Parkinson disease following COVID‐19: Report of six cases

• Published in: European journal of neurology Vol. 30; no. 5; pp. 1272 - 1280
• Main Authors: Calculli, Alessandra, Bocci, Tommaso, Porcino, Mattia, Avenali, Micol, Casellato, Chiara, Arceri, Sebastiano, Regalbuto, Simone, Priori, Alberto, Pisani, Antonio
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.05.2023
• Subjects: Abnormalities; Brain diseases; Complications; COVID-19; COVID-19 - complications; Dopamine receptors; Humans; Immune response; Infections; Inflammation; Medical imaging; Movement disorders; Nervous System Diseases; neurodegeneration; Neurodegenerative diseases; Neuroimaging; Neurological complications; Pandemics; Parkinson disease; Parkinson Disease - complications; Parkinson's disease; parkinsonism; Pathogenesis; Polymerase chain reaction; Public health; RNA-directed DNA polymerase; SARS-CoV-2; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Signs and symptoms; Tremor; Viral diseases; COVID-19; Parkinson disease; neurodegeneration; SARS-CoV-2; parkinsonism
• ISSN: 1351-5101; 1468-1331
• DOI: 10.1111/ene.15732

Background and purpose Core clinical manifestations of COVID‐19 include influenza‐like and respiratory symptoms. However, it is now evident that neurological involvement may occur during SARS‐CoV‐2 infection, covering an extensive spectrum of phenotypical manifestations. A major challenge arising from this pandemic is represented by detecting emerging neurological complications following recovery from SARS‐CoV‐2 infection. To date, a few post‐COVID‐19‐infected subjects diagnosed with Parkinson disease (PD) have been described, raising the possibility of a connection between the infection and neurodegenerative processes. Here, we describe a case series of six subjects who developed PD after COVID‐19. Methods Patients were observed at Scientific Institute for Research and Health Care Mondino Foundation Hospital, Pavia (Italy), and San Paolo University Hospital of Milan (Italy) between March 2021 and June 2022. In all subjects, SARS‐CoV‐2 infection was confirmed by means of reverse transcriptase polymerase chain reaction from a nasopharyngeal swab. Subjects underwent an accurate neurological evaluation, and neuroimaging studies were performed. Results We describe six subjects who developed PD with an average time window after SARS‐CoV‐2 infection of 4–7 weeks. Apparently, no relationship with COVID‐19 severity emerged, and no overt structural brain abnormalities were found. All subjects experienced unilateral resting tremor at onset and showed a satisfactory response to dopaminergic treatment. Conclusions Immune responses to SARS‐CoV‐2 infection have been shown to shape the individual susceptibility to develop long‐term consequences. We hypothesize that, in these subjects, COVID‐19 has unmasked a latent neurodegenerative process. Characterization of the neuroinflammatory signatures in larger cohorts is warranted, which might provide novel insights into the pathogenesis of PD.