Society

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Phenomenology and outcomes of in-patients with Parkinson's disease during COVID-19 pandemic.
Kobylecki C, Jones T, Lim CK, Miller C, Thomson AM.Kobylecki C, et al. Movement Disorders. 2020 Jun 24:10.1002/mds.28205.

Clinical Characteristics of Coronavirus Disease 2019 (COVID-19) among Patients at a Movement Disorders Center.
de Marcaida JA, Lahrmann J, Machado D, Bluth L, Dagostine M, Moro-de Casillas M, Bortan E, Kanchana S, Alberts M.de Marcaida JA, et al. Geriatrics (Basel, Switzerland). 2020 Sep 18;5(3):E54. 

Effects of COVID-19 on Parkinson's Disease Clinical Features: A Community-Based Case-Control Study.
Cilia R, Bonvegna S, Straccia G, Andreasi NG, Elia AE, Romito LM, Devigili G, Cereda E, Eleopra R.Cilia R, et al. Movement Disorders. 2020 May 25:10.1002/mds.28170.

Preview full abstract The impact of coronavirus disease 2019 (COVID-19) on clinical features of Parkinson's disease (PD) has been poorly characterized so far. Of 141 PD patients resident in Lombardy, we found 12 COVID-19 cases (8.5%), whose mean age and disease duration (65.5 and 6.3 years, respectively) were similar to controls. Changes in clinical features in the period January 2020 to April 2020 were compared with those of 36 PD controls matched for sex, age, and disease duration using the clinical impression of severity index for PD, the Movement Disorders Society Unified PD Rating Scale Parts II and IV, and the nonmotor symptoms scale. Motor and nonmotor symptoms significantly worsened in the COVID-19 group, requiring therapy adjustment in one third of cases. Clinical deterioration was explained by both infection-related mechanisms and impaired pharmacokinetics of dopaminergic therapy. Urinary issues and fatigue were the most prominent nonmotor issues. Cognitive functions were marginally involved, whereas none experienced autonomic failure. © 2020 International Parkinson and Movement Disorder Society.
 


Rapid worsening in Parkinson's disease may hide COVID-19 infection.
Hainque E, Grabli D. Parkinsonism Related Disorders. 2020 May 8:S1353-8020(20)30117-6.

An educational case series of Parkinson's disease during the COVID-19 pandemic.
Lo Monaco MR, Colacicco G, Marotta J, Bentivoglio AR; GEMELLI AGAINST COVID-19 group.Lo Monaco MR, et al. Revenue Neurologique (Paris). 2020 Sep 12:S0035-3787(20)30658-5. 

COVID-19 in Parkinson's Disease Patients Living in Lombardy, Italy.
Fasano A, Cereda E, Barichella M, Cassani E, Ferri V, Zecchinelli AL, Pezzoli G. Movement Disorders. Jul;35(7):1089-1093.

Preview full abstract

Background: It is unknown whether patients with PD are at greater risk of COVID-19, what their risk factors are, and whether their clinical manifestations differ from the general population.

Objectives: The study aimed to address all these issues.

Methods: In a case-controlled survey, we interviewed 1,486 PD patients attending a single tertiary center in Lombardy, Italy and 1,207 family members (controls).

Results: One hundred five (7.1%) and 92 controls (7.6%) were identified as COVID-19 cases. COVID-19 patients were younger, more likely to suffer from chronic obstructive pulmonary disease, to be obese, and vitamin D nonsupplemented than unaffected patients. Six patients (5.7%) and 7 family members (7.6%) died from COVID-19. Patients were less likely to report shortness of breath and require hospitalization.

Conclusions: In an unselected large cohort of nonadvanced PD patients, COVID-19 risk and mortality did not differ from the general population, but symptoms appeared to be milder. The possible protective role of vitamin D supplementation warrants future studies. 

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COVID-19: Implications for Sudden Death in Parkinson's Disease.
Fiorini AC, Fonseca MCM, Scorza CA, Finsterer J, Rodrigues AM, de Almeida AG, Scorza FA.Fiorini AC, et al. Journal of Movement Disorders. 2021 Jan;14(1):78-80.

COVID-19 case fatality and Parkinson's disease.
Zhang Q, Schultz JL, Aldridge GM, Simmering JE, Narayanan NS.Zhang Q, et al. Movement Disorders. 2020 Nov;35(11):1914-1915.

  Myoclonus in COVID Patients

Myoclonus and COVID-19: A Challenge for the Present, a Lesson for the Future.
Latorre A, Rothwell JC. Movement Disorders Clinical Practice. 2020 Nov 2;7(8):888-890. 

Myoclonus in Patients With Coronavirus Disease 2019: A Multicenter Case Series.
Anand P, Zakaria A, Benameur K, Ong C, Putman M, O'Shea S, Greer D, Cervantes-Arslanian AM. Critical Care Medicine. 2020 Nov;48(11):1664-1669.

View description

Multicenter case series to assess risk factors for and outcomes after myoclonus in a cohort of eight patients with coronavirus disease in 2019 from Massachusetts, Georgia, and Virginia.

The authors found that the outcomes in patients with myoclonus were variable. One patient died. Five were cognitively intact and without focal neurologic deficits. In five cases, the myoclonus completely resolved within 2 days of onset. In three cases, it persisted for 10 days or longer. Significant metabolic derangements, hypoxemia, or exposure to sedating medications that may have contributed to the development of myoclonus was observed in seven patients. One patient developed encephalopathy with prolonged myoclonus in the absence of clear systemic provoking factors. Thus, myoclonus may be observed in severe acute respiratory syndrome coronavirus 2 infected patients, even in the absence of hypoxia.

 


Reversible Myoclonus-Ataxia as a Postinfectious Manifestation of COVID-19.
Schellekens MMI, Bleeker-Rovers CP, Keurlings PAJ, Mummery CJ, Bloem BR. Movement Disorders Clinical Practice. 2020 Sep 28;7(8):977-979.

Subcortical myoclonus in COVID-19: comprehensive evaluation of a patient.
Muccioli L, Rondelli F, Ferri L, Rossini G, Cortelli P, Guarino M. Movement Disorders Clinical Practice. 2020 Aug 7;7(8):971-973.

Diaphragmatic myoclonus due to SARS-CoV-2 infection.
Borroni B, Gazzina S, Dono F, Mazzoleni V, Liberini P, Carrarini C, Russo M, Pontolillo M, Vecchiet J, Onofrj M, Bonanni L. Neurological Sciences. 2020 Dec;41(12):3471-3474.

View description A report of two Italian patients diagnosed with diaphragmatic myoclonus after COVID-19. Mild lymphocytosis was present in cerebrospinal fluid in both, no structural brain changes. In case 1, electroencephalogram did not reveal any cortical correlates and brain imaging of the spine was unremarkable. Case 2 had cortical origin of myoclonus was demonstrated, suggesting different pathophysiological mechanisms in the two cases.
 


Post-hypoxic myoclonus after COVID-19 infection recovery.
Ros-Castelló V, Quereda C, López-Sendón J, Corral I. Movement Disorders Clinical Practice. 2020 Jul 17;7(8):983-984.

Opsoclonus myoclonus ataxia syndrome (OMAS) in the setting of COVID-19 infection.
Shah PB, Desai SD. Neurology. 2021 Jan 5;96(1):33.

Opsoclonus Myoclonus Ataxia Syndrome Related to the Novel Coronavirus (COVID-19).
Sanguinetti S, Ramdhani RA. Journal of Neuro-Opthamology. 2021 Sep 1;41(3):e288-e289.

Myoclonus and cerebellar ataxia following Coronavirus Disease 2019 (COVID-19).
Dijkstra F, Van den Bossche T, Willekens B, Cras P, Crosiers D. Movement Disorders Clinical Practice. 2020 Aug 7;7(8):974-976.

Preview full abstract The Coronavirus disease 2019 (COVID-19) outbreak has led to a pandemic with an overwhelming impact on daily living and the health care system. Major life-threatening complications may occur [1]. Although most patients suffer from respiratory symptoms, different neurological symptoms have been described, either directly or indirectly caused by COVID-19 [2]. Within the movement disorder spectrum, myoclonus has been observed as a COVID-19-related feature in several patients [3-5].


Generalized myoclonus in COVID-19.
Rábano-Suárez P, Bermejo-Guerrero L, Méndez-Guerrero A, Parra-Serrano J, Toledo-Alfocea D, Sánchez-Tejerina D, Santos-Fernández T, Folgueira-López MD, Gutiérrez-Gutiérrez J, Ayuso-García B, González de la Aleja J, Benito-León J. Neurology. 2020 Aug 11;95(6):e767-e772.

View description The report of three Spanish COVID (2 men, 1 woman, aged 63-88 years) with generalized simullous-sensitive myoclonus and mild hypersomnia. Myoclonus was generalized with both positive and negative jerks, predominantly affecting the face, neck and arm. Movements occurred spontaneously or on voluntary action, exaggerated by startle Allimproved, at least partially, with immunotherapy.


Opsoclonus-myoclonus syndrome, a post-infectious neurologic complication of COVID-19: case series and review of literature.
Emamikhah M, Babadi M, Mehrabani M, Jalili M, Pouranian M, Daraie P, Mohaghegh F, Aghavali S, Zaribafian M, Rohani M. Journal of Neurovirology. 2021 Jan 25:1-9

View description Report of seven cases of opsoclonus-myoclonus syndrome, presumably parainfectious in nature, in the context of CIVD-19. The authors discuss the phenomenology, possible pathophysiological relationship to COVID-19, and diagnostic and treatment strategy in each case and review the literature for similar cases associated with COVID-19.
 
  Psychological / Psychiatric Issues in Movement Disorder Patients in the Era of COVID-19

Risk factors for neuropsychiatric symptoms in patients with Parkinson’s disease during COVID-19 pandemic in Japan
Kitani-Morii F, Kasai T, Horiguchi G, Teramukai S, Ohmichi T, Shinomoto M, et al. PLoS One. 2021;16:e0245864.

Incidence of anxiety in Parkinson’s disease during the coronavirus disease (COVID-19) pandemic
Salari M, Zali A, Ashrafi F, Etemadifar M, Sharma S, Hajizadeh N, et al. Movement Disorders. 2020;35:1095–1096.

Higher perceived stress and exacerbated motor symptoms in Parkinson's disease during the COVID-19 lockdown in New Zealand.
Blakemore RL, Pascoe MJ, Horne KL, Livingston L, Young BN, Elias B, Goulden M, Grenfell S, Myall DJ, Pitcher TL, Dalrymple-Alford JC, Le Heron CJ, Anderson TJ, MacAskill MR. The New Zealand Medical Journal. 2021 Jul 9;134(1538):44-51.

View description

The relationship between perceived levels of stress, changes in physical activity levels and PD motor symptoms (i.e. self-reported changes in PD motor symptoms and physical activity duration and intensity) during lockdown compared to before was assessed in 49 PD patients in New Zealand. Perceived stress was higher in PD than controls, and in those reporting a worsening of tremor, balance/gait, dyskinesia and bradykinesia compared to those indicating no change during the COVID-19 lockdown. Physical activity did not have a beneficial effect.

The authors recommend reducing stressors s important adjunct treatment strategy to improve motor function in PD.
 


The psychological impact of COVID-19 among a sample of Italian patients with functional neurological disorders: A preliminary study.
Nisticò V, Goeta D, Gambini O, Demartini B. Parkinsonism & Related Disorders. 2020 Sep;78:79-81.

COVID-19: Review of a 21st Century Pandemic from Etiology to Neuro-psychiatric Implications.
Yamamoto V, Bolanos JF, Fiallos J, Strand SE, Morris K, Shahrokhinia S, Cushing TR, Hopp L, Tiwari A, Hariri R, Sokolov R, Wheeler C, Kaushik A, Elsayegh A, Eliashiv D, Hedrick R, Jafari B, Johnson JP, Khorsandi M, Gonzalez N, Balakhani G, Lahiri S, Ghavidel K, Amaya M, Kloor H, Hussain N, Huang E, Cormier J, Wesson Ashford J, Wang JC, Yaghobian S, Khorrami P, Shamloo B, Moon C, Shadi P, Kateb B. Journal of Alzheimer's Disease. 2020;77(2):459-504. 

View description A comprehensive review of SARS-CoV-2-induced disease, its mechanism of infection, diagnostics, therapeutics, and treatment strategies, while also focusing on less attended aspects by previous studies, including nutritional support, psychological, and rehabilitation of the pandemic and its management. COVID-19 causes an acute respiratory distress syndrome, cytokine storm, acute hypercoagulable state, and autonomic dysfunction. The elderly and patients suffering from Alzheimer's disease and dementia related illnesses seem to be at the higher risk. In addition to vaccines, B-cell and T-cell immunotherapy in combination are emerging strategies for prophylaxis. For all, mental health and illness are among the most important side effects of this pandemic.
 


Incidence of Anxiety in Parkinson's Disease During the Coronavirus Disease (COVID-19) Pandemic.
Salari M, Zali A, Ashrafi F, Etemadifar M, Sharma S, Hajizadeh N, Ashourizadeh H. Movement Disorders. 2020 Jul;35(7):1095-1096.

Synergy of pandemics-social isolation is associated with worsened Parkinson severity and quality of life
Subramanian I, Farahnik J, Mischley LK. NPJ Parkinson's Disease. 2020 Oct 8;6:28.

View description Social isolation causing depression and sleep dysfunction poses a risk factor for worsened health outcomes and increased mortality. The authors surveyed idiopathic PD patients to assess the link between social isolation, symptom severity and quality of life. Primary outcome measures were the Patient-Reported Outcomes in PD (PRO-PD) and questions from PROMIS Global related to social health. PRO-PD scores increased with decreasing social performance and social satisfaction scores. Lonely patients experienced a 55% greater symptom. In contrary, those reporting having a lot of friends had 21% fewer symptoms than those with without. Social isolation was associated with greater patient-reported PD severity and lower quality of life, although it is unclear whether this is the cause and/or a consequence of the disease.
 


Changes in Motor, Cognitive, and Behavioral Symptoms in Parkinson's Disease and Mild Cognitive Impairment During the COVID-19 Lockdown.
Baschi R, Luca A, Nicoletti A, Caccamo M, Cicero CE, D'Agate C, Di Giorgi L, La Bianca G, Lo Castro T, Zappia M, Monastero R. Frontiers in Psychiatry. 2020 Dec 14;11:590134. 

View description

The authors evaluated the motor, cognitive, and behavioral changes in Italian PD patients with and without mild cognitive impairment (PD-MCI and PD-NC) and in patients with MCI not associated with PD (MCInoPD) during the COVID-19 lockdown.

In total, 34 patients with PD-NC, 31 PD-MCI, and 31 MCInoPD and their caregivers were interviewed 10 weeks after the COVID-19 lockdown in Italy, using the Neuropsychiatric Inventory (NPI) and MDS-UPDRS, parts I and II, to detect changes in cognitive, behavioral, and motor symptoms. The authors found that all groups showed worsening of cognitive (39.6%), pre-existing (37.5%), and new (26%) behavioral symptoms, and motor symptoms (35.4%) during the lockdown, resulting in an increased caregiver burden in 26% of cases. Compared to PD-NC, PD-MCI was significantly and positively associated with the IADL lost during quarantine. PD-MCI, compared to MCInoPD, had significant worsening of motor symptoms. PD-MCI showed a significantly higher frequency of cognitive impairment, fatigue, and speech than PD-NC. On the contrary, PD-MCI showed significantly higher frequencies in several MDS-UPDRS items compared to MCInoPD.

 

  Management of PD in the Time of COVID

The Challenge of Managing Parkinson's Disease Patients during the COVID-19 Pandemic.
Garg D, Dhamija RK. Annals of Indian Academy of Neurology. 2020 Apr;23(Suppl 1):S24-S27.

View description The authors discuss the potential effects and challenges posed by the pandemic for PD patients, particularly in the Indian context where telecommunication access or support group access may be lacking for these patients.


Management of a Parkinson's disease patient with severe COVID-19 pneumonia.
Li J, Long X, Zhu C, Wang R, Hu S, Wang T, Li J, Lin Z, Xiong N.Li J, et al. Therapeutic Advances in Chronic Disease. 2020 Aug 11;11:2040622320949423.

View description The authors examine whether patients with PD are more susceptible to COVID-19 and whether the treatment of PD would affect the management of COVID-19 or vice versa. They report a case of a PD patient with severe COVID-19 pneumonia in Wuhan, China, whose motor symptoms worsened after the infection, complicated with acute hypoxemic respiratory failure, urinary tract infection, and acute encephalopathy. Anti-PD medicine was adjusted by stepwise increasing the dose.


The impact of COVID-19 on access to Parkinson's disease medication.
Cheong JLY, Goh ZHK, Marras C, Tanner CM, Kasten M, Noyce AJ; Movement Disorders Society Epidemiology Study Group. Cheong JLY, et al. Movement Disorders. 2020 Dec;35(12):2129-2133.

Preview full abstract

Background: Many countries have implemented drastic measures to fight the COVID-19 pandemic. Restrictions and diversion of resources may have negatively affected patients with Parkinson's disease (PD). Our aim was to examine whether COVID-19 had an impact on access to PD medication by region and income.

Methods: This study was conducted as part of a survey sent to members of the Movement Disorders Society focusing on access to PD medication globally.

Results: Of 346 responses, 157 (45.4%) agreed that COVID-19 had affected access to PD medication, while 189 (54.6%) disagreed. 22.8% of high-income and 88.9% of low-income countries' respondents agreed that access to PD medication was affected by COVID-19. 59% of all 'yes' respondents reported increased disability of patients as an impact.

Conclusions: Access to PD medication is likely to have been affected by COVID-19 and result in deterioration of patients' symptomatic control. Resource-poor countries appear to be disproportionately affected compared to more affluent countries. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Keywords: Parkinson's disease; COVID-19; epidemiology; access; medication.

Full text »


Physical activity changes and correlate effects in patients with Parkinson's disease during COVID-19 lockdown.
Schirinzi T, Di Lazzaro G, Salimei C, Cerroni R, Liguori C, Scalise S, Alwardat M, Mercuri NB, Pierantozzi M, Stefani A, Pisani A.Schirinzi T, et al. Movement Disorders Clinical Practice. 2020 Jul 17;7(7):797-802.

Preview full abstract

Background: COVID-19 outbreak profoundly affected health systems and people's daily life worldwide. Parkinson's disease (PD) patients lost their normal routine and interrupted regular physical activity, either as physiotherapy or sport, with inevitable consequence on their daily life and well-being.

Objectives: To evaluate the changes in physical activity due to COVID-19 emergency, including self-management strategies or technology-assisted activities, and the subsequent clinical implications in PD patients.

Methods: Seventy-four patients from an Italian center have been remotely examined during the lockdown (April–May 2020) by an email structured survey, including self-administered scales. We collected and analyzed data on changes, modalities and amount of physical active practice, on the use of technology-based tools, and on self-perceived clinical condition.

Results: Sixty percent of patients reported a significant worsening of their general conditions during the lockdown, the reduction of physical activity being the main risk factor for such change. However, patients found ways to practice physical activity, using satisfactorily technology assistance in 50% of cases (mostly women).

Conclusions: The COVID-19 emergency has been an ordeal for PD patients. Nevertheless, patients adapted their habits to continue practicing physical activity that resulted a main determinant of their well-being; as well, they successfully approached technology-based assistance. Education, communication, and networking emerge as critical for a constructive reaction to the emergency's challenges.

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Mental Health, Physical Activity, and Quality of Life in Parkinson's Disease During COVID-19 Pandemic.
Shalash A, Roushdy T, Essam M, Fathy M, Dawood NL, Abushady EM, Elrassas H, Helmi A, Hamid E. Movement Disorders. 2020 Jul;35(7):1097-1099.

Hoping for the best, planning for the worst: Palliative care approach to Parkinson disease during the COVID-19 pandemic.
Indu Subramanian, Christina L Vaughan.Indu Subramanian, et al. Parkinsonism & Related Disorders. 2020 Oct 6:S1353-8020(20)30774-4. 

View description An outline of the palliative approach of hoping for the best while preparing for the worst in several "what if" scenarios for people with Parkinson disease and their families during the COVID-19 pandemic.


Novel Outreach Program and Practical Strategies for Patients with Parkinsonism in the COVID-19 Pandemic.
Sennott B, Woo K, Hess S, Mitchem D, Klostermann EC, Myrick E, Savica R, Fleisher JE.Sennott B, et al. Journal of Parkinson's Disease. 2020;10(4):1383-1388.

View description The pandemic led to disruptions to routine care, high volumes of patient and caregiver calls. The authors developed a proactive COVID-19 outreach program targeting patients with advanced Parkinson's disease and related disorders, specifically those who are homebound, receiving or eligible for palliative care, and/or lacking support networks. The paper descibes the program and practical strategies providers can implement to support wellbeing and successful telehealth uptake during this time of social isolation and gradual reopening.
 


Potential impact and challenges associated with Parkinson's disease patient care amidst the COVID-19 global pandemic.
Elbeddini A, To A, Tayefehchamani Y, Wen C.Elbeddini A, et al. Journal of Clinical Movement Disorders. 2020 Aug 8;7:7.

View description

A review on the direct and indirect associations between COVID-19 and PD patient care.

The authors discuss potential direct effects of COVID-19 including possible neurodegeneration, concerns of symptom self-management with over-the-counter (OTC) products and ICU challenges that can arise in PD patients. The social distancing measures and disruptions in health care systems and PD clinical trials have an indirect effects resulting in negative decreased mental wellbeing of PD patients.

On a more positive note, telemedical care is quickly emerging as a primary communication tool for virtual patient care.


Self-reported needs of patients with Parkinson's disease during COVID-19 emergency in Italy.
Schirinzi T, Cerroni R, Di Lazzaro G, Liguori C, Scalise S, Bovenzi R, Conti M, Garasto E, Mercuri NB, Pierantozzi M, Pisani A, Stefani A. Neurological Sciences. 2020 Jun;41(6):1373-1375.

View description
  COVID-19 and Deep Brain Stimulation

The global pandemic has permanently changed the state of practice for pre-DBS neuropsychological evaluations
York MK, Farace E, Pollak L, Floden D, Lin G, Wyman-Chick K, et al. Parkinsonism & Related Disorders. 2021;86:135–138. 

Recommendations for Deep Brain Stimulation Device Management During a Pandemic.
Miocinovic S, Ostrem JL, Okun MS, Bullinger KL, Riva-Posse P, Gross RE, Buetefisch CM. Journal of Parkinson's Disease. 2020;10(3):903-910.

View description

Due to the pandemic elective procedures and non-urgent clinic visits have been postponed in many hospitals. This poses a challenge for DBS patients. This includes the case of the battery reaching end of life with the risk of interruption of therapy which is associated with rare but potentially life-threatening complications known as DBS-withdrawal syndrome. This may clinically manifest with status dystonicus in patients with generalized dystonia, patients with obsessive compulsive disorder can become suicidal, and epilepsy patients can experience potentially life-threatening worsening of seizures. Likewise, DBS system infection can require urgent, and rarely emergent surgery.

The authors recommend that elective interventions including new implantations and initial programming should be postponed. However, for patients with existing DBS systems, the battery status and electrical integrity interrogation can now be performed using patient programmers, and employed through telemedicine visits or by phone consultations. The decision for replacement of the implantable pulse generator to prevent interruption of DBS therapy should be made on a case-by-case basis taking into consideration battery status and a patient's tolerance to potential therapy disruption.
 


Strategies to mitigate impacts of the COVID-19 pandemic on patients treated with deep brain stimulation.
Kostick K, Storch EA, Zuk P, Blumenthal-Barby JS, Torgerson L, Yoshor D, Sheth S, Viswanathan A, Tarakad A, Jimenez-Shahed J, Goodman W, Lázaro-Muñoz G.Kostick K, et al. Brain Stimulation. 2020 Oct 2;13(6):1642-1643.

  Technical Solutions, Virtual Consultation

Care, Convenience, Comfort, Confidentiality, and Contagion: The 5 C's that Will Shape the Future of Telemedicine
Dorsey ER, Okun MS, Bloem BR. Care, convenience, comfort, confidentiality, and contagion: the 5 C’s that will shape the future of telemedicine. J Parkinsons Dis. 2020;10(3):893–897.

A New Era: The Growth of Video-Based Visits for Remote Management of Persons with Parkinson's Disease
Larson DN, Schneider RB, Simuni T. A new era: the growth of video-based visits for remote management of persons with Parkinson’s disease. J Parkinsons Dis. 2021;11:S27–S34. 

Telemedicine in an Academic Movement Disorders Center during COVID-19
Esper CD, Scorr L, Papazian S, Bartholomew D, Esper GJ, Factor SA. Journal of Movement Disorders. 2021 May;14(2):119-125.

Telemedicine in Parkinson's Disease: How to Ensure Patient Needs and Continuity of Care at the Time of COVID-19 Pandemic.
Miele G, Straccia G, Moccia M, Leocani L, Tedeschi G, Bonavita S, Lavorgna L; Digital Technologies, Web and Social Media Study Group of the Italian Society of Neurology.Miele G, et al. Telemedicine Journal and E-Health. 2020 Dec;26(12):1533-1536.

View description The authors discuss potentials and limitations of teleneurology in PD and propose a specific battery of tests, including patient-reported outcomes, smartphone applications, and neurological examination through telemedicine. They argue that telemedicine will become more valuable in the future, within conventional health care, to support clinicians in decision making, enabling more efficacious follow-up, reducing burden for caregivers, and delivering neurological expertise to local realities, particularly when in-person consultations are not feasible.


Implementation of Telemedicine for Urgent and Ongoing Healthcare for Patients with Parkinson's Disease During the COVID-19 Pandemic: New Expectations for the Future.
Cubo E, Hassan A, Bloem BR, Mari Z; MDS-Telemedicine Study Group. Journal of Parkinson's Disease. 2020;10(3):911-913.

Parkinson's Disease Remote Patient Monitoring During the COVID-19 Lockdown.
Motolese F, Magliozzi A, Puttini F, Rossi M, Capone F, Karlinski K, Stark-Inbar A, Yekutieli Z, Di Lazzaro V, Marano M. Journal of Parkinson's Disease. 2020 Oct 7;11:567413.

View description

A study to assess the feasibility of smartphone remote patient monitoring in a real-life cohort including 54 PD patients during the Italian COVID-19 lockdown.

All patients used a smartphone application capable of providing indicators of gait, tapping, tremor, memory and executive functions, measured at least twice per week (i.e., full compliance). Non-motor symptoms and quality of life were assessed by phone using standardised questionnaires.

The authors found that forty-five patients (83.3%) ran the app at least once; Twenty-nine (53.7%) subjects were half-compliant, while 16 (29.6%) were fully compliant and satisfied by the provided monitoring program. Compliance was reduced by technical issues or digital illiteracy (38.7%), demotivation (24%) and health-related issues (7.4%). Ten patients (18.5%) had therapy changes for their PD medication.


Remote Administration of the MDS-UPDRS in the Time of COVID-19 and Beyond.
Schneider RB, Myers TL, Tarolli CG, Amodeo K, Adams JL, Jensen-Roberts S, Dorsey ER, Schneider RB, et al. Journal of Parkinson's Disease. 2020;10(4):1379-1382.

Promoting Physical Activity via Telehealth in People With Parkinson Disease: The Path Forward After the COVID-19 Pandemic?
Quinn L, Macpherson C, Long K, Shah H. Physical Therapy. 2020 Sep 28;100(10):1730-1736.

View description

The authors implemented a single cohort study of a coaching intervention grounded in self-determination theory and adapted to telehealth delivery, (called Engage-PD) conducted at Columbia University Parkinson's Foundation Center of Excellence in New York City, NY (USA), the early epicenter of the COVID-19 pandemic in the United States. The aim was to address an immediate need for support and guidance in the home environment, including people with early-mid-stage PD, delivered via a telehealth platform. Participants completed baseline and follow-up (3 months) assessments and participated in up to 4 coaching sessions. The intervention incorporated 1:1 coaching, goal-setting, physical activity monitoring, and use of a disease-specific workbook to promote and support safe exercise uptake.

27 individuals with PD enrolled in the first 2 months of the pandemic for a recruitment rate of 52%, with the program ongoing. The recruitment rate was larger than expected.


Virtual Parkinson's Disease Support Groups in the COVID-19 Era: Social Connection in the Time of Social Distancing.
Subramanian I.Subramanian I. Movement Disorders Clinical Practice. 2020 Jul 10;7(6):739-740

Global survey on telemedicine utilization for movement disorders during the COVID-19 pandemic.
Hassan A, Mari Z, Gatto EM, Cardozo A, Youn J, Okubadejo N, Bajwa JA, Shalash A, Fujioka S, Aldaajani Z, Cubo E; International Telemedicine Study Group.Hassan A, et al. Movement Disorders. 2020 Oct;35(10):1701-1711.

Preview full abstract

Background: The COVID-19 pandemic restricted usual healthcare management for movement-disorders patients, with a consequent upsurge in telemedicine to bridge the gap.

Objective: To assess global telemedicine usage in the context of the pandemic.

Methods: The Movement Disorder Society (MDS) Telemedicine Study Group surveyed telemedicine experts from 40 countries across all continents in March-April 2020. Four domains of telemedicine were assessed: legal regulations, reimbursement, clinical use, and barriers; comparing emerging responses to the pandemic versus the baseline scenario.

Results: All forms of telemedicine for movement disorders increased globally, irrespective of country income categorization, as an immediate response to the pandemic. This was aided by widespread availability of technology and updated government regulations. However, privacy concerns, lack of reimbursement, limited access, and lack of telemedicine training were barriers highlighted worldwide.

Conclusions: Questions remain about the longevity and extent of changes in regulations and reimbursement regarding telemedicine in the aftermath of the pandemic. © 2020 International Parkinson and Movement Disorder Society.

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E-Rehabilitation: One solution for patients with Parkinson's disease in COVID-19 era.
Srivastav AK, Samuel AJ.Srivastav AK, et al. Parkinsonism & Related Disorders. 2020 Jun 4:S1353-8020(20)30130-9.

Global Perspective on Telemedicine for Parkinson's Disease.
Shalash A, Spindler M, Cubo E. Journal of Parkinsonson's Disease. 2021;11(s1):S11-S18.

View description
Telemedicine programs can be helpful tool to overcome geographical barriers and increase access to healthcare service, particularly for rural and underserved communities, groups that traditionally suffer from lack of access to healthcare. The authors discuss the growing evidence of the feasibility of telemedicine, cost and time savings, patients' and physicians' satisfaction, and its outcome and impact on patients' morbidity and quality of life, particularly in the times of theCOVID-19 pandemic. They also discuss current challenges including obstacles when implementing telemedicine including the limited performance of parts of the neurological exam, limited technological savvy, fear of loss of a personal connection, or uneasiness about communicating sensitive information. This article summarizes and reviews the current state and future directions of telemedicine from a global perspective.
  COVID-19 and Other Movement Disorders

Impact of Italian lockdown on Tourette’s syndrome patients at the time of the COVID-19 pandemic
Graziola F, Garone G, Criscio LD, Grasso M, Curatolo P, Vigevano F, et al. Psychiatry and Clinical Neuroscience. 2020;74:610–612. 

Acute-onset chorea and confusional state in 77-year-old COVID-19 patient: a case report
Sawczyńska K, Wężyk K, Bosak M, Jagiełła J, Andrasik S, Kępińska-Wnuk A, Dec-Ćwiek M, Słowik A. Neurologia I Neurochirurgia Polska. 2022 Jan 5.

Bilateral chorea as a manifestation of cerebral venous sinus thrombosis associated with COVID-19
Barberà AR, Gazquez IE, Mármol MBB, Campello AR. Neurologia. 2021 Nov 20. Neurologia. 2021 Nov 20. 

Rapid Onset Functional Tic-Like Behaviors in Young Females During the COVID-19 Pandemic.
Pringsheim T, Ganos C, McGuire JF, Hedderly T, Woods D, Gilbert DL, Piacentini J, Dale RC, Martino D. Movement Disorders. 2021 Dec;36(12):2707-2713.

Movement Disorders Associated with COVID-19.
Salari M, Zaker Harofteh B, Etemadifar M, Sedaghat N, Nouri H. Parkinson's Disease. 2021 Nov 8;2021:3227753.

View description A review based on 64 reports of de novo movement disorders developing after/during SARS-CoV-2 infection including demographic, clinical, and treatment-associated information and a discussion of probable causal links. The authors find that myoclonus and ataxia are the most frequent movement disorders occurring in COVID-19 patients. Tremor, chorea, and hypokinetic-rigid syndrome have also been observed.


Functional movement disorders in a patient with COVID-19.
Piscitelli D, Perin C, Tremolizzo L, Peroni F, Cerri CG, Cornaggia CM.Piscitelli D, et al. Neurological Sciences. 2020 Sep;41(9):2343-2344.

  Other Publications

Unmet Needs of People With Parkinson's Disease and Their Caregivers During COVID-19-Related Confinement: An Explorative Secondary Data Analysis.
Hanff AM, Pauly C, Pauly L, Schröder VE, Hansen M, Meyers GR, Kaysen A, Hansen L, Wauters F, Krüger R. Frontiers in Neurology. 2021 Jan 18;11:615172

View description In March and April 2020, 679 PD patients in Luxembourg and the Greater Region were contacted by phone to identify address self-perceived unmet needs during confinement, as well as the prevalence of self-reported COVID-19 related symptoms, confirmed SARS-CoV-2 infection, and self-reported COVID-19 related hospitalization. 25 themes where PwP need to be supported in order to cope with consequences of the pandemic, and to adapt their daily and health-related activities, ranging from one-directed information over interaction up to proactive counseling and monitoring. During the pandemic health professionals could expand their services in a meaningful way i.e., personalize their support in the identified themes and thus improve the healthcare in times of crisis.

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