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  • A case of probable Parkinso...
    Cohen, Mikhal E; Eichel, Roni; Steiner-Birmanns, Bettina; Janah, Amir; Ioshpa, Maxim; Bar-Shalom, Rachel; Paul, Jefri J; Gaber, Hanaa; Skrahina, Volha; Bornstein, Natan M; Yahalom, Gilad

    Lancet neurology, 10/2020, Letnik: 19, Številka: 10
    Journal Article

    Parkinson's disease or parkinsonism have been described after infections by viruses, such as influenza A, Epstein-Barr virus, varicella zoster, hepatitis C virus, HIV, Japanese encephalitis virus, or West Nile virus.1 We report a patient with probable Parkinson's disease, who was diagnosed after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Because of the worsening of tremor in his right extremities, in a follow-up visit on June 29, biperiden was added at a dose of 2 mg daily, and increased to 4 mg daily after 1 week, which resulted in improvement of the tremor. Other researchers have proposed the so-called multiple hit hypothesis, by which the combination of toxic stress and an inhibition of neuroprotective responses can lead to neuronal death.4 Parkinson's disease is often preceded by anosmia, which is a common feature of SARS-CoV-2 infection.5 Immune activation in the olfactory system might eventually lead to the misfolding of α-synuclein and the development of Parkinson's disease.6 This mechanism is supported by post-mortem studies, showing increased levels of TNF,7 IL1, and IL6.8 Moreover, patients with Parkinson's disease had an elevated CSF antibody response to seasonal coronaviruses, compared with age-matched healthy controls.9 In Ashkenazi-Jewish people with Parkinson's disease, about a third are carriers of either a GBA or a LRRK2 mutation.10 A genetic analysis for these mutations and 62 other mutations associated with the disease was negative and our patient had no previous family history of Parkinson's disease.