- The current pandemic is about to repeat the Spanish flu scenario
Prof. Penko Shotekov is one of our greatest neurologists. He has over 45 years of experience and prominent scientific interests in the field of epilepsy. He is the head of the Clinic for Nervous Diseases at the University Hospital “St. Ivan Rilski” in Sofia.
- A Parkinson’s patient boom is possible, says prof. Penko Shotekov in the special interview for the newspaper STANDART
– Prof. Shotekov, you comment that together with the coronavirus the scenario of the so-called Spanish disease can be repeated. Is it possible that people who passed Covid-19 later developed Parkinson’s disease?
– Not only me, but also other authors make the analogy with the so-called Spanish disease that developed as a pandemic exactly 100 years ago (1918-1924), after the First World War.
It is a contagious disease that used to have severe inflammation of the brain, etc. Lethargic encephalitis accompanied by high mortality. It is known that more than 20 million people died worldwide, and some authors speak of 40 million.
By the way, this Spanish disease has proven to be a variant of bird flu, ie those flu that prevail in autumn and winter around the world. But, apparently as a result of the war and the famine, in those days a precondition was created for this flu to be very pathogenic. Those suffering from this severe infectious disease were 2-3 times more likely to develop parkinsonism after five to six years than a healthy population. In Bulgaria, this disease has been studied by the founder of Bulgarian neurology, prof. А. Janishevski.
– What exactly is the analogy between the current epidemic and the then pandemic?
– It is interesting that then, as now, patients had a loss of smell and taste. This indicates that the virus is penetrating the nasal cavity, from there through the olfactory nerve to the central nervous system. At the beginning of the current pandemic, it was claimed that about 6% of patients had a foul odor, and now, on closer inspection, it turns out that they are about 80 percent. Odor disorders are also one of the first symptoms of Parkinson’s disease (90% of cases). It has already been identified that there are particles of the virus in different parts of the nervous system – separate parts of the cerebral hemisphere cortex, the vegetative ganglia, which are responsible for respiration. So, the severe respiratory disorders that are observed are not only a result of the involvement of the lungs, but also of the involvement of the respiratory centers in the brain. The most interesting thing is that the virus particles are also found in the so-called substance nigra (black substance). This is a structure of the brain that is responsible for the production of the neurotransmitter Dopamine, and its reduction is associated with the development of Parkinson’s disease. Cells of this structure in the central nervous system have been found to develop neurodegenerative changes, which are also characteristic of Parkinson’s disease. Such neurodegenerative changes are also seen in cells in other parts of the nervous system. So, infection with Covid 19 affects not only the lungs, but almost all organs and systems. It was found that 35-55% of hospitalized patients have a nervous system disorder.
A few weeks ago, Spanish authors published an article on the case of acute infectious parkinsonism after Covid 19. Such cases are known in other viral infections. This case shows that Covid 19 may affect this structure of the brain, which is associated with the development of Parkinsonism.
All these facts give reason to think about the late consequences after the infection with Covid 19. Of course, it can not be said categorically that the Spanish flu scenario will be repeated, but in the medical literature such assumptions are already being made.
– Can dementia develop?
– Isolated cases of development of dementia syndrome and memory impairment in elderly patients have been described. But no definite conclusion can be drawn from this scanty data.
– What other complications of the nervous system can be noticed?
– Most symptoms of the nervous system are mild – headache, dizziness, vertigo, fatigue. Significantly fewer cases of encephalitis, myelitis (inflammation of the spinal cord), exacerbation of previous epileptic manifestations, toxometabolic encephalopathies, and others.
In 5% of cases, the development of strokes has been described. Most of them are ischemic strokes, single haemorrhages, and venous sinus thrombosis. Patients are usually older people with many risk factors for cerebrovascular complications. The reason is probably multifactorial. Involvement of endothelial cells in the arteries of the lungs and brain with the development of vascular inflammation and secondary thrombosis in the CNS or embolization of thrombi from the damaged lung.
Recently, attention has been drawn to some mental complications, such as depression, exacerbation of a previous mental illness, and memory impairment.
Other diseases, such as the autoimmune effects of Covid 19, include acute peripheral nerve involvement, and so on. acute demyelinating polyneuropathy, in which autoimmune damage to peripheral nerves develops with paralysis of the extremities. Exceptions are post-infectious autoimmune myelitis or inflammation of the spinal cord.
As you can see, the whole nervous system can be affected, but fortunately these complications of the infection are not so common.
– Can demyelinating diseases also develop – is it multiple sclerosis?
– At the beginning of the pandemic there was a great deal of concern about what to do with people with multiple sclerosis being treated with immunomodulatory drugs and immunosuppression. Many patients with multiple sclerosis are treated in our clinic and therefore this issue is still relevant. These patients were found not to be affected more frequently than other population contingents. However, international registries have been established for the inclusion of patients with multiple sclerosis and covidium 19. The aim is to monitor these patients and report on how their specific therapy affects their susceptibility to infection and how it develops.
– And, do we have the resources to examine all those who have shown symptoms related to the nervous system?
– Yes, there is such a possibility. At the beginning of the pandemic, less attention was paid to the nervous system. With the development of the pandemic, much evidence has been gathered that the nervous system is affected frequently and to varying degrees. These facts have yet to be summarized and a more comprehensive picture of the disease, the nervous system and subsequent possible long-term complications can be obtained.
– How did the Covid 19 epidemic affect your daily activities? Are patients with neurological diseases and stroke on the rise?
– Our clinic does not deal directly with the treatment of patients with Covid 19. But we helped in our hospital UMHAT “St. Ivan Rilski” to build a department to fight infection. Half of the beds at the Neurology Clinic were reserved for the Covid ward. We also let the sisters work there. So, we indirectly got involved in the fight against Covid-19. We now only accept emergency neurological patients. We should not think that other types of diseases are reduced. People continue to suffer from strokes, severe pain syndromes, brain tumors and more. neurological diseases.
– Are there more cases of neurosis around Covid-19?
– Of course. Psychologists have yet to work to assess the impact of pandemic stress on our psyche.