Haaretz - newspaper website - health section 11-04-2021

The corona epidemic has hit Parkinson's patients hard. Now we have to get them back to normal.
The congestion in the hospitals delayed operations for patients and the corona restrictions reduced the response to treatments. In the health system, we now need to raise awareness of the accumulated hardships and increase assistance to patients.

The corona virus has been with us for more than a year, and its effects are enormous on a personal, family and social level. Parkinson's disease is a common degenerative brain disease in Israel, with estimates speaking of more than 30 sufferers. The disease most often affects the elderly population, but up to 10% of patients are diagnosed before the age of 50. The disease combines motor and non-motor symptoms, and has consequences on the functioning and quality of life of the contestants. Although it has not been proven that the corona virus causes a more severe illness among those with Parkinson's, they are often in a risk group for severe corona morbidity in terms of age and associated risk factors. Because of this, the virus is a source of concern among patients.

How does the corona affect the lives of Parkinson's contenders?
The virus has direct and indirect effects on the disease. Among the direct effects are neurological symptoms such as dizziness, headaches and decreased sense of smell, which are added to the already existing symptoms and can temporarily worsen the functional problem. Furthermore, it is known that the virus (like many other viruses) can infectiously involve the brain and brainstem, theoretically worsening the symptoms of the disease. A fever accompanied by prolonged lying down can lead to an aggravation of the motor symptoms of the disease. Over-the-counter medications taken during a febrile illness can also affect contestants, especially if they contain antihistamine ingredients, which can worsen non-motor symptoms such as urinary disturbances, drops in blood pressure with changes in position, dry mouth and constipation.

The indirect effects include changes that took place in the health system and in the response of the medical and paramedical staff to the contestants. For a long period of time, there was a decrease in the amount of neurologists available for treatment, as a result of exposure and the need for isolation, as well as because of their referral to the treatment of corona patients, which affected the ongoing treatment of patients and the availability of treatment. The congestion in hospitals caused a delay in surgeries such as pacemaker implantation surgeries for cerebral palsy to treat the symptoms of the disease, or a delay in the start of treatment with pumps for infusing dopamine, and also led to a deterioration in the quality of treatment. The epidemic led to a delay in international clinical studies related to the quality of life and drug treatment for the disease. Now, when the situation in Israel is improving in terms of the morbidity burden, we hope that it will be possible to restore the ongoing care of the contestants in an optimal way.

Furthermore, the patients experienced lifestyle changes as a result of restricting movement and maintaining social distance. The main treatment for Parkinson's disease is movement therapy, which combines physical therapy, fitness activities, walking, swimming, dancing, martial arts, rowing and more, these are social activities with many participants that usually take place in gyms or closed places. Restrictions on movement and gatherings have led to a significant decrease in compliance with these treatments, which are a cornerstone in maintaining a level of function and stopping the progression of the disease.

Another important aspect is the consequences created by social distancing on the contestants, which led to a decrease in cognitive stimulation, which is so important to preserve, as well as a decrease in mood, depression and anxiety, and because of this, their quality of life was significantly affected.

What should we do now?
At this time, and especially after the extensive vaccination campaign, we must provide answers and suggestions for improvement in the treatment of those dealing with the disease. The best way is through raising awareness among the patients and their families and the various caregivers of the hardships that have intensified in the past year. There is an urgent need to bring back the frameworks that combine physical activity in its many shades, and not only through remote access but in meetings that meet the standards.

The health funds must allocate financial resources for the purpose of increasing the amount of treatments provided to contestants such as physical therapy, occupational therapy, communication clinics - also in a rehabilitation setting. There is a need to increase the number of nurses and health professionals who treat Parkinson's patients in the various institutes and health funds. In addition, efforts should be made to identify mental distress among the patients following the prolonged isolation and to refer them to the appropriate parties, such as psychologists or social workers. Also, one must continue to promote face-to-face meetings or through remote access of contestants, and joint activity for the purpose of raising awareness of the difficulties listed and the ways to deal with them, all in cooperation with the Parkinson's Association in Israel, which supports and helps patients.

Dr. Sa'ar Anis is an expert neurologist from the Movement Disorders Institute at the Sheba Medical Center. The article is published as part of Parkinson's Awareness Month which is celebrated this month. For inquiries to the Parkinson's Association in Israel 054-6125043

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