Alfonso Fasano1,2,3, Angelo Antonini4, Regina Katzenschlager5, Paul Krack6, Per Odin7, Andrew H Evans8, Thomas Foltynie9, Jens Volkmann10, Marcelo Merello11,12. 1. Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, University Health Network, Division of Neurology University of Toronto Toronto Ontario Canada. 2. Krembil Brain Institute Toronto Ontario Canada. 3. The Center for Advancing Neurotechnological Innovation to Application Toronto Ontario Canada. 4. Department of Neuroscience University of Padua Padua Italy. 5. Department of Neurology and Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders Donauspital Vienna Austria. 6. Department of Neurology, Center for Parkinson's Disease and Movement Disorders Inselspital, Bern University Hospital, University of Bern Bern Switzerland. 7. Division of Neurology, Department of Clinical Sciences Lund Lund University Lund Sweden. 8. Department of Neurology the Royal Melbourne Hospital Victoria Australia. 9. Department of Clinical & Movement Neurosciences University College London Institute of Neurology, Queen Square London United Kingdom. 10. Neurologischen Klinik Universitätsklinikum Würzburg Würzburg Germany. 11. Movement Disorders Section Fleni Buenos Aires Argentina. 12. Consejo Nacional de Investigaciones Científicas y Técnicas Buenos Aires Argentina.
Abstract
BACKGROUND: Although the COVID-19 pandemic is affecting a relatively small proportion of the global population, its effects have already reached everyone. The pandemic has the potential to differentially disadvantage chronically ill patients, including those with Parkinson's disease (PD). The first health care reaction has been to limit access to clinics and neurology wards to preserve fragile patients with PD from being infected. In some regions, the shortage of medical staff has also forced movement disorders neurologists to provide care for patients with COVID-19. OBJECTIVE: To share the experience of various movement disorder neurologists operating in different world regions and provide a common approach to patients with PD, with a focus on those already on advanced therapies, which may serve as guidance in the current pandemic and for emergency situations that we may face in the future. CONCLUSION: Most of us were unprepared to deal with this condition given that in many health care systems, telemedicine has been only marginally available or only limited to email or telephone contacts. In addition, to ensure sufficient access to intensive care unit beds, most elective procedures (including deep brain stimulation or the initiation of infusion therapies) have been postponed. We all hope there will soon be a time when we will return to more regular hospital schedules. However, we should consider this crisis as an opportunity to change our approach and encourage our hospitals and health care systems to facilitate the remote management of chronic neurological patients, including those with advanced PD.
BACKGROUND: Although the COVID-19 pandemic is affecting a relatively small proportion of the global population, its effects have already reached everyone. The pandemic has the potential to differentially disadvantage chronically ill patients, including those with Parkinson's disease (PD). The first health care reaction has been to limit access to clinics and neurology wards to preserve fragile patients with PD from being infected. In some regions, the shortage of medical staff has also forced movement disorders neurologists to provide care for patients with COVID-19. OBJECTIVE: To share the experience of various movement disorder neurologists operating in different world regions and provide a common approach to patients with PD, with a focus on those already on advanced therapies, which may serve as guidance in the current pandemic and for emergency situations that we may face in the future. CONCLUSION: Most of us were unprepared to deal with this condition given that in many health care systems, telemedicine has been only marginally available or only limited to email or telephone contacts. In addition, to ensure sufficient access to intensive care unit beds, most elective procedures (including deep brain stimulation or the initiation of infusion therapies) have been postponed. We all hope there will soon be a time when we will return to more regular hospital schedules. However, we should consider this crisis as an opportunity to change our approach and encourage our hospitals and health care systems to facilitate the remote management of chronic neurological patients, including those with advanced PD.
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