ABSTRACT
INTRODUCTION: Parkinson's disease (PD) is more frequent in the elderly and increases the risk of respiratory infections. Previous data on PD and SARS-CoV-2 are scarce, suggesting a poor prognosis in advanced disease and second-line therapies. METHODS: A retrospective case-control study comparing patients with PD and COVID-19 and patients with PD without COVID-19 was conducted during the pandemic period in Spain (March 1st-July 31st 2020) in a tertiary university hospital. RESULTS: Thirty-nine (COVID-19 +) and 172 (COVID-19-) PD patients were included. Fifty-nine percent were males in both groups, with similar age (75.9 ± 9.0 COVID-19 + , 73.9 ± 10.0 COVID-19-), disease duration (8.9 ± 6.2 COVID-19 + , 8.5 ± 5.6 COVID-19-) and PD treatments. COVID-19 was mild in 10 (26%), required admission in 21 (54%) and caused death in 8 (21%) patients. Dementia was the only comorbidity more frequent in COVID-19 + patients (36% vs. 14%, p = 0.0013). However, in a multivariate analysis, institutionalization was the only variable associated with COVID-19 + (OR 17.0, 95% CI 5.0-60.0, p < 0.001). When considering severe COVID-19 (admission or death) vs. mild or absent COVID-19, institutionalization, neoplasm, dementia and a lower frequency of dopamine agonists were associated with severe COVID-19. In multivariate analysis, only institutionalization [OR 5.17, 95% CI 1.57-17, p = 0.004] and neoplasm [OR 8.0, 95%CI 1.27-49.8, p = 0.027] remained significantly associated. CONCLUSION: In our experience, institutionalization and oncologic comorbidity, rather than PD-related variables, increased the risk of developing COVID-19, and impacted on its severity. These findings suggest that epidemiologic factors and frailty are key factors for COVID-19 morbidity/mortality in PD. Appropriate preventive strategies should be implemented in institutionalized patients to prevent infection and improve prognosis.
Subject(s)
COVID-19 , Parkinson Disease , Aged , Case-Control Studies , Humans , Male , Parkinson Disease/complications , Parkinson Disease/drug therapy , Parkinson Disease/epidemiology , Retrospective Studies , SARS-CoV-2 , Spain/epidemiologyABSTRACT
Background and aims: B-lymphocytes play an important role in the pathophysiology of MS. As with other anti- CD20-antibodies, there is evidence that Rituximab may be effective and safe in this disease. Methods: Retrospective study in MS patients treated with Rituximab between 2017-2021. Demographic, clinical, radiologic and laboratory variables were analyzed. Results: 45 patients were included (60% males, mean age 48.3±8;84.4% presented SPMS;median baseline EDSS 6.0, IQR 4-6.5;mean follow-up 22.69±8.75 months). After one year of treatment, there was a significant reduction of relapses (ARR 0.51 vs 0.1, p=0.002), new/enlarged T2 lesion (60% vs 10%, p<0.001) or gadolinium-enhancing lesions (40% vs 0%, p<0.001) on MRI. EDSS, T25FWT, 9HPT or SDMT did not significally change. 33.3% presented confirmed disability progression (CDP). 56.4% achieved NEDA-3. Retreatment was guided by B-lymphocytes count. Mean B-cells count was 285.7, 1.553, 4.456, 54.35, 10.47 at baseline, 3, 6, 9 and 12 months, respectively. Mean time to retreatment was 9.05±3.14 months. Lipidospecific IgM-OCB were associated with CDP (adjusted OR 6.33, p=0.047). At first dose, 31.1% presented an infusion reaction, with fewer cases with retreatment. 28.8% presented infections of any kind, including three cases of Covid19 (only one case of severe infection was reported). No cases of hypogammaglobulinemia were reported. Conclusion: B-lymphocytes count guiding retreatment with Rituximab among patients with MS may favor a good safety profile, while being effective in reducing inflammatory activity. CDP was associated with lipidospecific IgM-OCB.
ABSTRACT
Background and aims: SARS CoV2 encephalopathy is now a recognized entity. We present five cases of encephalopathy associated with SARS CoV2 with focal presentation. Methods: Case series Results: Five patients were included (4 males and one woman), mean age was 60 (58-76). Four patients required mechanical ventilation. The clinical presentation were aphasia (3/5), hemianopia (1/5), hemiparesis (1/5) and akinetic mutism (1/5) Metabolic disturbances and vascular etiology were ruled out. Neuroimaging with cranial CT with CT angiography or MRi was performed in all cases. In 3/5 CNS lumbar puncture was performed, showing mirror pattern oligoclonal bands in all of them. The clinic progressively improved until it disappeared in all of them. Conclusion: SARS CoV2 encephalopathy may present with focal symptoms. More studies are needed to elucidate its pathogenesis. As possible explanations, we propose inflammatory activation at the CNS level, sustained hypoxia. Direct CNS invasion seems less probable.