Parkinson's Disease in Times of War: Gaps in Knowledge and Emerging Controversies

Abstract

Parkinson's disease (PD), the second most common neurodegenerative disorder, is influenced by genetic susceptibility and environmental exposures. Conditions of war, including traumatic brain injury, chronic stress, toxin exposure, malnutrition, and healthcare disruption, may significantly affect both PD risk and management. Studies have linked traumatic brain injury, post-traumatic stress disorder, and prolonged psychological stress to increased PD risk, while wartime deprivation may serve as a long-latency factor, with disease onset occurring decades later. Management of PD during conflict presents distinct challenges. Healthcare system collapse, medication shortages, and loss of follow-up care exacerbate motor and non-motor symptoms, often accelerating disability. Patients dependent on advanced therapies such as deep brain stimulation face particular risks given the reliance on specialist care and device maintenance. Ethical dilemmas also arise regarding the allocation of scarce dopaminergic medications, highlighting the need for triage frameworks in humanitarian contexts. Major gaps remain, including limited longitudinal data on PD progression in war-affected populations, a lack of tailored telemedicine approaches, and the absence of emergency guidelines for neurological care. Addressing these issues requires conflict-sensitive research, innovative care models, and the development of standardized humanitarian protocols.