- The current pandemic is preparing to repeat the Spanish flu scenario
Prof. Penko Šotekov is one of our greatest neurologists. He has over 45 years of experience and prominent scientific interests in the field of epileptology. He is the head of the Clinic for Nervous Diseases at the St. Ivan Rilski University Hospital in Sofia.
- It is possible that Parkinson’s patients will flourish, says prof. Penko Shotekov in a special interview for the STANDART newspaper
– Professor Shotekov, you commented that together with the coronavirus, the scenario of the so-called Spanish disease can be repeated. Is it possible that people who spent Covid-19 later developed Parkinson’s disease?
– Not only me, but also other authors make an analogy with the so-called Spanish disease, which developed as a pandemic exactly 100 years ago (1918-1924), after the First World War.
It is a contagious disease that once had severe inflammation of the brain etc. Lethargic encephalitis accompanied by high mortality. It is known that more than 20 million people have died worldwide, and some authors speak of 40 million.
By the way, it turned out that this Spanish disease is a variant of bird flu, that is, the flu that prevails in autumn and winter around the world. But apparently as a result of the war and famine of those days, a precondition was created for this flu to be very pathogenic. Those who suffered from this severe infectious disease were 2 to 3 times more likely to develop parkinsonism after five to six years than a healthy population. In Bulgaria, this disease was studied by the founder of Bulgarian neurology, prof. A. Yanishevski.
– 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 penetrates 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 weakened odor, and now, upon closer examination, it turns out that there are about 80 percent of them. Odor disorders are also one of the first symptoms of Parkinson’s disease (90% of cases). It has already been established that in different parts of the nervous system there are virus particles – separate parts of the cerebral hemisphere cortex, vegetative ganglia, which are responsible for respiration. Thus, the serious respiratory disorders observed are not only due to the involvement of the lungs, but also due to 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 nigra substance (black substance). This is the brain structure responsible for the production of the neurotransmitter dopamine, and its reduction is associated with the development of Parkinson’s disease. Cells of this structure were found to develop neurodegenerative changes in the central nervous system, which are also characteristic of Parkinson’s disease. Such neurodegenerative changes are also observed in cells of other parts of the nervous system. Thus, Covid 19 infection affects not only the lungs, but almost all organs and systems. It has been found that 35 to 55% of hospitalized patients have a nervous system disorder.
A few weeks ago, Spanish authors published an article on a case of acute infectious parkinsonism after Covid 19. Such cases are also known in other viral infections. This case shows that Covid 19 may affect this brain structure, which is associated with the development of parkinsonism.
All these facts give reason to think about the late consequences after Covid 19 infection. Of course, it cannot be categorically said that the Spanish flu scenario will be repeated, but in the medical literature such assumptions are already made.
– Can dementia develop?
– Isolated cases of dementia and memory impairment syndrome have been reported in elderly patients. But from these scarce data no definitive conclusion can be drawn.
– 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), worsening of previous epileptic manifestations, toxometabolic encephalopathies and some others.
The development of strokes has been described in 5% of cases. Most of them are ischemic strokes, single bleeding and venous sinus thrombosis. Usually, patients are elderly with many risk factors for cerebrovascular complications. The reason is probably multifactorial. Involvement of endothelial cells of the pulmonary arteries 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 previous mental illnesses, and memory impairment.
Other diseases, such as the autoimmune effects of Covid 19, are acute peripheral nerve involvement, etc. acute demyelinating polyneuropathy, in which autoimmune damage to peripheral nerves with limb paralysis develops. The exceptions are postinfectious autoimmune myelitis or inflammation of the spinal cord.
As you can see, the entire nervous system can be affected, but fortunately these complications of infection are not so common.
– Can demyelinating diseases also develop – ie multiple sclerosis?
– At the beginning of the pandemic, there were very big concerns about what to do with multiple sclerosis patients being treated with immunomodulatory drugs and immunosuppression. Many patients with multiple sclerosis are treated in our clinic and that is why this issue is still relevant. It turned out that these patients were not affected more often than other contingents of the population. However, international registries have been established to include patients with multiple sclerosis and Covid 19. The goal 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 accumulated 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, nervous system and subsequent possible long-term complications can be obtained.
– How has the Covid 19 epidemic affected your daily activities? Are patients with neurological diseases and stroke increasing?
– Our clinic does not deal directly with the treatment of patients with Covid 19. But we helped in our hospital UMHAT “St. John of Rila” to build a department to fight infections. Half of the bed at the Neurology Clinic was set aside for the Kovid ward. We also let the sisters work there. So, we indirectly got involved in the fight against Kovid-19. We now only accept emergency neurological patients. We should not think that other types of disease have diminished. People still suffer from strokes, severe pain syndrome, brain tumors and more. neurological diseases.
– Are there more cases of neurosis around Kovid-19?
– Of course. Psychologists have yet to work on assessing the impact of pandemic stress on our psyche.