Brain Connectomic Studies And Improved Precision Of Neuromodulation Targets
The process of altering brain function through direct manipulation of neural activity has long been used to treat patients with neuropsychiatric disorders and deep brain stimulation has provided clinical benefit to more than 150 000 patients with PD, dystonia and essential tremor . Apart from the conventional application in advanced PD, DBS has also been suggested to exert disease-modifying traits . In multiple preclinical studies on rat models, chronic STN electrical stimulation was shown to result in preservation of SNpc dopaminergic neurons and an increase of brain-derived neurotrophic factors followed by activation of the tropomyosin receptor kinase type B receptor signaling in the nigrostriatal system . Although preclinical experiments suggest potential neuroprotective effects of DBS, results from clinical studies have shown that dopaminergic neuron degeneration remains unaltered , and -syn burden is not reduced in PD patients treated with DBS .
Focused ultrasound as a newly developed neuromodulation technique
Repetitive transcranial magnetic stimulation
Few studies have investigated the effect of rTMS on levodopa-induced dyskinesias, showing only short-lasting or no beneficial effect.
New Parkinsons Disease Treatments
The interventions that were presented are not entirely new, and they are not highly available.
Duodopa is a gel form of Levodopa delivered with use of an external pump and tubing, directly to the stomach and small intestine. It involves a minor surgical procedure, takes 45 minutes to perform and does not require a hospital stay.
There are only 5 centres in Ontario offering this intervention. This intervention has been successful in eliminating the extremes of on and off periods of medication effectiveness and has been associated with an improved quality of life and social functioning for patients.
Deep Brain Stimulation was described as a pacemaker for the brain. It involves the placement of an electrode in the brain attached to a small device inserted under the skin, below the collarbone. Just as with the Duodopa therapy, patients who receive this intervention enjoy less dyskinesia and improved quality of life and social functioning.
There was a lot of discussion around best candidates. The presenters defined best candidates as having:
The speaker addressed the question of a transdermal patch to deliver medication apparently it is available, just not very effective.
How Do I Take Care Of Myself
If you have Parkinsons disease, the best thing you can do is follow the guidance of your healthcare provider on how to take care of yourself.
- Take your medication as prescribed. Taking your medications can make a huge difference in the symptoms of Parkinson’s disease. You should take your medications as prescribed and talk to your provider if you notice side effects or start to feel like your medications aren’t as effective.
- See your provider as recommended. Your healthcare provider will set up a schedule for you to see them. These visits are especially important to help with managing your conditions and finding the right medications and dosages.
- Dont ignore or avoid symptoms. Parkinsons disease can cause a wide range of symptoms, many of which are treatable by treating the condition or the symptoms themselves. Treatment can make a major difference in keeping symptoms from having worse effects.
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Treatments For Speech And Swallowing Difficulties
Speech and swallowing problems for people with PD also respond to exercise or strategies. A speech pathologist specialised in movement disorders such as PD can assess the persons speech and teach strategies to improve it.
Speech can be improved through particular exercises and programs such as the Lee Silverman Voice Therapy, Parkinson Voice Project SPEAK OUT!
Often identifying strategies to improve the communication environment or method can lead to more successful speech. Strategies and communication partner training can become invaluable to family and friends if a person with Parkinsons is experiencing cognitive changes which impact on communication such as word finding difficulties. Communication Devices such as amplifiers can help to increase volume and other devices or apps can be used when an alternative to speech is needed. Speech Pathologists can help guide you through what is available and potential avenues to help fund these aids.
Swallowing difficulties are more common in the later stages of PD and need to be investigated by a speech pathologist. Assessment may involve observing a meal or snack and completing an x-ray study call a videofluoroscopy. Once the reason for the dysphagia is identified the speech pathologist will advise on how to manage the difficulty. This may involve strengthening exercises for muscles involved in swallowing, modification to the diet and adaptive behavioural strategies such as improving head and neck posture.
Gait And Lower Limb Movement Therapy
This section is opened with a review article from Hackney et al., which provides a comprehensive introduction to the core theme of this research topic. The focus is on neural substrates used for internally and externally guided movement in healthy participants and PD patients. The compendium of articles presented in this review provides an overview of the possible functional basis for the efficacy of pace-based rehabilitation interventions and also identifies future directions that merit additional investigation. The next article by Ashoori et al. continues along this theme and takes an in-depth look at the subject of rhythmic auditory stimulation . The authors not only discuss the underlying mechanisms for its therapeutic power but also deliver a synopsis of the benefits stemming from RAS-based interventions and other technological innovations that enable the creation of online cues that are adapted to the needs of each patient. This article is supplemented by the work of Maculewicz et al. and presents a roundup of the technological solutions currently available that make use of instrumented footwear and that can also be used for RAS. We would like to redirect readers, who are interested in finding out more about the progress of health informatics in PD management, to the recently published article of Espay et al. .
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Education Regarding Parkinsons Disease And Managing Medications
A nurse with specialist training in PD can provide education and support to the person with PD and their caregiver. This may include:
- monitoring the effects of changes to PD medications as recommended by the neurologist and liaising with the neurologist
- providing education and support around the recommended PD medications and assist with the minimisation of side effects
- providing individualised education for the person with PD and their caregivers to ensure optimal understanding and management of the various PD symptoms as the condition progresses
- arranging referrals to other relevant health professionals within the specialist team
How Might Stem Cell Therapy Benefit Parkinsons
Researchers are exploring various approaches to use stem cells to treat Parkinsons disease.
The current idea is to introduce stem cells directly into the affected areas of your brain where they can transform into brain cells. These new brain cells could then help regulate dopamine levels, which should improve the symptoms of the disease.
Its important to note that experts believe this would only be a treatment for Parkinsons disease and not a cure.
While stem cell therapy has the potential to replace the brain cells destroyed by Parkinsons disease, the disease would still be present. Parkinsons disease would likely destroy the implanted stem cells eventually.
Its unclear right now whether stem cell therapy could be used multiple times to continue to reduce symptoms of Parkinsons disease or if the effect would be the same after multiple procedures.
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The Lee Silverman Voice Treatment
The Lee Silverman Voice Treatment is the first speech treatment for PD proven to significantly improve speech after one month of treatment.
- Exercises taught in the LSVT method are easy to learn and typically have an immediate impact on communication.
- Improvements have been shown to last up to two years following treatment.
- LSVT methods have also been used with some success in treating speech and voice problems in individuals with atypical PD syndromes such as multiple-system atrophy and progressive supranuclear palsy .
LSVT® Guidelines
- Must be administered four days a week for four consecutive weeks.
- On therapy days, perform LSVT exercises one other time during the day. On non-therapy days, perform LSVT exercises two times a day.
- Once you complete the four-week LSVT therapy, perform LSVT exercises daily to maintain your improved voice.
- Schedule six-month LSVT re-evaluations with your specialist to monitor your voice.
- If available in your area, participate in a speech group whose focus is on thinking loud.
- A Digital Sound Level Meter can help you monitor voice volume. Place the meter at arm distance to perform the measurement. Normal conversational volume ranges between 68-74dB.
Neurosurgical Treatments Of Parkinsons Disease
It is beyond the scope of this manuscript to comprehensively review neurosurgical treatment of PD. Only a brief review will be provided here and the reader is referred to other published literature on for additional information about this important therapeutic strategy. The renewed interest in surgical treatment of movement disorders has been stimulated in part by improved understanding of the functional anatomy underlying motor control, as well as refinement of methods and techniques in neurosurgery, neurophysio logy, and neuroimaging .
Besides thalamotomy and pallidotomy, another promising surgical approach for the treatment of tremors and other movement disorders is high-frequency DBS via electrodes implanted in the VIM nucleus of the thalamus, GPi, STN or other subcortical nuclei. The mechanism of electrical stimulation is not known, but the following explanations have been offered: 1) disruption of the network , 2) depolarization block, 3) preferential activation of inhibitory neurons, and 4) a functional ablation by desynchronizing a tremorogenic pacemaker.
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How Is It Treated And Is There A Cure
For now, Parkinsons disease is not curable, but there are multiple ways to manage its symptoms. The treatments can also vary from person to person, depending on their specific symptoms and how well certain treatments work. Medications are the primary way to treat this condition.
A secondary treatment option is a surgery to implant a device that will deliver a mild electrical current to part of your brain . There are also some experimental options, such as stem cell-based treatments, but their availability often varies, and many aren’t an option for people with Parkinsons disease.
What Will A Cure For Parkinsons Look Like
Parkinsons varies so much from person to person. There are over 40 symptoms of Parkinsons. Tremor. Pain. Hallucinations. Everyones experience is different.
Because of this, there may not be a single cure.
Instead we may need a range of different therapies to meet the needs of the individual and their specific form of the condition.
This mix may include treatments, therapies and strategies that can:
- slow or stop the progression of the condition
- replace or repair lost or damaged brain cells
- control and manage particular symptoms
- diagnose Parkinsons at the earliest possible stage.
And this could involve medical treatments, such as drugs and surgical approaches, as well as lifestyle changes, for example to diet and exercise.
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Parkinsons Disease Pipeline Offers Promising New Options For Treatment
DelveInsights Parkinsons Disease Pipeline Insight report provides comprehensive insights about 150+ companies and 150+ pipeline drugs in the Parkinsons Disease pipeline landscapes.
Los Angeles, USA, Jan. 17, 2022 Parkinsons Disease Pipeline Offers Promising New Options for Treatment | DelveInsight
DelveInsights Parkinsons Disease Pipeline Insight report provides comprehensive insights about 150+ companies and 150+ pipeline drugs in the Parkinsons Disease pipeline landscapes.
The report comprises Parkinsons Disease pipeline drug profiles, including clinical and non-clinical stage products. It also includes the Parkinsons Disease therapeutics assessment by product type, stage, route of administration, and molecule type and further highlights the inactive Parkinsons Disease pipeline products.
Get an overview of pipeline landscape @ Parkinsons Disease Clinical Trials Analysis
Parkinsons Disease is a progressive disorder caused by degeneration of nerve cells in the part of the brain called the substantia nigra, which controls movement.
· Combination· Mono/Combination
Key Questions regarding Current Parkinsons Disease Treatment Landscape and Emerging Therapies Answered in the Pipeline Report
The Choice Between Advanced Therapies For Parkinsons Disease Patients: Why What And When
Issue title: Special Issue: Clinical management of Parkinsons disease: Essentials and new developments
Guest editors: Bastiaan R. Bloem and Patrik Brundin
Article type: Review Article
Authors: Dijk, Joke M.a | Espay, Alberto J.b | Katzenschlager, Reginac | de Bie, Rob M.A.a *
Affiliations: Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands | Department of Neurology, James J. and Joan A. Gardner Family Center for Parkinsons Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA | Donauspital, Department of Neurology and Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Vienna, Austria
Correspondence: Correspondence to: Rob M. A. de Bie, Amsterdam UMC, Department of Neurology, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, Netherlands. E-mail: .
Keywords: Parkinsons disease, deep brain stimulation, external infusion pumps, parenteral infusions, carbidopa, levodopa drug combination, apomorphine, review literature
DOI: 10.3233/JPD-202104
Journal: Journal of Parkinson’s Disease, vol. 10, no. s1, pp. S65-S73, 2020
Abstract
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Clinical Trials For Complementary Therapies In Pd
Just like they do for medications, clinical trials are also done for complementary therapies. Trials that test complementary therapies in PD can be conducted in a variety of ways, some more rigorous than others. Typically, patients are assessed for different outcome measures depending on the treatment. For example, a study of massage investigated the change in pain level as an outcome measure, whereas studies of acupuncture looked at changes in sleep and depression as outcome measures. The different types of treatments have not been compared to each other, so there is little way of knowing if one edges out the others in terms of effectiveness on any given measure.
In general, however, these modalities are low-risk and typically demonstrate improvement in either a motor or a non-motor symptom. Additional research with larger and more rigorous trials is needed, but it is exciting to realize that there are many possible therapeutic avenues to explore. It is also important to note that complementary therapies are typically not covered by insurance, so they may be out of financial reach for many people with PD. Increased research demonstrating the efficacy of these modalities is the first step in convincing insurance providers that these services are worth covering.
Tips and Takeaways
Top Ways To Treat Parkinsons Disease
This content was developed in partnership with the Parkinsons Foundation.
Every person living with Parkinsons disease experiences symptoms, disease progression and treatments that are unique to them. There is no single treatment plan that works for everyone.
The most common way to treat and manage PD symptoms include medications, exercise, rehabilitation therapies and surgical procedures. Treatment plans should be tailored to respond to an individuals symptoms and personal circumstances. While there is currently no cure for PD, the goals of treatment are to minimize symptoms and improve overall quality of life.
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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:
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Fredric P. Manfredsson, Parkinsons Disease Research Unit, Department of Neurobiology, Barrow Neurological Institute, Phoenix, Arizona, USA
No competing interests were disclosed.
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Tipu Z. Aziz, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
No competing interests were disclosed.
What Does It Look Like
Gait in Parkinsons refers to changes in a persons ability to take usual, purposeful steps after developing the disease. Their movements may be slow and stiff. Although the specific presentation may vary among people, a persons steps will typically be smaller and shuffling in nature.
People also may have less arm swing, or arm swing may be absent altogether. There will be less rotation and movement of the torso. The feet will land flat on the floor rather than on the heel. Sometimes, the feet may feel stuck to the floor, a condition known as freezing.
When evaluating Parkinsons gait, a doctor will look for a few common symptoms. They may include:
- taking smaller steps than usual
do not yet know the exact cause of Parkinsons. The disease develops when nerve cells in a portion of the brain called the basal ganglia, that controls movement, become damaged or begin to die. The nerve cells in this region control movement.
In some cases, Parkinsons is hereditary, and experts have found links with specific genetic mutations in a few other cases. However, it does not generally seem to run in families. A combination of genetic and environmental factors is most likely responsible for the development of Parkinsons.
Parkinsons gait is the result of bradykinesia, or slow movements, which is one of the main symptoms of the disease. The brain is less able to process what would normally be automatic movements like swinging arms when walking or moving one foot after another.
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Who Does It Affect
The risk of developing Parkinsons disease naturally increases with age, and the average age at which it starts is 60 years old. Its slightly more common in men or people designated male at birth than in women or people designated female at birth .
While Parkinsons disease is usually age-related, it can happen in adults as young as 20 .