Parkinson's disease increasing, but so are better treatments

Friday, May 15, 2015

JON-MICHAEL SULLIVAN/STAFF

Dr. David Standaert, professor and chair of neurology at the University of Alabama at Birmingham, gives a presentation during the "Know More; Live More: Parkinson's 101" event presented by the Georgia Regents Neuroscience Center held at the Kroc Center in Augusta.

There is a “tsunami” of new Parkinson’s disease cases that will hit the U.S. in coming years as the population ages overall, an expert told the audience at a Georgia Regents Health System forum on Friday.But better treatments and new insights into the way damage may spread in the brain could help stem that tide.

Dr. David Standaert, director of the Center for Neurodegeneration and Experimental Therapeutics at the University of Alabama at Birmingham, spoke to a forum for patients and caregivers hosted by Georgia Regents Neuroscience Center.

Risk for Parkinson’s increases with aging, with an average of one case per 100 at age 65 but two or three per 100 at age 85, he said. With the Baby Boomer population just now hitting their 60s, the number of people with Parkinson’s is expected to increase from 1.5 million now to 4 million within the next 25 years, Standaert said.

“We’re going to see a tsunami of Parkinson’s disease as a result of the aging of the population,” he said. “We need to have better treatments for this or we’re going to have a very serious problem.”

Parkinson’s patients have long had treatments that can really help them, notably the drug levadopa and carbidopa, and more recently electrical deep brain stimulation, which makes it different from many other neurodegenerative diseases, Standaert said.

In the last year, it has seen three new treatments, including a gel form for levadopa and carbidopa delivered by an infusion pump directly into the gastrointestinal tract that can provide a “leveling out” of drug relief for patients, Standaert said.

But future treatments could come from a better understanding of not only what causes Parkinson’s disease but what really causes the damage and makes the disease progress from year to year. An excess of a particular 

protein called alpha-synuclein is known to accumulate in the brains of Parkinson’s patients and is thought to misfold and clump together, similar to what is thought to happen in the brains of Alzheimer’s patients with another type of protein.

Standaert and others believe these clumped, misfolded proteins can travel through the brain and cause an inflammatory reaction there.

“Synuclein is the upstream culprit of the thing that actually is killing neurons and producing the damage,” he said. While there are other causes, from genetics to the environment, of why people start to develop Parkinson’s, “I think once you trigger that, then that’s where inflammation becomes important,” Standaert said. “The cause is upstream but inflammation is what makes it worse from year to year.”

There are other diseases where there are drugs to fight an improper immune response in the brain, such as lupus or multiple sclerosis, so even if the cause is different some of the treatments might eventually be beneficial, he said.

“I think there could be a convergence in treatments, absolutely,” Standaert said.

His own lab has used a mouse model to knock out a key immune protein that found where synuclein was not toxic to those animals. While that is not possible in humans, Standaert’s lab has targeted the gene that controls that protein and has a grant from the Michael J. Fox Foundation for Parkinson’s Research to explore whether that could be a target for interventions.

But part of the problem will also be just getting the correct diagnosis in the first place.

Marilyn Sullivan, of Aiken, noticed years before her husband, Robert, was diagnosed with Parkinson’s that he was shuffling his feet and she was having trouble hearing him. She bought him new shoes and took him around to different specialists before he was finally diagnosed two years ago.

“No one ever mentioned Parkinson’s,” she said. Dr. Kapil Sethi, director of the Georgia Regents Movement Disorders Program, told her she shouldn’t feel bad it took so long.

“You did your job,” he said. “It’s a common problem” with the diagnosis.

http://health.einnews.com/article/265709286/cDuNcheGGHypvWKC