Spotlight on: Parkinson’s Disease Symptoms Treatment
As a neurodegenerative condition, Parkinson’s disease is challenging to manage effectively, and there is no cure for it. But promising novel treatments are emerging on a global scale, which are widening options for patients.
Arguably one of the most important advances of recent years is deep brain stimulation (DBS), which involves surgically implanting electrodes into brain areas such as the subthalamic nucleus (STN) and globus pallidus (GPi).
The electrodes are connected through a wire to a battery-operated neurostimulator similar to a pacemaker, which is implanted under the skin in the chest wall. The neurostimulator sends mild electrical impulses to the electrodes, blocking brain signals responsible for the symptoms of PD.
The procedure is highly effective at improving tremor, slow movement, rigidity and pain. But, because of elevated energy consumption, implanted batteries must be surgically replaced every three to five years, which is associated with a significant risk of infection.
Evolutionary Deep Brain Stimulation for Parkinson’s Disease Patients
Now, Duke University researchers, led by Professor Warren Grill, have developed a DBS system incorporating a breakthrough computer algorithm, which working in a similar way to biological evolution, randomly generates multiple patterns of brain stimulation and then selects the one that is most effective and uses the least energy.
When the researchers tested the technology in a study of PD patients, symptom relief was comparable or superior to that of standard brain stimulation, and was associated with a cut in energy usage of up to 75 per cent.
This could extend battery life by two or three times, greatly reducing the need for surgical replacement.
Focused Ultrasound Technology for Treating Parkinson’s Disease Symptoms
Researchers are also developing non-invasive methods for treating Parkinson’s disease symptoms.
In one of these, high-energy ultrasound beams are used to break abnormal brain circuits that cause hand tremor, under real-time magnetic resonance imaging (MRI) guidance.
The beams are aimed at areas deep inside the brain from outside the skull. There is no need for surgery.
The procedure is performed under local anaesthetic, with the patient inside an MRI scanner. A team from Imperial College Healthcare NHS Trust successfully used the technique, as part of a clinical trial of patients with essential tremor.
Professor Wladyslaw Gedroyc, who is leading the trial, said: “We anticipate that this new approach to therapy in essential tremor and other movement disorders, including Parkinson’s, will allow huge improvements in patients’ quality-of-life without the need for invasive procedures …”
Other researchers are using the same technology to destroy brain areas involved in the generation of hand tremor, in patients with Parkinson’s disease. In a study, published in the journal Neurosurgery, the researchers found that the procedure improved tremor as well as other symptoms.
Transcranial magnetic stimulation
Another method for controlling motor symptoms non-invasively is repetitive transcranial magnetic stimulation (rTMS).
It uses magnetic pulses generated by a small electromagnetic coil placed against the patient’s scalp. The pulses are similar to those used in an MRI scanner.
They travel through the skull to the brain areas of interest, where they stimulate certain nerve cells, leading to an improvement of the symptoms.
A review in JAMA, which looked at the results from 20 relevant studies for a total of 470 PD patients, concluded that the available “evidence suggests that rTMS improves motor symptoms for patients with PD.”
Next-generation drug delivery systems
Exciting results have been reported also for cutting-edge ways to deliver Parkinson’s drugs, making them more effective.
Among the most promising are drug-loaded nanoparticles administered through injection that can reach target brain areas, and silicon-based transdermal patches for the continuous delivery of dopamine or other PD medication.
Both methods can potentially improve drug absorption, allowing for a more effective control of symptoms, compared with oral tablets.
The same is true for another novel drug-delivery system consisting of tiny biosensors that are implanted into the brain and can automatically release the required dose of a medication exactly when needed.
Novel Parkinson’s Medications
Last year, the UK has seen the launch of a new drug that, in a clinical trial, was associated with significantly reduced off periods.
These are characterised by a worsening of motor symptoms and are typically experienced by patients treated with existing medications.
The novel drug, called safinamide, is a monoamine oxidase B inhibitor.
A number of other novel agents are in in pipeline, including KW-6002, which, too, has been shown to reduce significantly off periods in Parkinson’s disease; and the pill IPX066, which slowly releases medication in the bloodstream, reducing the number of pills a patient needs throughout the day.
Seeking a Second Opinion
That so many different new treatments are being developed is clearly a good thing. But it can be challenging for patients to understand whether they might benefit from a certain novel treatment, or know how to access them. So, it might be worth seeking a second opinion.
Richard Kensett, managing director at Alivia UK, says: “A second opinion can not only help patients make difficult treatment decisions; it can also assist them in accessing leading specialists and state-of-the art technologies, in the UK and globally. What’s more, it can give them the peace of mind that comes from knowing that they are playing an active role in finding ways to better control their condition.”
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