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Review
. 2020 May 4;7(4):361-372.
doi: 10.1002/mdc3.12965. eCollection 2020 May.

Management of Advanced Therapies in Parkinson's Disease Patients in Times of Humanitarian Crisis: The COVID-19 Experience

Alfonso Fasano  1   2   3 , Angelo Antonini  4 , Regina Katzenschlager  5 , Paul Krack  6 , Per Odin  7 , Andrew H Evans  8 , Thomas Foltynie  9 , Jens Volkmann  10 , Marcelo Merello  11   12
Affiliations
Review

Management of Advanced Therapies in Parkinson's Disease Patients in Times of Humanitarian Crisis: The COVID-19 Experience

Alfonso Fasano et al. Mov Disord Clin Pract. .

Abstract

Background: Although the COVID-19 pandemic is affecting a relatively small proportion of the global population, its effects have already reached everyone. The pandemic has the potential to differentially disadvantage chronically ill patients, including those with Parkinson's disease (PD). The first health care reaction has been to limit access to clinics and neurology wards to preserve fragile patients with PD from being infected. In some regions, the shortage of medical staff has also forced movement disorders neurologists to provide care for patients with COVID-19.

Objective: To share the experience of various movement disorder neurologists operating in different world regions and provide a common approach to patients with PD, with a focus on those already on advanced therapies, which may serve as guidance in the current pandemic and for emergency situations that we may face in the future.

Conclusion: Most of us were unprepared to deal with this condition given that in many health care systems, telemedicine has been only marginally available or only limited to email or telephone contacts. In addition, to ensure sufficient access to intensive care unit beds, most elective procedures (including deep brain stimulation or the initiation of infusion therapies) have been postponed. We all hope there will soon be a time when we will return to more regular hospital schedules. However, we should consider this crisis as an opportunity to change our approach and encourage our hospitals and health care systems to facilitate the remote management of chronic neurological patients, including those with advanced PD.

Keywords: COVID‐19; Parkinson's disease; SARS‐CoV‐2; advanced therapies; telemedicine.

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Conflict of interest statement

A.F. received honoraria and research support from Abbvie, Abbott, Boston Scientific, and Medtronic. A.A. received honoraria from AbbVie and Neuroderm and research support from Chiesi Pharmaceuticals. R.K. has received honoraria from AbbVie, Britannia, Ever Pharma, and Stada and research grants from Britannia and Stada. P.K. reports grants from Boston Scientific and Aleva and lecturing fees paid to the employing institution from Boston Scientific. P.O. has received honoraria and research support from AbbVie, Britannia, and Nordic Infucare. A.H.E. received honoraria from AbbVie, Britannia, and Abbott. T.F. has received honoraria from Boston Scientific. J.V. reports grants and lecturing fees from Boston Scientific and advisory fees paid by Boston Scientific, Medtronic, and Newronika. M.M. reports grants and lecturing fees from St. Jude Medical/Abbott.

Figures

Figure 1
Figure 1
The impact of SARS CoV‐2 pandemic and Parkinson's disease on patients (modified from refs. 20, 21). BoNT, botulinum neurotoxin; SARS CoV‐2, severe acute respiratory syndrome coronavirus 2.
Figure 2
Figure 2
Proposed triaging system for PD outpatients during the severe acute respiratory syndrome coronavirus 2 pandemic. CSAI, continuous subcutaneous apomorphine infusion; DBS, deep brain stimulation; IPG, implantable pulse generator; LCIG, levodopa‐carbidopa intestinal gel; PD, Parkinson's disease; PEG, percutaneous endoscopic gastrostomy. *After having ruled out accidental switching off or kinking/compression of the tubing system (in case of CSAI or LCIG).
Figure 3
Figure 3
Examples of telemedicine assessment in a patient with levodopa‐carbidopa intestinal gel showing the status of percutaneous endoscopic gastrostomy (A), a patient of deep brain stimulation changing the stimulating parameters on her controller to improve gait (B), and a patient recently operated with deep brain stimulation showing the status of the surgical wounds (C).
See this image and copyright information in PMC

References

    1. Guan Y, Zheng BJ, He YQ, et al. Isolation and characterization of viruses related to the SARS coronavirus from animals in southern China. Science 2003;302:276–278. - PubMed
    1. Nassar MS, Bakhrebah MA, Meo SA, Alsuabeyl MS, Zaher WA. Middle East Respiratory Syndrome Coronavirus (MERS‐CoV) infection: epidemiology, pathogenesis and clinical characteristics. Eur Rev Med Pharmacol Sci 2018;22:4956–4961. - PubMed
    1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497–506. - PMC - PubMed
    1. Mao L, Wang M, Chen S, et al. Neurological manifestations of hospitalized patients with COVID‐19 in Wuhan, China: a retrospective case series study. mdRxiv 2020. 10.1101/2020.02.22.20026500 - DOI
    1. Buchman AS, Yu L, Wilson RS, Schneider JA, Bennett DA. Association of brain pathology with the progression of frailty in older adults. Neurology 2013;80:2055–2061. - PMC - PubMed