- The current pandemic is about to repeat the Spanish flu scenario
Prof. Penko Shotekov is one of our biggest neurologists. He has over 45 years of experience in epileptology and distinguished scientific interests. Head of the Clinic for Nervous Diseases at the University Hospital “St. Ivan Rilski” in Sofia.
- In an exclusive interview with the newspaper STANDART, Professor Penko Shotekov says the explosion of Parkinson’s patients is possible.
Prof. Shotekov said that with the coronavirus, the so-called Spanish disease scenario could be replicated. Is it possible that those who had Covid-19 later got Parkinson’s disease?
– Not only me, but also other authors allegedly 100 years ago (1918-1924), a Spanish disease that developed as an epidemic after the First World War.
Severe inflammation of the brain, etc. It is an infectious disease used for. Drowsy encephalitis accompanied by high mortality. It is known that more than 20 million people died worldwide, and some authors cite 40 million.
By the way, it turns out that this Spanish disease is a form of avian flu, that is, the flu that prevails all over the world in autumn and winter. But apparently, in those days, a precondition was created for this flu to be highly pathogenic due to war and famine. Those who survived this severe infectious disease were 2 to 3 times more likely to develop parkinsonism after five to six years than the healthy population. This disease in Bulgaria, the founder of Bulgarian neurology Prof. It was studied by A. Yanishevski.
– What exactly is the similarity between the current epidemic and the epidemic back then?
The interesting thing is that as now, patients had a loss of smell and taste. This indicates that the virus has penetrated into the nasal cavity, from there through the olfactory nerve to the central nervous system. At the beginning of the current pandemic, about 6% of patients were claimed to have bad odor, and now it turns out to be about 80 percent when examined more closely. Smell disorders are also one of the first symptoms of Parkinson’s disease (90% of cases). It has been established that there are virus particles in different parts of the nervous system – separate parts of the cortex of the cerebral hemispheres, vegetative ganglia responsible for respiration. In other words, the observed serious respiratory disorders arise not only from the involvement of the lungs but also from the involvement of the respiratory centers in the brain. The most interesting thing is that viral particles are also present in the substance called Substance nigra (black matter). This is a brain structure responsible for the production of the neurotransmitter Dopamine, and its decrease is associated with the development of Parkinson’s disease. It has been found that cells of this structure in the central nervous system develop neurodegenerative changes that are also characteristic of Parkinson’s disease. Such neurodegenerative changes are also observed in cells of other parts of the nervous system. In other words, Covid 19 infection affects not only the lungs, but almost all organs and systems. 35 to 55% of hospitalized patients have been found to have a nervous system disorder.
A few weeks ago, Spanish authors published an article about the acute infectious case of parkinsonism after Covid 19. Such cases are known in other viral infections. This suggests that Covid 19 can affect this brain structure involved in the development of parkinsonism.
All these facts give reason to think about the late results after Covid 19 infection. Of course, it cannot be said categorically that the Spanish flu scenario will repeat, but such assumptions are already made in the medical literature.
– Can dementia develop?
Isolated cases of dementia syndrome and memory impairment have been reported in elderly patients. However, no definitive conclusion can be drawn from these scarce data.
– What other complications of the nervous system can be seen?
Most nervous system symptoms are mild – headache, dizziness, lightheadedness, tiredness. Significantly less encephalitis, myelitis (inflammation of the spinal cord), exacerbation of previous epileptic symptoms, toxometabolic encephalopathies and others.
In 5% of cases, the development of paralysis is described. Most are ischemic strokes, single hemorrhages, and venous sinus thrombosis. Generally, patients are elderly people with many risk factors for cerebrovascular complications. The reason is probably multifactorial. The development of vascular inflammation and secondary thrombosis in the CNS and the involvement of endothelial cells of the lung and brain arteries or embolization of the thrombus from the damaged lung.
Recently, some mental complications such as depression, exacerbation of previous mental illness and memory impairment have been noted.
Other diseases such as autoimmune effects of Covid 19, acute involvement of peripheral nerves etc. Acute demyelinating polyneuropathy, in which autoimmune damage to peripheral nerves develops with paralysis of the limbs. Exceptions are post-infection autoimmune myelitis or spinal cord inflammation.
As you can see, the entire nervous system can be affected, but fortunately these complications of the infection are not very common.
– Can demyelinating diseases also develop – ie multiple sclerosis?
– At the beginning of the pandemic, there were huge concerns about what to do with people with Multiple Sclerosis who were treated with immunomodulatory drugs and immunosuppression. Many patients with Multiple Sclerosis are treated in our clinic and therefore this problem is still valid. It turns out that these patients are not affected more often than other groups of the population. However, international registries have been created to include Multiple Sclerosis and Covid 19 patients. The aim is to monitor these patients and report how their specific treatments affect their susceptibility to infection and how they develop.
– Do we have resources to examine anyone with symptoms related to the nervous system?
– Yes, there is such a possibility. Less attention was paid to the nervous system at the onset of the pandemic. With the development of the pandemic, much evidence has accumulated that the nervous system is affected frequently and to varying degrees. These facts have not yet been summarized and a more comprehensive picture of disease, nervous system involvement and possible subsequent complications should be obtained in the long term.
– How did the Covid 19 outbreak affect your daily activities? Are patients with neurological diseases and stroke on the increase?
– Our clinic is not directly interested in the treatment of Covid 19 patients. But in our hospital we helped UMHAT “St. Ivan Rilski” build a ward to fight infection. Half of the beds in the Neurology Clinic were allocated to the Kovid ward. We gave our sisters to work there too. Therefore, we were indirectly involved in the fight against Kovid-19. We now only accept neurological emergency patients. We shouldn’t assume that other types of illness are decreasing. People continue to suffer from strokes, severe pain syndromes, brain tumors, and more. neurological diseases.
– Are there any other cases of neurosis around Kovid-19?
– Of course. Psychologists have not yet worked to assess the impact of pandemic stress on our psyche.