Year : 2020 | Volume
: 3 | Issue : 2 | Page : 71--72
COVID-19 and the future of movement disorders in India
Pramod Kumar Pal
Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, Karnataka, India
Dr. Pramod Kumar Pal
Neuroscience Faculty Centre, Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Room No. B-13, Bengaluru, Karnataka.
|How to cite this article:|
Pal PK. COVID-19 and the future of movement disorders in India.Ann Mov Disord 2020;3:71-72
|How to cite this URL:|
Pal PK. COVID-19 and the future of movement disorders in India. Ann Mov Disord [serial online] 2020 [cited 2022 Sep 27 ];3:71-72
Available from: https://www.aomd.in/text.asp?2020/3/2/71/291081
The coronavirus disease-2019 (COVID-19) pandemic has made us introspect on health and well-being at a population level; at the same time, it gives an opportunity to look at different solutions for the new normal. As medical practitioners, we are challenged to offer patient care in a safe and effective manner without compromising on the health and safety of ourselves and our teams.
The impact of COVID-19 is wide and medical conditions that are not acute or life threatening such as movement disorders will see lower manpower development, research, and/or funding. The patient visits will also reduce due to the fear of visiting hospitals because of the risk of COVID-19 exposure and higher cost due to Personal Protective Equipment and additional tests. This will deteriorate the clinical management of patients.
The new approach will have to rely on a brief inspection or video-consultation and important laboratory, imaging, and genetic studies in lieu of detailed history taking and clinical examination. This may not be a problem for experienced movement disorders specialists, but will definitely be an impediment to the new-comers in this field. Monitoring treatment, detailed assessments of patients with Parkinson’s disease (PD) in OFF and ON states, and hospital admission for pre-DBS workup will take longer due to the new norms. Elective DBS will see postponements as will programming of patients who have undergone DBS. The management of other movement disorders such as dystonia especially those who need botulinum toxin injections is also impacted. Emergencies in PD are being reported more often––DBS battery exhaustion and neuropsychiatric manifestations, especially in patients with PD already having psychosis. Depressive episodes are likely to increase causing more burden to the caregivers.
The good news is that with tech-savvy applications, India has geared up to provide internet and web-based services. Many hospitals and practitioners offer teleconsultation and in comparison to many other disorders this works well for movement disorders. Teleconsultation is also increasingly used for monitoring therapy in patients with PD who are unable to travel in the current pandemic.
The other area where there is an indirect impact is on the training of residents across clinical specialties including neurology and postdoctoral fellowships in movement disorders. Most fellowship courses in India are of 1-year duration for intensive hands-on training in botulinum toxin therapy and DBS along with clinical management of patients. In the past 6 months, the training has been minimal and will be difficult to offset.
The alternative is online training modules for the residency and fellowship programs. Web platforms can be used for didactic lectures, video-based clinical case discussions, journal club, and seminars. Most scientific societies including Movement Disorders Society of India have scheduled Webinars which help train the students. It is imperative that we use well-documented training videos of patients covering a variety of movement disorders to ensure that the knowledge sharing is optimal.
Research in Movement Disorders and allied specialties globally and particularly in India which is constrained by the growing number of COVID-19 patients will see a reduction. Hospital admission for research studies will not be easy since those with PD and other movement disorders are not advised to visit hospitals unless it is an emergency. Clinical studies in PD have been halted indefinitely due to lack of staff, patients, insurance and funding, lack of dedicated space, and quarantine issues. The Government advisory is to temporarily cut down any new research staff recruitment except for essential services and funding for existing research projects have been withheld in most places. Accordingly, there will be widespread ramifications on research publications. With reduced prospective clinical studies, submission of good quality original articles in the field of Movement Disorders will definitely come down. The scientific journals may face shortage of funds, stop print issues and change to online open access journals.
While prospective clinical research may be kept on hold for time being, movement disorders specialists should explore options of retrospective studies. Other options include designing telephone or Internet-based prospective clinical and epidemiological studies.
This is a temporary setback and we continue to be intellectually active and use this time to introspect and innovate for the times ahead.
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Conflicts of interest
There are no conflicts of interest.