A Treatment That’s All In Your Head
Strick believes the placebo effect deserves more respect than it often gets.
“I love it when people say it’s all in your head, because your brain is in your head,” he says. “There are real biological underpinnings for these kinds of things.”
So Strick has assembled a team of prominent scientists to find the biological underpinnings of paradoxical kinesia. The team hopes what they learn will lead to new treatments for Parkinson’s disease, which affects nearly 1 million people in the U.S.
The effort involves several labs at the University of Pittsburgh and one at the University of California, Santa Barbara. It’s being funded by a $12 million grant from the Aligning Science Across Parkinson’s Initiative and implemented by the Michael J. Fox Foundation.
Strick’s collaborators plan to focus on two circuits in the brain that appear to control voluntary movement. One is damaged by Parkinson’s, leading to symptoms including tremor, freezing, and poor balance and coordination.
“Our hypothesis is that there’s another circuit that’s intact, and that this circuit isn’t affected in Parkinson’s disease,” Strick says.
Strick’s team believes this other circuit can be switched on by strong emotions, including positive ones.
“It’s engaged by our sense of reward, by the joy of doing something,” he says.
New Therapies Aim To Stop Parkinson’s Disease
Claudine Brownfelt uncharacteristically tired. She also felt depressed and lethargiclike she was moving in slow motion. “I figured I was getting older. Still, friends my age didn’t feel this way,” she says.
Brown, then 67, was experiencing the early effects of Parkinson’s disease. Within four years, she was bent over and could not walk without dragging her left foot.
All this changed last year, when the homemaker from Kansas City, Mo., was first diagnosed with Parkinson’s disease , and in December started taking her first prescriptiona new formulation of a standard PD drug that combined carbidopa-levodopa . After taking the pills for three days, her symptoms completely cleared up, so much so that her doctors were amazed.
Parkinson’s disease is a movement disorder that results from a loss of dopamine, a chemical in the brain that helps control movement. Many PD drugs are made from levodopa, a compound that replaces dopamine. Although levodopa-based drugs are usually effective at first, they can become less effective with time and people who take them often develop jerky movements called dyskinesias.
The new formulation is one of several new therapies that are emerging from years of research, says Stewart Factor, D.O., a professor of neurology and director of the Movement Disorders Program at Emory School of Medicine in Atlanta, Ga.
New Drugs Offer Options
Pending FDA Approval
Protecting Brain Cells
Alternative Approaches to Dopamine Replacement
Stem Cell Implants
A Decade In The Making
Nearly one million people are living with Parkinsons disease in the United States alone, according to the Parkinsons Foundation. About 60,000 people are diagnosed with Parkinsons each year, and that number is expected to rise to 1.2 million by the end of this decade. It is the fastest rising neurological disorder in the world, with the global number of diagnosed people doubling from 3 to 6 million people between 1990 and 2015. If this development continues, the number of cases will again have doubled by 2040.
If the rate at which Parkinsons growth continues, were going to outgrow the capacity to be able to handle all of the consequences of letting a chronic neurodegenerative disease go unchecked, Michael S. Okun, a neurologist at the University of Florida and one of the worlds leading Parkinsons scientists, told The Daily Beast.
After decades of research, what we know so far is that Parkinsons is caused when dopamine-producing nerve cells in the brain die too fast. Often called the happy hormone, dopamine is critical for relaying signals from the brain that give orders of movement to different body parts. A dearth of dopamine will cause tremors and slowed movement. These symptoms only worsen over time, and make it extremely difficult to do even the simplest activities in the late stages of the illness.
And Parkinsons can lead to cognitive effects as well, such as short-term memory loss, difficulties with staying focused, and challenges with impulse control.
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What Kinds Of Genetic Research Is Being Done
What other treatments are being researched?
- Drug treatments. Researchers are investigating drugs that block the action of glutamate, an amino acid that destroys nerve cells, as well as the role of the antioxidant coenzyme Q-10 in slowing the progression of Parkinson’s disease.
- Neural growth factor. Preliminary studies have shown that neural growth factor revives the dormant cells needed to produce dopamine, dramatically improving symptoms.
- Deep brain stimulation. Research is underway to better understand how deep brain stimulation works in Parkinson’s disease. Researchers are also studying improved ways of stimulating the brain.
High Hopes Realistic Expectations
Still, although theres quite a bit of hope about what the new stem cell treatment could do for patients and their families alike, theres a history of new therapies petering out during rigorous testing.
It happens very rarely that we actually cure an illness, Ray Dorsey, a neurologist at the University of Rochester Medical Center, told The Daily Beast. A lot more often we find a way to prevent them. Think about what it takes to cure someone with Parkinsons after half of their nerve cells have died. I just think we need to take a cool, rational look at this and say that thats really hard to do.
And while we have a clear picture of the dopamine connection, we have very little understanding about exactly why nerve cells will start to produce less dopamine in certain people. Age is obviously a big correlation, and some research has pointed to associations with the use of certain pesticides and metals due to the disproportionately high number of rural inhabitants who come down with Parkinsons. Some scientists speculate that if we lived long enough, all humans would eventually develop Parkinsons since cells begin to die due to old age.
Karin Christiansen, 57, and her husband Keld Hansen, 65, live in Odense, Denmarks third-largest city. In 2018, Karin was diagnosed with Parkinsons disease after several years of living with symptoms, including strong pain in the right leg and having a hard time keeping balance.
Karin Christiansen and her husband Keld Hansen.
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What We Know So Far
- We’ve uncovered clues to the causes and genetic involvement in Parkinson’s.
- We’re figuring out the chain of events that leads to the damage and loss of brain cells.
- We’re working to advance new treatments and therapies.
- We’re exploring repurposing drugs to help manage some of the more distressing symptoms, like hallucinations and falls.
- And we know that, although people with Parkinson’s share symptoms, each person’s experience of the condition and response to treatment is different.
Now, the science is ready for us to develop the new treatments and cure that people with Parkinson’s so desperately need.
Research takes time but if you have Parkinsons, you need better treatments now. Thats why weve launched the Parkinson’s Virtual Biotech to speed up the most promising potential treatments. The more we can invest, the sooner we’ll get there.
A New Era For Parkinsons Disease Treatment
March 2, 2022 | By
A non-invasive ultrasound treatment for Parkinsons disease that was tested in a pivotal trial led by University of Maryland School of Medicine researchers is now broadly available at the University of Maryland Medical Center .
Howard Eisenberg, MD, Dheeraj Gandhi, MD, MBBS, Paul Fishman, MD, PhD, Bert W. OMalley, MD.
The device, called Exablate Neuro, was approved in November by the U.S. Food and Drug Administration to treat advanced Parkinsons disease on one side of the brain. The approval was based on findings from the UMSOM clinical trial and effectively expands access to focused ultrasound beyond clinical trial participation.
Rapid Reversal of Symptoms
Focused ultrasound is an incisionless procedure, performed without the need for anesthesia or an in-patient stay in the hospital. Patients, who are fully alert, lie in a magnetic resonance imaging scanner, wearing a transducer helmet. Ultrasonic energy is targeted through the skull to the globus pallidus, a structure deep in the brain that helps control regular voluntary movement. MRI images provide doctors with a real-time temperature map of the area being treated. During the procedure, the patient is awake and providing feedback, which allows doctors to monitor the immediate effects of the tissue ablation and make adjustments as needed.
Patient: Focused Ultrasound Changed My Life
A New Era for Parkinsons Disease Treatment
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What Is Fetal Cell Transplantation
Fetal cell transplantation is a procedure in which fetal cells are implanted into the brains of people with Parkinson’s disease to replace the dopamine-producing cells in the substantia nigra. Although promising, this area of research is one of the most controversial. Some studies have found that fetal cell transplantation caused an increase in severe involuntary movements due to too much dopamine in the brain. There are also moral and ethical objections to the use of fetal cell implants. As a result, other methods of treatment are being explored.
Editorial Note On The Review Process
F1000 Faculty Reviews are commissioned from members of the prestigiousF1000 Faculty and are edited as a service to readers. In order to make these reviews as comprehensive and accessible as possible, the referees provide input before publication and only the final, revised version is published. The referees who approved the final version are listed with their names and affiliations but without their reports on earlier versions .
The referees who approved this article are:
Fredric P. Manfredsson, Parkinson’s Disease Research Unit, Department of Neurobiology, Barrow Neurological Institute, Phoenix, Arizona, USA
No competing interests were disclosed.
Tipu Z. Aziz, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
No competing interests were disclosed.
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The Light Treatments Available Now
Those already suffering with Parkinsons dont need to wait for the trial results, as there are light therapy products from SYMBYX already available on the market.
It is legal and regulated and its available for purchase, Dr Wayne Markman, CEO of SYMBYX an Australian medical technology company told 7NEWS.
Breakthrough In Parkinsons Disease: Israeli Scientists Discover New Therapeutics
Ben-Gurion University Researchers are focusing on bringing their discovery closer to clinical application
Scientists at the Ben-Gurion University of the Negev have discovered that a promising therapeutics protein called BMP5/7 could slow down or even halt the progression of Parkinsons disease .
The findings were published in clinical neurology journal, Brain.
Parkinsons disease affects 1 percent of the population over the age of 60 which is 10 million worldwide or over one million Americans. Approximately 60,000 people are diagnosed with PD each year in the U.S.
This disease causes tremors and severe movement impairment due to progressive degeneration of dopamine-producing brain cells. It is believed that the protein alpha-synuclein, present in all human brains, misfolds and forms toxic clumps in these cells, which causes the disease.
While current Parkinsons disease therapies improve symptoms, they are not effective in advanced illness stages and, unfortunately, do not slow or cure the disease.
Dr. Claude Brodski, M.D., head of the BGUs Laboratory for Molecular Neuroscience, discovered that BMP5/7 signaling in neurons was significantly reduced in dopamine-producing brain cells, which could contribute to Parkinsons disease advancement.
Dr. Brodski said: We found that BMP5/7 treatment can, in a mouse model, efficiently prevent movement impairments caused by the accumulation of alpha-synuclein and reverse the loss of dopamine-producing brain cells.
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Searching To Control Symptoms: New Methods Of Delivery
In recent months, symptomatic treatment of PD has had some new developments as well. A new drug for PD, rotigotine, has been introduced in Europe and elsewhere as Neupro. This compound is a dopaminergic agonist, a class of drugs that also includes drugs that have been available for many years in the U.S., including Mirapex, Requip, and Permax . Neupro is unique in how it is delivered: it is absorbed through the skin and so has been marketed as a transdermal patch with continuous delivery over 24 hours. So far, experience with Neupro suggests that it is effective and well tolerated. However, whether this drug or its unique mode of delivery will offer a significant advantage over currently marketed medications of the same class still remains to be learned.
PD still presents many challenges for the medications of the future. Among the unmet needs are ways to reverse the problem of imbalance, especially falling backward. The flexed posture of PD, swallowing and speech difficulties, and situation-specific “freezing” are all challenges for improved drug therapy. Scientists have not yet determined where in the brain and what types of biochemical disturbance underlie these problems.
Can Diet Help People With Parkinsons
Like everyone else, people with Parkinsons feel their best when they consistently eat a healthy, balanced diet. There is no specific diet for Parkinsons but following certain guidelines can ensure that your medications work their best, minimize the side effects of certain drugs, and lower your risk of developing other conditions. Some nutrients may offer neuroprotective benefits and help you preserve function and slow decline associated with Parkinsons. A balanced, nutritious diet can also help maintain a healthy weight and lower the risk for developing dangerous chronic conditions such as diabetes, osteoporosis, and heart disease.
If you are taking Levodopa/Carbidopa, it is important to time your intake of foods rich in protein. Protein can delay or diminish the effects of Levodopa/Carbidopa, so it is best to eat mostly carbohydrates during the day and reserve protein-rich foods for dinner.
If you are taking a monoamine oxidase inhibitor such as Azilect, Eldepryl, or Zelapar, limit your intake of foods that contain high amounts of tyramine. Foods such as cheese, aged meat, smoked fish, dry sausages, sauerkraut, miso, or other fermented or aged products contain tyramine and can contribute to high blood pressure in those taking MAOIs.
Many Parkinsons medications can cause constipation. To prevent constipation, be sure to eat plenty of dietary fiber and drink six to eight 8-ounce glasses of water every day.
Read more about nutrition for people with Parkinsons.
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Surgery For Parkinsons Disease
Based on the severity of the condition and the medical profile, the doctor may recommend surgery as one treatment option for Parkinson’s disease.
There are several types of surgery that may be performed that can help patients with Parkinson’s disease. Most of the treatments are aimed at helping the tremor or rigidity that comes with the disease. In some patients, surgery may decrease the amount of medication that is needed to control the symptoms.
There are three types of surgeries that may be performed for Parkinson’s disease, including the following:
It is important to remember that surgery may help with symptoms of Parkinson’s disease, but does not cure the disease or stop the progression of the disease.
Why Scientists Believe Theyve Made New Breakthrough In Parkinsons Disease Treatment By Building On Gdnf Research
The Finnish researchers are now working to improve the properties of BT13 to make it more effective as a potential treatment that could benefit many people living with the disease.
The study, which was published online yesterday in the journal Movement Disorders, builds on previous research on another molecule that targets the same receptors in the brain.
GDNF or glial cell line-derived neurotrophic factor is an experimental treatment for Parkinsons discovered in 1993 that has been shown to bring dying brain cells back to life and particularly effective in dopamine neurons.
It was the subject of a BBC documentary in February 2019 that followed a phase two trial in Bristol involving 42 patients. While the results werent clear cut, GDNF has shown promise to restore damaged cells in people with Parkinsons.
However, the GDNF protein requires complex robot-assisted surgery to deliver the treatment to the brain because its a large molecule that cant cross the blood-brain barrier a protective wall that prevents some drugs from getting into the brain.
BT13 is a smaller molecule that is able to cross the blood-brain barrier and therefore could be more easily administered as a treatment if shown to be beneficial in further clinical trials.
Dr Yulia Sidorova, lead researcher on the study, said: We are constantly working on improving the effectiveness of BT13.
Our ultimate goal is to progress these compounds to clinical trials in a few coming years.
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New Brain Target Could Improve Treatment For Parkinson’s
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Parkinson is a neurodegenerative disease where dopaminergic neurons progressively die in the brainstem. Tremor and difficulties to walk are recognizable movement symptoms for many people suffering from Parkinson. Over time, nearly a quarter of patients will have so much trouble walking that they often end up freezing on the spot and falling, and many become housebound.
People are primarily treated with medicine, but in some cases doctors use Deep Brain Stimulation . In DBS, the surgeon places a thin metal wire in the brain, which can be used to send electrical pulses. DBS is effective in treating tremor, but alleviating difficulties in walking and freezing remains a challenge.
Medication For Parkinsons Disease
Once the doctor diagnoses Parkinsons disease, the next decision is whether a patient should receive medication, which depends on the following:
The degree of functional impairment
The degree of cognitive impairment
Ability to tolerate antiparkinsonian medication
The advice of the attending doctor
No two patients react the same way to a given drug, therefore, it takes time and patience to find an appropriate medication and dosage to alleviate symptoms.
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