Objective: To document the phenotypic range and nature of all published cases of new-onset parkinsonism developing with or shortly after a reported Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection.

Background: A “perfect storm” for a post-Coronavirus Disease 2019 (Covid-19) emergence of parkinsonism in some susceptible individuals has been recently discussed [1, 2], due to a potential pathogenic effect of the SARS-CoV-2 inflammatory response in the central nervous system, and the selective affinity of SARS-CoV-2 for Angiotensin-Converting Enzyme-2 (ACE-2) molecules, which are highly expressed in the brain stem, and may facilitate the viral brain entry [3, 4].

Method: We performed a review of the literature up to February 2022 to detect and analyze published cases of new-onset parkinsonism after a SARS-CoV-2 infection in otherwise healthy individuals.

Results: 20 cases met our criteria and developed parkinsonian features simultaneously or shortly after a confirmed SARS-CoV-2 infection  ADDIN EN.CITE.DATA [5-20]. In 11 patients, parkinsonism appeared in the context of encephalopathy, while four patients developed post-infectious parkinsonism without encephalopathy, and four had phenotypic similarities to idiopathic PD. Nine patients were responsive to levodopa, while four required immunomodulatory treatment.

Conclusion: Although cases have already been reported, current data does not yet justify the concept of a post-Covid-19 parkinsonism. However, long-term surveillance is crucial to ensure that reports of further cases are carefully documented and analyzed.

References: 1. Beauchamp LC, Finkelstein DI, Bush AI, Evans AH, Barnham KJ. Parkinsonism as a Third Wave of the COVID-19 Pandemic? J Parkinsons Dis. 2020;10(4):1343-53. 10.3233/JPD-202211
2. Brundin P, Nath A, Beckham JD. Is COVID-19 a Perfect Storm for Parkinson’s Disease? Trends Neurosci. 2020;43(12):931-3. 10.1016/j.tins.2020.10.009
3. Zhang H, Penninger JM, Li Y, Zhong N, Slutsky AS. Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target. Intensive Care Med. 2020;46(4):586-90. 10.1007/s00134-020-05985-9
4. Sulzer D, Antonini A, Leta V, et al. COVID-19 and possible links with Parkinson’s disease and parkinsonism: from bench to bedside. NPJ Parkinson’s disease. 2020;6:18-. 10.1038/s41531-020-00123-0
5. Faber I, Brandão PRP, Menegatti F, de Carvalho Bispo DD, Maluf FB, Cardoso F. Coronavirus Disease 2019 and Parkinsonism: A Non-post-encephalitic Case. Mov Disord. 2020;35(10):1721-2. 10.1002/mds.28277
6. Méndez-Guerrero A, Laespada-García MI, Gómez-Grande A, et al. Acute hypokinetic-rigid syndrome following SARS-CoV-2 infection. Neurology. 2020;95(15):e2109-e18. 10.1212/wnl.0000000000010282
7. Cohen ME, Eichel R, Steiner-Birmanns B, et al. A case of probable Parkinson’s disease after SARS-CoV-2 infection. Lancet Neurol. 2020;19(10):804-5. 10.1016/s1474-4422(20)30305-7
8. Pilotto A, Masciocchi S, Volonghi I, et al. Clinical Presentation and Outcomes of Severe Acute Respiratory Syndrome Coronavirus 2-Related Encephalitis: The ENCOVID Multicenter Study. J Infect Dis. 2021;223(1):28-37. 10.1093/infdis/jiaa609
9. Akilli NB, Yosunkaya A. Part of the Covid19 puzzle: Acute parkinsonism. Am J Emerg Med. 2021;47:333.e1-.e3. 10.1016/j.ajem.2021.02.050
10. Makhoul K, Jankovic J. Parkinson’s disease after COVID-19. J Neurol Sci. 2021;422:117331. 10.1016/j.jns.2021.117331
11. Roy D, Song J, Awad N, Zamudio P. Treatment of unexplained coma and hypokinetic-rigid syndrome in a patient with COVID-19. BMJ Case Rep. 2021;14(3). 10.1136/bcr-2020-239781
12. Fearon C, Mikulis DJ, Lang AE. Parkinsonism as a Sequela of SARS-CoV-2 Infection: Pure Hypoxic Injury or Additional COVID-19-Related Response? Mov Disord. 2021;36(7):1483-4. 10.1002/mds.28656
13. Tiraboschi P, Xhani R, Zerbi SM, et al. Postinfectious Neurologic Complications in COVID-19: A Complex Case Report. J Nucl Med. 2021;62(8):1171-6. 10.2967/jnumed.120.256099
14. Rass V, Beer R, Schiefecker AJ, et al. Neurological outcome and quality of life 3 months after COVID-19: A prospective observational cohort study. Eur J Neurol. 2021;28(10):3348-59. 10.1111/ene.14803
15. Ghosh R, Ray A, Roy D, Das S, Dubey S, Benito-León J. Parkinsonism with akinetic mutism following osmotic demyelination syndrome in a SARS-CoV-2 infected elderly diabetic woman: A case report. Neurologia. 2021. 10.1016/j.nrl.2021.09.007
16. Ayele BA, Demissie H, Awraris M, et al. SARS-COV-2 induced Parkinsonism: The first case from the sub-Saharan Africa. Clin Park Relat Disord. 2021;5:100116-. 10.1016/j.prdoa.2021.100116
17. Morassi M, Palmerini F, Nici S, et al. SARS-CoV-2-related encephalitis with prominent parkinsonism: clinical and FDG-PET correlates in two patients. J Neurol. 2021:1-8. 10.1007/s00415-021-10560-3
18. Cavallieri F, Fioravanti V, Toschi G, et al. COVID-19 and Parkinson’s disease: a casual association or a possible second hit in neurodegeneration? Journal of neurology. 2021:1-3. 10.1007/s00415-021-10694-4
19. Ong TL, Nor KM, Yusoff Y, Sapuan S. COVID-19 Associated Acute Necrotizing Encephalopathy Presenting as Parkinsonism and Myorhythmia. J Mov Disord. 2022;15(1):89-92. 10.14802/jmd.21063
20. Rao AR, Hidayathullah SM, Hegde K, Adhikari P. Parkinsonism: An emerging post COVID sequelae. IDCases. 2022;27:e01388. 10.1016/j.idcr.2022.e01388

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MDS Abstracts - https://www.mdsabstracts.org/abstract/new-onset-parkinsonism-after-covid-19-is-there-a-link-a-2022-report-of-clinical-cases/