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Front Neurol ; 11: 616550, 2020.
Article in English | MEDLINE | ID: covidwho-1006082


Background: The containment measures taken by Italian government authorities during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic caused the interruption of neurological activities of outpatient clinics. Vulnerable patients, as Parkinson's disease (PD) and dystonic patients with deep brain stimulation (DBS), may have an increased risk of chronic stress related to social restriction measures and may show a potential worsening of motor and psychiatric symptoms. Methods: This cross-sectional multicenter study was carried out during the SARS-CoV-2 pandemic and was based on a structured survey administered during a telephone call. The questionnaire was designed to gather motor and/or psychiatric effects of the lockdown and coronavirus disease 2019 (COVID-19) epidemiologic information in PD and dystonic patients with a functioning DBS implant. Results: One hundred four patients were included in the study, 90 affected by PD and 14 by dystonia. Forty-nine patients reported a subjective perception of worsening of global neurological symptoms (motor and/or psychiatric) related to the containment measures. In the multivariate analysis, having problems with the DBS device was the only independent predictor of motor worsening [odds ratio (OR) = 3.10 (1.22-7.91), p = 0.018]. Independent predictors of psychiatric worsening were instrumental activities of daily living (IADL) score [OR = 0.78 (0.64-0.95), p = 0.012] and problems with DBS [OR = 5.69 (1.95-16.62), p = 0.001]. Only one patient underwent nasopharyngeal swabs, both negative, and no patient received a diagnosis of COVID-19. Conclusions: Lockdown restriction measures were associated with subjective worsening of motor and psychiatric symptoms in PD and dystonic patients treated with DBS, and they may have exacerbated the burden of neurological disease and increased the chronic stress related to the DBS management.

Mov Disord Clin Pract ; 7(7): 797-802, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-723229


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 e-mail 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.

Neurol Sci ; 41(6): 1373-1375, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-155217


Because of COVID-19 outbreak, regular clinical services for Parkinson's disease (PD) patients have been suddenly suspended, causing worries, confusion and unexpected needs in such frail population. Here, we reviewed the messages spontaneously sent by patients to an Italian PD clinic during the first two weeks of COVID-19 lockdown (9-21 March 2020), in order to highlight their main needs and then outline appropriate strategies of care for this critical period. One hundred sixty-two messages were analysed. Forty-six percent queried about clinical services; 28% communicated an acute clinical worsening for which a therapeutic change was done in 52% of cases; 17% (those patients with younger age and milder disease) asked about the relationship between PD and COVID-19; 8% informed about an intercurrent event. Our analysis suggests that PD patients' needs during COVID-19 emergency include appropriate and complete information, a timely update on changes in clinical services, and the continuity of care, even in a remote mode. By addressing these issues, acute clinical worsening, complications and subsequent therapeutic changes could be prevented. In this perspective, telecommunication systems and virtual medicine should be implemented.

Betacoronavirus , Coronavirus Infections/epidemiology , Emergency Service, Hospital/trends , Health Services Needs and Demand/trends , Parkinson Disease/epidemiology , Pneumonia, Viral/epidemiology , Self Report , Adult , Aged , Aged, 80 and over , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Female , Humans , Italy , Male , Middle Aged , Pandemics , Parkinson Disease/diagnosis , Parkinson Disease/therapy , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , SARS-CoV-2 , Telemedicine/methods , Telemedicine/trends