The Covid-19 global pandemic is having a dramatic impact on many chronic conditions including those affecting neurological patients and among them those with movement disorders.
In many cases, to protect vulnerable movement disorders patients from becoming infected, appointments have been postponed and many were left without appropriate alternatives to obtain a consultation.
Public health systems in many European countries have been unprepared to deal with this new situation. Telemedicine services outside Telestroke are often not available or not reimbursed. In addition, to allow sufficient access to Intensive Care Unit beds, most surgical procedures have been delayed, including deep brain stimulation or initiation of infusion therapies for Parkinson’s disease as they are classified as “non-urgent”.
Patients with movement disorders have asked for stratification of their risk and guidance on management of therapies during the COVID-19 pandemic.
Our EAN Movement disorders management group here provides some general recommendations regarding major questions related to the presence of specific risks, therapy and long-term complications related to this emergency.
Are patients with movement disorders particularly at risk of suffering respiratory complications due to COVID-19 infection?
Overall, patients with movement disorders do not suffer from specific deficits in their immune system which could put them at increased risk in case of COVID-19 infection. So far, experience from the most affected regions in Italy does not show an apparent increased risk, although there are no systematic data yet available.
However, some patients may be particularly vulnerable to respiratory infections or pneumonia due to limited respiratory capacity related to reduced mobility of their thoracic cage. This may apply particularly to advanced Huntington’s and Parkinson’s disease patients, but also to patients with multiple system atrophy who may complain about stridor and breathing difficulties at an earlier stage of disease. Therefore, it is important to be vigilant in counseling patients to undertake all precautions for reducing exposure risk.
What is the best approach in case of need to adjust medication given the difficulties in reaching hospital?
Unfortunately, in many European countries telemedicine is underdeveloped. However, especially for Parkinson’s disease patients, movement disorders neurologists are making efforts to organize their practice to address patients’ and caregivers’ questions related to therapy, to limit self-management of medication doses and optimize treatment. Many national societies have set up recommendations and patients associations have allocated resources for these purposes. There have been sporadic indications of shortages of medication supplies in some regions but this has been, so far, very limited.
Clinical trial activities are also suffering limitations or have been halted given the difficulties of performing hospital visits in many cases.
Are limitations in mobility due to COVID19 affecting movement disorders patients?
For many patients and caregivers, the current national mandatory restrictions in outdoor activities and in accessing rehabilitation services are aggravating motor problems, particularly for people who live in metropolitan areas. Some walking and light physical activity should be preserved during periods of restricted mobility. Several movement disorders clinics and patients associations are sending recommendations for adapted physical activities which can be obtained locally through regional societies and support groups.
Angelo Antonini and Carlo Colosimo, co-Chairs of the EAN Movement Disorders Scientific Panel
Cristian Falup Pecurariu, Elena Moro and Claudia Trenkwalder, from the Management Group of the EAN Movement Disorders Scientific Panel