NEUROTHERAPY IN PARKINSON’S DISEASE: THE PATH FORWARD AFTER SARS-COV-2 INFECTION AND CONTRACTING COVID-19, AND LONG COVID?
Authors: Pąchalska Maria , Góral-Półrola Jolanta , Jarosz Paulina 
Published: December 2022

There is growing evidence to support the view that a variety of neurological, neurocognitive and neuropsychiatric sequelae occur following SARS-CoV-2 infection and NeuroCovid 19. Furthermore, scholars report that various syndromes, including Parkinson's disease (PD), can develop within a short period of time following on from COVID-19. Although the mechanism of this phenomenon is not fully understood and it is not known whether this is in fact an acceleration of the development of PD already 'smouldering' in the body or related to a viral infection, these patients need rehabilitation assistance. Recently, as adjuvant therapy, transcranial direct current stimulation (tDCS) has been shown to improve the motor and non-motor function of patients with Parkinson's disease (PD), including neurocognitive impairment and therefore potentially change their quality of life. The aim of this article is to show the effectiveness of tDCS in the treatment of the patient with newly diagnosed Parkinson's disease after infection with the SARS-CoV-2 virus and the contracting of NeuroCovid 19, and equally developing long COVID. The motivation would be to help other patients with a similar situation during the COVID-19 pandemic.

A 62-year-old man, an academic Art Teacher, was infected with SARS-CoV-2 and contracted NeuroCOVID-19 on November 11, 2021. Initially, he lost his sense of smell (anosmia), of taste (ageusia), developed headaches, and dizziness. After 10 days of illness, the patient developed severe, level two infextion (according to Wise 2020), and he was hospitalized, sedated and mechanically ventilated for 30 days. After discharge from hospital, the patient was still weak with different symptoms. Four months later he was diagnosed with long COVID and also the neurodegenerative disease PD (according to the DSM-5 criteria). He received levodopa therapy, and was referred to the Reintegration and Training Center of the Polish Neuropsychological Society for further treatment. The functional neuromarker, that is hypoactivation of the left dorsolateral prefrontal cortex (DLPFC), obtained with the use of QEEG/ERPs was helpful in choosing the appropriate tDCS protocol. Neurostimulation with the use of anodal tDCS over these area of the brain was administered systematically for 20 days. He also received individual sessions of art therapy for 20 day. After the treatment the patient improved and returned to his previous work as a university art teacher. The proposed anodal tDCS over the left dorsolateral prefrontal cortex (DLPFC), in combination with goal-oriented individual art therapy, offered to the patient, was effective in the reduction of all his syndromes.

ERPs can be useful in the diagnosis and treatment of patients following infection by SARS-CoV-2 who contracted COVID-19, developed long COVID and additionally PD. It allows for the detection of the functional neuromarker of PD (e.g., hypoactivation of the dorsolateral prefrontal cortex, DLPFC) and enabled the choosing of a proper tDCS protocol with the anode over these region of the brain, and also the selection of effective neurostimulation. The proposed protocol of tDCS tailored by the neuromarker offered to our patient, was effective in the reduction of longCOVID symptoms as well as early PD symptoms.