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| Dr. Frank Nemec talks with Russell Robertson as nurses Jennifer Lawrie, left, and Lisa Murphy wait to take him to the operating room at the Ambulatory Surgical Center of Southern Nevada at 3820 S. Hualapai Way in Las Vegas on Wednesday, April 29, 2015. Nemec was to perform a surgery on Robertson that would allow a new form of a medication used for treating Parkinson's disease to be delivered in a new way. (Bill Hughes/Las Vegas Review-Journal) |
Russell Robertson has struggled with Parkinson’s disease for more than 10 years.
He didn’t even realize he was changing in the early 2000s when a golfing buddy called him “shuffler.” But by the time of his diagnosis in 2004, his condition was unmistakable.
The progressive neurodegenerative disorder became more advanced by 2014, making Robertson open to new options to relieve his symptoms.
On Monday at the Cleveland Clinic Lou Ruvo Center for Brain Health, Robertson became the first patient in Nevada to receive a new form of carbidopa-levodopa, the tried-and-true medication for Parkinson’s patients.
The U.S. Food and Drug Administration in January approved Duopa, a gel form of the drug, for the treatment of motor fluctuations for people with advanced Parkinson’s disease. It is administered using a small, portable infusion pump that delivers the medicine directly into the small intestine for 16 continuous hours.
There is no cure for Parkinson’s, which causes tremors, muscle stiffness, slowed movements and a shuffling gait. Some patients experience attention difficulties, slowed thinking and memory problems. Cognitive changes are mild for some patients.
Over time, however, side effects of carbidopa-levodopa can disrupt a person’s ability to control movements, causing spasmodic or repetitive motions or lack of coordination. Duopa is designed to achieve a balance: enough medication to manage the symptoms without so much that the patient experiences that lack of control and coordination.
Administering a steady supply of the medication into the intestine keeps a more stable level in the bloodstream.
“It’s important for people to know that there are new treatments for this very difficult disease,” he said. “It’s not the end all and be all, and not every patient is a candidate for this.”
Duopa itself will be suited only for a small percentage of Parkinson’s patients in an advanced stage of the disorder, said Dr. Ryan Walsh, director of the movement disorders program at the Ruvo center.
The pill form of the carbidopa-levodopa, sold under the brand name Sinemet, has been used for the past 50 years. The pill can control the symptoms but also has the side effects, and patients often are forced to endure both extremes.
“Patients end up getting on this roller-coaster ride,” Walsh said. “They take their medication. They have improvement of their symptoms but also side effects from the medication. And then the medications start to wear off, and their Parkinson’s symptoms come back.”
Robertson, 77, a retired computer hardware technician from central Michigan who has wintered in Las Vegas since the late 1990s, has achieved moderate control of his symptoms since being prescribed Sinemet in 2007. For the first three years after he was diagnosed, doctors attempted to treat his condition with various physical, occupational and water therapies designed to reduce stiffness and improve mobility, posture, balance and gait.
The disease especially affected Robertson’s right arm and hand. He measured the effects by his golf game.
“Where I could drive the ball 230 yards, I would be happy for 140,” he said.
He chose the Duopa therapy after being screened as a suitable candidate for deep brain stimulation, another treatment for advanced Parkinson’s involving a surgically implanted electrode that blocks or overrides tremor signals from the brain.
People in the advanced stages of Parkinson’s can be candidates for either therapy, Walsh said, but both require surgery, which can pose a challenge for some patients.
The Duopa therapy is a partnership between the Ruvo center and Dr. Frank Nemec, a Las Vegas gastrointerologist. On Wednesday, Nemec surgically created the channel to deliver the drug. Known as a percutaneous endoscopic gastrostomy tube with jejunal extension, the route through the abdomen is the key to providing the stable level of medication.
The pump regulates the amount of the drug infused, but Robertson can give himself a booster by pushing a button on the pump, in the same way people can self-administer painkillers after surgery.
“The whole goal of the pump is that you can give a very measured dose, and it’s continuously administered, drip by drip,” Walsh said. “They get a steady level of medication all throughout the day.”
Duopa is the result of medical professionals working to improve the mechanisms of delivering medications to the estimated 1 million people living with Parkinson’s in the United States. Based on population estimates and the prevalence of Parkinson’s nationwide, between 10,000 and 12,000 people have the condition in Southern Nevada. Another drug the FDA approved in January, Rytary, is an extended release form of carbidopa-levodopa formulated to kick in rapidly, then maintain blood levels longer. But like Sinemet, the pills must be taken several times per day.
“There’s no free lunch when it comes to Parkinson’s disease treatment unfortunately,” Walsh said. “There are always potential side effects and potential benefits. The art in Parkinson’s treatment is to minimize the side effects while optimizing the benefits, and that is a moving target.”
In Duopa, the goal is for improved movement control for people with advanced Parkinson’s.
“The expectation is for this to have a meaningful impact on quality of life for at least several years,” he said.
Contact Steven Moore at smoore@reviewjournal.com or 702-380-4563.
http://www.reviewjournal.com/life/health/new-drug-parkinson-s-administered-nevada
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