Parkinson’s Disease: Towards Finding a Cure

The BBC has reported exciting developments in the treatment of some of the symptoms of Parkinson’s disease. Researchers in Canada have managed to develop a new treatment that helps restore the ability to walk in affected patients through an implant that provides electrical stimulation in the spine. The following video, provided courtesy of the BBC, provides further details.

The British National Formulary (BNF) defines Parkinson’s disease as a progressive neurodegenerative condition resulting from the death of dopaminergic cells of the substantia nigra in the brain.

Substantia Nigra
Substantia Nigra

Motor-symptoms may include hypokinesia (decreased bodily movement), bradykinesia (slowness of movement), rigidity (stiffness), rest tremor, and postural instability. Non-motor symptoms include dementia, depression, sleep disturbances, bladder and bowel dysfunction, speech and language changes, swallowing problems and weight loss. Patients with suspected Parkinson’s disease should be referred to a specialist and reviewed every 6 to 12 months.

Both the BNF and the National Institute for Health and Care Excellence (NICE) highlight the need for both pharmacological and non-drug treatment options for the various symptoms. In respect of non-drug treatment, patients should be offered physiotherapy if balance or motor function problems are present, speech and language therapy if they develop communication, swallowing or saliva problems, and occupational therapy if they experience difficulties with their daily activities. Dietitian referral should be considered.

Drug treatment has centred on negating the effects of the loss of dopamine through replacing dopamine (via levodopa), using dopamine agonists or using a range of drugs that offset the negative effects of dopamine loss. The medical challenge is being able to attain the fine balance that mimics normal brain and motor function without the development of unacceptable side effects from the drugs themselves.

NICE highlights that initial drug treatment should be subject to a consideration of the relative benefits and harms of the treatment options, using the following comparative chart for reference:

Screenshot 2019-04-22 at 23.03.57

The guidance highlights that in early stages of Parkinson’s disease, patients whose motor symptoms decrease their quality of life should be offered levodopa combined with carbidopa (co-careldopa) or benserazide (co-beneldopa), which help prevent the peripheral metabolism of levodopa. Parkinson’s disease patients whose motor symptoms do not affect their quality of life, could be prescribed a choice of levodopa, non-ergot-derived dopamine-receptor agonists (pramipexole, ropinirole or rotigotine) or monoamine-oxidase-B inhibitors (rasagiline or selegiline hydrochloride).

The NICE guidance goes on to provide more guidance on what to do in the event that a patient develops motor fluctuations, uncoordinated movements or simply that the medicines stop being as effective due to progression of the disease.

The news of the development of new treatment via electrical stimulation therefore offers promise as an option with comparatively low side effects, particularly where traditional approaches have reached their limits. It also comes on the back of recent findings that Parkinson’s disease may start in the gut, a promising field of research that may yet yield other avenues towards treating, preventing or reversing this debilitating condition.