Effects of COVID-19 Lockdown on Movement Disorders Patients With Deep Brain Stimulation: A Multicenter Survey

Abstract

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.

Remote smartphone gait monitoring and fall prediction in Parkinson’s disease during the COVID-19 lockdown

“…Indeed, physiotherapy and physical activity were not considered among the "essential needs" universally allowed during the 2020 lockdown in Italy. Their beneficial effect on PTs and on the falling risk is well acknowledged nowadays [12,13] and the discontinuation of physiotherapy was declared as a main factor of a detrimental in PD-related quality of life in a similar cohort from Italy collected during the same timeframe [14].…”

Moving Forward from the COVID-19 Pandemic: Needed Changes in Movement Disorders Care and Research

“…In a large, survey-based study, the majority of people with PD (64%) reported disruptions in their medical care during the pandemic [7•]. During the early phase of the pandemic, there was decreased access to care for management of deep brain stimulation [22], botulinum toxin injections [17], and initiation of levodopa-carbidopa intestinal gel and continuous subcutaneous apomorphine infusion [23]. These disruptions extended to rehabilitative therapies; in one survey-based study, 60% of individuals with PD lost their access to rehabilitative care [12].…”

“…Those who had disruptions in their PD care or access to medications were more likely to experience symptomatic decline or increased disability [ 7 •, 25 ]. Patient-reported difficulties with deep brain stimulation devices predicted worsened symptoms [ 22 ]. In another study, one-third of those who reported worsening of PD symptoms associated this with loss of rehabilitative care [ 12 ].…”

Needs and Perceptions of Patients With Dystonia During the COVID-19 Pandemic: A Qualitative Framework Analysis of Survey Responses From Italy

“…Dystonia management, therefore, encompasses regular follow-ups and various strategies frequently managed in a multidisciplinary setting ( 2 ). The main treatment plan not only consists of medical [oral drugs ( 2 ), such as benzodiazepine and botulinum neurotoxin injection (BoNT) ( 12 )] and surgical approaches [i.e., deep brain stimulation (DBS) ( 2 , 11 , 13 )] but also, more recently, rehabilitation ( 14 , 15 ).…”