What is new with COVID-19
Recently I was surprised to hear that COVID-19 patient can develop Parkinson’s disease. This disease indeed has mastered the art of defying the Medical science. There have been three cases reported where patients suffering of COVID-19 has developed Parkinson, a disease that impair a person movements and coordination. Should we worry then when we see trembling of the hands and legs, slow motion with sudden nail, stiff limbs and finally poor balance?
Professor Patrick Brundin, director at the center for Neurodegenerative Science at the Vandal Research Institute in Michigan, wrote a new article, titled “Is COVID-19 a perfect storm for Parkinson’s disease? He detailed the recent cases he observed while three patients infected with the SARS-CoV-2 for 4 to 5 weeks, have developed parkinsonism.
Two patients: a 35-year-old woman and a 45-year-old male were treated with Dopamine and recovered well while another 58-year-old male recovered spontaneously. Their brain imaging showed that the nigrostriatal system” has decreased in size. This system is known to be in control of the body motion after brain imaging, the same way it is observed in patient suffering of Parkinson disease.
These 3 patients have no previous signs of Parkinson, nor did they have any family history which generally attack people in their sixties or older.
It appears that those patients may have been destined to suffer from Parkinson Disease or were showing a deficient functioning nigral dopamine neurons and perhaps the viral infection precipitated the neurodegenerative process at a critical point. Professor Brundin suggested three mechanisms to explain how this virus may have induced the signs of parkinsonism:
1- The blood vessels in the brain become infected damaging the nigrostriatal system, the same way it happens in the vascular form of Parkinson disease caused by a cerebrovascular accident like a stroke impairing the blood flow to the brain.
2- The inflammation may reach the brain with the COVID-19, extending to the nigrostriatal system.
3- The virus SARS-Co-V-2 may invade and damage the brain neurons rich in ACE receptors and facilitating the entry of the virus into the brain cells.
We have seen viruses in chronic diseases like Hepatitis B (HBC) and Hepatitis C (HBC) cause chronic liver disease and failure. Other viruses like the human papillomavirus is known to cause cervical cancer. The virus of the Herpes Simplex type has been associated to Alzheimer’s disease, and finally, the adenovirus has been found to accelerate obesity. The Influenza pandemic appeared has preceded a Parkinson disease epidemic of the 1940-1950 decade. Animal model have demonstrated that the influenza virus was able to infiltrate the brain’s nigrostriatal system to induce Parkinson Disease.
COVID-19 may has surprised most physicians in all specialties but our neuro-scientists appear to be ready to face the neurological sequelae especially the one precipitating Parkinson disease. Researchers have identified other neuro-invasive pathogens linked to Parkinson Disease like the Epstein Barr virus (EPV), Varicella zoster (VZV), Hepatitis C (HCV), West Nile virus (WNV), Japanese encephalitis virus (JEV). Human immunodeficiency virus (HIV) and the helicobacter pylori bacterium.
Varicella zoster, Hepatitis C virus and H pylori infections have found all to be increasing the risk of a patient suffering from Parkinson disease. While Herpes Simple (HSV-1), Epson Barr virus, HIV virus and the Japanese Encephalitis virus are more Prevalent in Parkinson disease than in the general population.
SARS-CoV-2 infection may be in a silent mode even if the virus may no longer be present in the immune system, but remains rampant. The world was caught off guard by the first wave of COVID-19 but it appears that the neurologists are confident they will be ready for the next wave of neurological sequelae such as Parkinson disease in Australia, a national screening program is being developed and scientists are applying for grants to help them catch the early signs of Parkinson Disease. They know well the way no cure has ever been developed for this disease.
No other coronaviruses have acted like the SARS-CoV-2 although a 1992 study has detected antibody protection against common cold causing the coronavirus to reach the cerebrospinal fluid of Parkinson disease patients. Nothing can be concluded from this experience but may simply indicate that Parkinson disease patients are more susceptible to coronavirus infections rather than coronavirus itself inducing Parkinson disease. It has been demonstrated that many other pathogens can accelerate Parkinson disease progression while the brain become infected. We will have to attest if in the future such theory can be proven. pathogens can accelerate Parkinson disease progression while the brain become infected. Are there any risk factors involved like age, sex, head trauma, exposure to toxic metal, or certain psychiatric drugs? Are there any protective factors like exercises, Vitamins D or E or even caffeine intake? Let us wait what the post COVID19 era will bring us.
Three cases of COVID19 were documented with symptoms of Parkinson’s disease month later after the onset. There was no known family history nor the three patients have shown any previous signs of Parkinson disease but they have demonstrated brain abnormalities in the nigrostriatal system which control the body movement. Only one patient recovered and the other one have received the usual therapy received by Parkinson patients.
SARS-CoV-2 virus is known to be able to injure the brain. Evidence can be speculative let us agree that this virus can also hasten the progression of Parkinson in at least susceptible persons.
Maxime Coles MD
Ste Croix, Virgin Island
11-21-2020