Wednesday, September 21, 2022

Laser Treatment For Parkinson’s Disease

Aids Daytime Sleepiness And Other Sleep Disorders

New Laser Device Helps Parkinson’s Patients Walk

Humans rest and wake based on a daily cycle called the circadian rhythm. Both light and melatonin play a role in the regularity of the cycle. Many people with PD suffer from sleep disturbances. It is thought that NIr may play a role in improving healthy sleep patterns.3

People with Parkinson’s often experience excessive daytime sleepiness, general fatigue, nighttime sleep disturbances, and depression all of which can affect healthy sleep and the circadian rhythm. According to research reported in the February 2017 JAMA Neurology Journal, light therapy significantly reduced daytime sleepiness, improved sleep quality, decreased overnight awakenings, improved daytime alertness and activity level, and improved motor symptoms in people with Parkinson’s.6

Different kinds of light therapy have been used effectively for other sleep, psychiatric, and medical conditions for decades. NIr continues to be studied in the clinical setting in order to determine how it can best be applied in treating Parkinson’s and other medical conditions. Long-term, large scale controlled studies will help to better evaluate the efficacy of NIr as way to mitigate symptoms as well as possibly slow or limit or reverse disease progression.

Is It Available To Me

There are infrared light sources on the market that you can buy in a specialty store or on the internet. These however, are not the same as the light sources that are used in a clinical study environment. They may or may not prove helpful to people with Parkinson’s suffering from sleep disturbances, and should only be used after seeking input from your physician.

Laser Pointer Helps Parkinson’s Patients Take Next Step

Date:
University Of Rochester
Summary:
A patient’s discovery that an everyday laser pointer helps him walk may point the way toward an effective remedy for a common and frustrating symptom of Parkinson’s disease.

A patient’s discovery that an everyday laser pointer helps him walk may point the way toward an effective remedy for a common and frustrating symptom of Parkinson’s disease. The patient’s physicians at the University of Rochester’s Strong Memorial Hospital are presenting the results of a study involving just a few patients at this week’s meeting of the American Academy of Neurology in Toronto. While the small size of the study should make patients and doctors pause before assuming the treatment will help, the authors say neurologists would do well to have a laser pointer handy to let patients give it a try.

The simple device seems to help patients overcome freezing episodes, where patients’ legs literally freeze in place as they’re trying to walk. For about 30 percent of Parkinson’s patients, this “sudden transient freezing” is one of the most difficult symptoms of the disease. The episodes can last for seconds or even several minutes. Some patients experience only momentary hesitation occasionally, while for others the episodes occur dozens of times a day, making almost any simple movement from room to room a laborious task taking several minutes.

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How Can Lasers Help

The lasers create visual cues that keep your attention and allow your concentration to remain on moving forward. Visual cueing with these specially equipped shoes was tested in the lab and found to be successful. Lines projected on the floor, created by movement in the opposite foot, give you direction to move.

Some people already use this approach, without the lasers, by crossing the street where there is a striped crosswalk. They also put tiles or floorboards in their home where they can move over the lines with each successive step. Visual cueing is used in other aspects of PD as well, particularly when addressing memory and psychological issues. Lasers are a new application in this area.3

Treatment Delivers Immediate Results

This laser

When the process is complete, tremors on the treated side of the body often completely disappear.

An online video demonstrates Baltuch performing the procedure on a patient with essential tremor. Before treatment the patient tries to bring a cup of water to his mouth, but his tremors prevent him from doing do. After the procedure, he is shown touching the tips of his two index fingers together, remarking, “I couldn’t do this an hour or so ago.” He later brings a water cup directly to his lips with no tremor.

“This has really been my second epiphany in medicine,” says Baltuch. “My first in this field was when we saw the early deep brain stimulation videos.” Watching patients’ symptoms instantly disappear “was like magic,” he says. Witnessing patients discover their Parkinson’s tremors have vanished following a procedure, “is the same thing. When you see it, it’s phenomenal.”

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What To Expect On The Day Of Surgery

When you go for your surgery, you will meet with a nurse and have your vital signs checked. You will have an intravenous line placed in a vein, most likely in your arm. You will meet with your anesthesiologist and your surgeon, and you will be taken to the operating room.

Before your surgery, your head will be shaved and cleansed with a sterile solution if you are having invasive surgery. If you are having a device implanted in your brain, you will also have a generator implanted in your chest or abdomen, and this area will be cleansed as well.

You may have general anesthesia or local anesthesia and light sedation. If you are having general anesthesia, you will be put to sleep and you will have a tube placed in your throat to help you breathe. If you are having local anesthesia and light sedation, you will receive medication to make you drowsy, but you will be able to breathe on your own.

During your surgery, you will not feel any pain. Your doctors will monitor your vital signs throughout your procedure. Often, the surgery is done with imaging guidance, and sometimes it is done with electrical signal monitoring of the brain as well.

For some procedures, your surgeon will make a cut in the skin of your scalp and then will make a cut into your skull bone, as follows:

After your surgery is complete, your anesthetic medication will be stopped or reversed. If you have been intubated , this will be removed, and you will be able to breathe on your own.

What Is Brain Surgery For Parkinsons Disease

Brain surgery for Parkinsons disease is done to balance the activity in certain areas of the brain that control physical movement. The surgery can involve placement of a stimulator device or creation of a surgical lesion in the brain.

The areas of the brain that are affected by Parkinsons disease are very small, and they are located deep within the brain. These procedures are done with precision and often with imaging guidance so your surgeon can see the structure of your brain with real-time pictures during the surgery.

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Additional File : Supplementary Table 1

Parameters of the photobiomodulation devices and treatment used in the study. Supplementary Table 2. Mean of measures of fine motor control, mobility, balance and cognition before PBM treatment in a second study of PD treatment with PBM. Supplementary Table 3. Individual data for participants before and after treatment with the photobiomodulation protocols.

Nir For Alzheimer’s Disease

Laser Technology Helps Parkinson’s Patients Walk

The majority of the studies reporting beneficial effects of NIr treatment in Alzheimer’s disease or dementia have been in transgenic animal models, in particular those displaying -amyloid , or tau pathologies .1). In general, with either acute or more chronic NIr treatment, these studies have reported reductions in -amyloid plaques, neurofibrillary tangles of hyperphosphorylated tau protein, inflammation and oxidative stress, together with increased ATP levels and improved overall mitochondrial function. In addition, NIr reduced the characteristic cognitive deficits associated with the CD1 and APP/PS1 transgenic mouse models. One in vitro study reported that, after internalization of -amyloid into human neuroblastoma cells, NIr treatment increased ATP levels and overall cell number, while reducing -amyloid aggregates .

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Nir Therapy In Alzheimer’s And Parkinson’s Disease Patients: Can It Work

The key question that still remains is whether NIr therapy can be neuroprotective in humans. In order for maximum effect, the primary goal would be for sufficient NIr signal to reach the main zones of pathology, to elicit a protective, or reparative effect within damaged cells a secondary goal would be for the NIr signal to also trigger systemic neuroprotective factors, for example circulating cells or molecules .

The issue of NIr reaching the zones of pathology is of most concern in humans. There are no such concerns when there are few or no tissue barriers, as in the culture dish , the retina or in the mouse brain . But can NIr be effective when there are many intervening body tissues, namely skin, thick cranium, and meninges, and brain parenchyma, as in humans?

Previous studies have estimated that NIr can be measuredthrough body tissuesat a distance of 2030 mm from the transmission source , albeit with a considerable dissipation of signal . For example, Moro et al. have noted that at a distance of 10 mm through brain parenchyma, the NIr signal is < 1% of that emitted from the source. They estimated a 65% reduction of signal across each millimeter of brain tissue.

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Inclusion And Exclusion Criteria

We included all in vivo studies reporting the effects of PBM, as opposed to vehicles, on the behavioral and molecular outcomes in PD models. Studies conducting PBM via transcranial, intracranial, systemic irradiation as well as whole-body irradiation approaches in PD models were included. Studies performed on ex vivo or in vitro , as well as clinical trials, were excluded. Additionally, studies conducted on intact animals were excluded from our review. Moreover, non-English language publications and studies involving NIR spectroscopy and conference papers were excluded.

Nir For Parkinson’s Disease

Parkinson

Mainly due to the existence of effective toxin-based in vitro and in vivo models, there have been considerably more reports on the beneficial effects of NIr for Parkinson’s disease .2). The first studies to report neuroprotection by NIr after parkinsonian insult demonstrated that NIr treatment reduced cell death, increased ATP content and decreased levels of oxidative stress in rat striatal and cortical cells exposed to the parkinsonian toxins rotenone and MPP+ in vitro . In cultures of human neuroblastoma cells engineered to overexpress -synuclein, NIr increased mitochondrial function and reduced oxidative stress after MPP+ exposure . Further, in hybrid cells bearing mitochondrial DNA from Parkinson’s patients, mitochondrial movement along axons improved substantially after NIr treatment, with movement restored to near control levels .

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The Human Light Trials Begin

Three years on, Mr Burr and the other Tasmanians using their own light treatment have inspired an Australia-wide “proof-of-concept” clinical trial to test whether the lights are actually making a long-term difference to people’s health or whether it’s just a placebo effect.

The trial, run by The University of Sydney School of Medicine and Parkinson’s SA, involves people from Brisbane, South Australia and Sydney.

Some participants are using placebo lights, while others are using red and near-infrared lights on their heads and stomachs.

Catherine Hamilton, a retired Tasmanian specialist occupational physician who specialises in photobiomodulation and helped Mr Burr with his light treatment, is developing helmets with her electronics expert friend Ron Brown for Sydney trial participants.

“For people with Parkinson’s the lights are giving them an improvement now, right now, they’re not having to wait 10 years for a pill,” Dr Hamilton said.

Ann Liebert from the University of Sydney, who is co-ordinating the trial, said she had worked with light therapy for 10 years and had seen many positive results.

“We have medical evidence and case study evidence, so now’s the time to look at experimental evidence at a higher level,” she said.

Professor Simon Lewis, a neurologist who specialises in Parkinson’s and Alzheimer’s disease, said people with Parkinson’s experienced “progressive and relentless” brain cell death.

Limitations Side Effects And Long

Baltuch cautions, however, that focused ultrasound thalamotomy is not without risk or side effects, there are limitations, and there are not yet long-term studies.

  • Side effects: Side effects include difficulty walking or unsteadiness following the procedure, along with tingling or numbness in the lips or fingers. Most issues resolve within months.
  • Limitations: Currently, only one side of the body can be treated. Earlier forms of surgical ablation sometimes resulted in speech difficulties, so for now, the FDA has limited treatment to one side of the brain. The side that controls the patient’s dominant hand is usually targeted. INSIGHTEC is exploring bilateral treatment in medical centers outside the U.S. In addition, while treatment can reduce or eliminate tremors on one side of the body, it does not stop other symptoms of Parkinson’s or slow disease progression.
  • Long-term studies: Because five- and 10-year studies have not yet been conducted, “We dont yet long-term effectiveness” of focused ultrasound thalamotomy for tremor-dominant Parkinson’s and essential tremor, says Baltuch. “The published data show that this may not be as effective in tremor reduction as, potentially, deep brain stimulation can. And, although it’s non-invasive, you’re still making a thermal lesion .”

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Is Nir Therapy Safe

To date, there are no reports of major safety issues nor side-effects after NIr treatment. The commercial LED panels for NIr therapy have already received non-significant risk status by the Food and Drug Administration and previous studies have indicated no adverse impact on brain tissue structure and function after NIr treatment . There is one sole account of some neuronal damage and negative behavioral outcomes in mice, but this was evident after an exceptionally high power intensity , approximately one hundred times higher than the dose required to elicit a therapeutic response . Hence, when taken together, these data indicate that when NIr was applied at therapeutic doses , its impact on body tissue was overwhelmingly positive, and had a very large safety margin of application . Further, there appears to be no longer-term side effects associated with NIr application in a long-term study in rats, no adverse effects were noted after daily treatment for 12 months .

Barriers To Popularizing Nir As A Neuroprotective Modality For Pd

Could laser therapy give relief to people suffering from Parkinson’s disease?

Figure 2. Alternative sites for implantation of NIR delivery device apart from the ventral midbrain. Wirelessly powered NIR delivery devices in the 3rd ventricle and the sphenoid sinus , both of which are close to the ventral midbrain. Insertion of the device into the 3rd ventricle can be achieved safely via a straight trajectory traversing the Foramen of Monroe. Insertion of the NIR device within the SS in the posterior part of the nasal cavity can be achieved using an endoscopic endonasal approach. Abbreviations: FoM, foramen of Monroe NIR, near-infrared SNpc, substantia nigra pars compacta SS, sphenoid sinus.

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Australian Company Achieves Promising Results With Laser Therapy

Australian medical technology company SYMBYX has completed its first human trial of the use of laser light therapy to reduce the symptoms of Parkinsons by targeting the gut-brain axis.

The proof-of-concept trial showed that measures of mobility, cognition, dynamic balance, sleep, motivation, and fine motor skills of participants were all significantly improved.

Since then, these results have been confirmed in a follow-up trial in Sydney soon to be published in the Journal of Photomodulation, Photomedicine and Laser Surgery.

Combined, these results reinforced that larger, randomized placebo-controlled trials are warranted to further consolidate the data. Two such trials using SYMBYX lasers are about to commence in Sydney and Canada, with results expected in April 2022.

SYMBYX uses proprietary, super-pulsing laser technology that delivers optimal doses of light therapy without generating heat. The lasers are non-invasive, painless to use and portable. They are medical grade lasers, containing diodes manufactured in Sweden under exclusive license to SYMBYX, and are CE marked and ARTG listed.

Photobiomodulation therapy can energise cell mitochondria and help with the loss of cellular energy that is common in Parkinsons, said SYMBYX CEO Dr. Wayne Markman.

Most people dont realise that their colon has the capacity to produce both dopamine and serotonin, the critical neurotransmitters required for healthy brain function.

Light Therapy And Parkinson’s

NIr therapy works by using infrared illumination to treat brain tissue affected by a lack of oxygen, toxic environments, and mitochondrial dysfunction. Mitochondria help to produce energy in cells and play a role in regulating cell function when working properly. NIr attempts to reduce cell damage and death by protecting the dopamine-producing neurons.2 NIr has been shown to reduce tissue inflammation and improve mitochondrial function.

It is not a targeted therapy because it works on the neural symptoms of many conditions by reducing the neurodegenerative process. Light therapy targets the brain and therefore it is likely to impact multiple facets of neural functioning. Studies have yielded results that show improvement in cognitive, emotional, and executive function.

Photobiomodulation is the ability of light to modulate biological processes at a cellular level.4 The use of controlled exposure of red to infrared wavelengths of light have successfully improved healing, reduced inflammation and pain. It has done this by improving mitochondrial function and stimulating antioxidant pathways in the brain. Photobiomodualtion has been therapeutically effective to improve the recovery rate for other medical conditions, and has shown promise in the lab for people and animals with PD.

Strategic use of specific light applied at a targeted time of day for a specific length of time should be able to “attack” melatonin, and reduce it, thus restoring dopamine balance.5

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