THE LONG TERM EFFECT OF DBS ON PARKINSON'S DISEASE

13th October 2013 - New research

Journal of the Formosan Medical Association [2013] Oct 5 [Epub ahead of print] (J.L.Jiang, S.Y.Chen, T.C.Hsieh, C.W.Lee, S.H.Lin, S.T.Tsai) Complete abstract

Deep Brain Stimulation (DBS) involves the use of electrodes that are implanted into the brain and connected to a small electrical device called a pulse generator that can be externally programmed. For more information go to Deep brain stimulation Subthalamic nucleus deep brain stimulation (STN-DBS) has been shown to produce long-term improvements in Parkinson's Disease.
The aim of this study was to assess the improvements that can be expected after 1 year and after 5 years. Patients with Parkinson's Disease were assessed after 1 year and 5 years according to the Unified Parkinson's disease rating scale (UPDRS) parts I, II, III, and IV scores, the Hoehn and Yahr stage, and Schwab and England activities of daily living (SEADL) scores in the conditions of off-medication/on-stimulation and off-medication/off-stimulation. Further analysis included the changes in the L-dopa equivalent daily dose.
After 1 year  significant improvements were seen in the UPDRS parts I, II, III, and IV and the Schwab and England scale. Five years after STN-DBS had been initiated improvements in UPDRS scores were observed only for parts II, III, and IV. In the off-medication/off-stimulation condition no significant improvement was observed. However, after 5 years there were significant deteriorations when compared to the improvements seen after 1 year in the scores for the UPDRS parts I, II, III and the Schwab and England scale.

DUAL LAYER L-DOPA CLINICAL TRIAL RESULTS

7th October 2013 - New research

Parkinsonism Related Disorders [2013] Sep 5 [Epub ahead of print] (R.Pahwa, K.E.Lyons, R.A.Hauser, S.Fahn, J.Jankovic, E.Pourcher, A.Hsu, M.O'Connell, S.Kell, S.Gupta)

L-dopa usually comes in two different formats : either the immediate release version, which satisfies the immediate need for L-dopa, or the controlled release version, which avoids the excessive effects of L-dopa by spreading out the effect over time. Dual layer L-dopa (IPX066), which is being developed for the treatment of Parkinson's Disease, has the advantages of both by combining the two types of L-dopa.

A randomized, double-blind, placebo-controlled, clinical trial of IPX066 assessed three dosages of L-dopa : 145mg, 245mg or 390mg taken three times daily. The main efficacy measure was the Parkinson's Disease symptom score, the Unified Parkinson's Disease Rating Scale (UPDRS), and also the Parkinson's Disease Questionnaire (PDQ-39).
All three dosages improved Parkinson's Disease, with the 145mg dosage, then the 245mg dosage giving better results. The most commonly reported adverse events with IPX066 included nausea, dizziness, and headache. No unexpected drug-related serious adverse events were reported.

3rd October 2013 - New research
DEPRESSION TREBLES THE RISK OF PARKINSON'S DISEASE
Neurology [2013] Oct 2 [Epub ahead of print] (Cheng-Che Shen, Shih-Jen Tsai, Chin-Lin Perng, Benjamin Ing-Tiau Kuo, Albert C.Yang)

In the largest study of its kind, involving more than 23,000 subjects, people who had depression were found to have more than three times the chance of developing Parkinson's Disease. This suggests that depression is a strong indication of future Parkinson's Disease, even beyond that of other early indicators. 
Parkinson's Disease is primarily due to the insufficient formation of dopamine in the brain, in the dopaminergic neurons. Besides affecting muscle function and therefore the characteristic muscular symptoms of Parkinson's Disease such as as rigidity and tremor, dopamine insuffiency also affects the emotions.
This is why dopamine insufficiency can also lead to depression. However, even biochemically, dopamine is not the only factor involved in depression, which is why depresssion and Parkinson's Disease do not always coincide. Therefore, depression, even when severe, does not inevitably lead to Parkinson's Disease and why it is possible to have Parkinson's Disease without also having depression.  

UNDERSTANDING PARKINSON'S DISEASE : AN INTRODUCTION FOR PATIENTS AND CAREGIVERS

3rd October 2013- New book

Naheed Ali

Publisher's description :  Understanding Parkinson’s Disease offers patients and their caregivers the kind of cutting-edge information that will allow them to successfully confront this debilitating disease on a number of fronts. Patients will also be uniquely exposed to alternative approaches to managing the symptoms of the disease, including allopathic, osteopathic, and naturopathic approaches. The reader will be introduced to essential information on the risk factors associated with Parkinson’s, the signs and symptoms, the different stages of the disease, the various treatments, as well as how the disease develops. Anyone looking for an introduction will find the information they need in this accessible resource.  

HOUSEHOLD PESTICIDES INCREASE THE RISK OF PARKINSON'S DISEASE

29th September 2013 - New research

International Journal of Epidemiology [2013] Sep 20 [Epub ahead of print] (S.Narayan, Z.Liew, K.Paul, P.C.Lee, J.S.Sinsheimer, J.M.Bronstein, B.Ritz)

Household pesticide use is widespread, and for over 40 years organophosphorus chemicals have been common active ingredients in these products. Parkinson's Disease has been linked to pesticide exposures but little is known about the contributions of chronic exposures to household pesticides.

Consequently, researchers investigated whether long term use of household pesticides, especially those containing organophosphorus chemicals, increases the risk of developing or worsening Parkinson's Disease. Frequent use of any household pesticide increased the risk of developing Parkinson's Disease by 47%. Frequent  use of products containing organophosphorus chemicals increased the risk of Parkinson's Disease by 71%. Frequent organothiophosphate use almost doubled the risk of Parkinson's  Disease. The evidence shows that household use of organophosphorus pesticides is clearly associated with an increased risk of Parkinson's Disease. 

THE WORLD'S LOWEST INCIDENCE OF PARKINSON'S DISEASE

26th September 2013 - New research

Journal of  Neural Transmission [2013] Sep 22 [Epub ahead of print] (C.L.Ma, L.Su, J.J.Xie, J.X.Long, P.Wu, L.Gu)   
The world's lowest incidence of Parkinson's Disease has been found to be in China. Incidence is the rate at which Parkinson's Disease is being newly diagnosed. The incidence of Parkinson's Disease in China, at only 2 people per 100,000 is remarkably low. In constrast, the incidence rate in the U.S.A. is about ten times that number. The prevalence of Parkinson's Disease in China is remarkably high, with 797 per 100,000 being one of the highest rates in the world. The ratio of men to women with Parkinson's Disease is, at 1.29 men for every woman, more typical.
With very high prevalence (those people that have Parkinson's Disease now) and very low incidence (those people that are being diagnosed) means that the number of people in China with Parkinson's Disease must be dropping rapidly, and at a greater rate than anywhere else in the world. The researchers provide no reasons for this.  In China, instead of standard Parkinson's Disease drugs, people tend to use more Chinese herbal remedies, a number of which are known to have effect in Parkinson's Disease.
The former Chinese leader Chairman Mao is known to have had Parkinson's Disease. However, it is never disclosed in China that Chairman Mao, who is given almost God like status in China, ever actually had Parkinson's Disease.

THE EFFECT OF TEN YEARS WITH PARKINSON'S DISEASE

22nd September 2013 - New research

Parkinsonism Related Disorders [2012] 18 supplement, 3 : S10-S14 28 (3) : 380-383 (A.Hassan, S.S.Wu, P.Schmidt, I.A.Malaty, Y.F.Dai, J.M.Miyasaki, M.S.Okun)

A large number of people who had Parkinson's Disease for more than ten years were assessed to see what effect it had on them. The clinical status and health-related quality of life of patients reaching this milestone had not been well documented before. Their average age was 68 years old. Their average age of onset was 53 years old. Their average disease duration was 14 years. Many of them were minimally disabled (44%) or experiencing postural instability (40%). Most (88%) were able to stand unaided but falls were common (55%). Almost all (93%) were living at home, with a family member as a regular caregiver (84%).
They had an average of two additional medical disorders with arthritis (49%) and heart problems (32%) being the most common. Most of them  (87%) took at least 2 medications, with L-dopa (96%), dopamine agonists (45%) and antidepressants (37%) being the most common. Most of them were not currently utilizing physical, occupational or speech therapy, but two-thirds of them reported engaging in physical activity. Deep brain stimulation was documented in 22%. Overall the mean health-related quality of life and caregiver burden was impaired in all domains. 

COFFEE INTAKE AND THE RISK OF DYSKINESIA

21st September 2013 - New research

Movement Disorders [2013] 28 (3) : 380-383 (A.M.Wills, S.Eberly, M.Tennis, A.E.Lang, S.Messing, D.Togasaki, C.M.Tanner, C.Kamp, J.F.Chen, D.Oakes, M.P.McDermott, M.A.Schwarzschild)

Caffeine is a naturally occurring adenosine antagonist that is commonly found in coffee, and to a lesser extent in tea, cola drinks, cocoa, and chocolate. Adenosine antagonists reduce or prevent the development of dyskinesia in animal models of L-dopa induced dyskinesia.

Researchers examined the association between the intake of caffeine and  the time taken to develop dyskinesia. Those people who consumed 12 ounces of coffee per day, which is about two cups, reduced their likelihood of developing dyskinesia to 61%. Those people who consumed 4 to 12 ounces of coffee per day, which is less than two cups per day, reduced their likelihood of developing dyskinesia to 73%. The authors suggest tha these results support the possibility that caffeine may reduce the likelihood of developing dyskinesia.

BILLY CONNOLLY DIAGNOSED WITH PARKINSON'S DISEASE

16th September 2013 - News report

The 70 year old Scottish comedian Billy Connolly has been diagnosed with

 Parkinson's Disease but has vowed to continue with his stage and screen 

career despite also having prostate cancer. Besides being known for stand up 

comedy on television and in large arenas he has appeared as a comedian 

and as a serious actor in films such as The Last Samurai, The Hobbit, Indecent Gulliver's Travels. Connolly’s spokesman revealed that "Billy has been 

assured by experts that the findings will in no way inhibit or affect his

 ability to work, and he will start filming a TV series as well as 

undertaking an extensive theatrical tour." 

SAFINAMIDE CLINICAL TRIAL RESULTS

6th September 2013 - New research European Journal of Neurology [2013] September 11 [Epub ahead of print]   (A.H.Schapira, F.Stocchi, R.Borgohain,  M.Onofrj, M.Bhatt, P.Lorenzana, V.Lucini, R.Giuliani, R.Anand)  Safinamide is believed to have both dopaminergic and non-dopaminergic  actions, including the inhibition of MAO-B and inhibition of glutamate release.  It is undergoing  Phase III clinical development as a once-daily add-on to  dopamine agonists for the treatment of early Parkinson's Disease. In a one year clinical trial people with Parkinson's  Disease received 100mg or 200mg Safinamide daily.  They were assessed according to how long it was   before they had to increase their dopamine agonist dose  or add another Parkinson's Disease treatment.  People receiving 100 mg/day safinamide experienced  a significantly lower rate of intervention compared with placebo, of 25%  instead of 51% and a small delay before the need to increase other  Parkinson's Disease treatments of 9 days. In a previous study of once daily dosages of 50mg to 100mg Safinamide  improved Parkinson's Disease symptoms after six months and reduced  "off" time when added on to the use of existing Parkinson's Disease  treatments. However, the reduction in "off" time in comparison to  the use of a placebo was minimal. The increase in "on" time beyond  that of a placebo was only 40 minutes for 50mg safinamide, and 50 minutes  for 100mg safinamide.

DEMENTIA WITH LEWY BODIES AND PARKINSON'S DISEASE DEMENTIA

4th September 2013- New book

J.Eric Ahlskog

Publisher's description : In Dementia with Lewy Bodies and Parkinson's Disease Dementia, Dr. J. Eric Ahlskog draws on 30 years of clinical and research work at Mayo Clinic to arm patients and families with crucial information that will enable them to work in tandem with their doctors. Dr. Ahlskog clearly explains all aspects of these disorders, their causes, symptoms, most effective drug treatments, proper doses, and which medications to avoid. He also discusses the complications that can arise in treating these conditions, given the variety of available medications and their possible side effects and interactions. Dr. Ahlskog shows that optimal medical treatment can markedly improve the quality of life for both patients and family.

NEUPRO CLINICAL TRIAL RESULTS

1st September 2013 - New research

PLoS One [2013] 8 (7) : e69738 (C.Q.Zhou, S.S.Li, Z.M.Chen, F.Q.Li, P.Lei, G.G.Peng)

A systematic review has been carried out on the clinical trials of rotigotine transdermal patch, in order to evaluate the efficacy, tolerability, and safety in Parkinson's Disease. Rotigotine transdermal patch is marketed as Neupro. Neupro is a transdermal system that provides continuous delivery of rotigotine, which is a dopamine agonist, for 24 hours following application to intact skin.

The use of rotigotine resulted in greater improvements in Parkinson's Disease symptom scores (the UPDRS) concerning the activities of daily living score, motor score, and the activities of daily living and motor subtotal score. However, rotigotine was associated with a significantly higher rate of withdrawals due to adverse events, and higher rates of application site reactions, vomiting, and dyskinesia. No differences were found in the relative risks of headache, constipation, back pain, diarrhea, or serious adverse events. 

THE EFFECT OF GAMMA KNIFE THALAMOTOMY ON TREMOR

18th August 2013 - New research

Journal of Neurosurgery [2013] 118 (4) : 713-718 (A.Kooshkabadi, L.D.Lunsford, D.Tonetti, J.C.Flickinger, D.Kondziolka)
                                                                                                                                                                                The surgical management of disabling tremor has gained renewed vigour with the availability of deep brain stimulation. However, in the face of an aging population of patients with increasing surgical comorbidities, noninvasive approaches for tremor management have gained interest. Researchers evaluated outcomes in people who underwent a unilateral Gamma Knife thalamotomy (GKT) for tremor.

Gamma Knife radiosurgical thalamotomy is a technique in which a thalamotomy is performed with beams of radiation rather than a surgical incision or use of electrodes. The surgeon uses a Gamma Knife device to focus high-energy gamma rays precisely on an area in the brain that causes tremor. These rays result in the death of the brain cells that generate tremor. The procedure takes approximately one hour and the benefit may not be apparent until three to six weeks afterwards.

The tremor was related to either essential tremor, Parkinson's Disease or multiple sclerosis. The Fahn-Tolosa-Marin clinical tremor rating scale was used to grade tremor, handwriting, and ability to drink. After Gamma Knife thalamotomy : the average tremor score reduced from 3.3 to 1.8,  the average handwriting score reduced from 2.8 to 1.6,  the average drinking score reduced from 3.1 to 1.8. After Gamma Knife thalamotomy : 66% of patients showed improvement in all 3 scores, 13% of patients showed improvement in 2 scores, 2% of patients showed improvement in just 1 score, and 19% of patients failed to improve in any of the three scores.