Kirk Gibson in 'attack mode' against Parkinson's

 Lynn Henning, The Detroit News 3:48 p.m. EDT July 2, 2015

Detroit – He realized on Opening Day that things were amiss.

Kirk Gibson remembers it as an "anxiety" that washed over him as he worked alongside his FSD broadcast mates, Mario Impemba and Rod Allen, in his first stint since 2002 as a Tigers broadcaster.

"I had a hard time talking," Gibson recalled Thursday as he sat in FSD's open-air booth at Comerica Park, 45 minutes before the Tigers and Pirates were to play and Gibson was to join Impemba for his first full-game shift since that April 6 game against the Twins.

"It was huge anxiety, something I had never felt in my life. After that, I knew I had to get it checked out."

The diagnosis was Parkinson's disease, a neurological disorder that affects motor skills and can make speech complicated. Gibson had been gone from the booth, and from public appearances, for the past three months until he returned Wednesday for a three-inning cameo.

Parkinson's has brought a harsh and ironic change in life to a man who was one of the game's most colorful and dramatic stars when he played outfield for the Tigers, and later, for the Dodgers, in the 1980s and beyond. Gibson has been forced at age 58 to accept new daily-life responsibilities as challenging for his body as for a man's mind and soul.

"Getting there," he said, dressed in a blue-green jacket, print shirt, and tie, as he and Impemba went over game notes and schedules. "There's a lot of therapy. It's a work in progress, learning what I'm dealing with, and how to do it. I'm working with movement therapists and voice therapists."

Sense of humor is back

Neither he nor his wife, JoAnn, had any clue that something neurological had been gradually taking hold. If his gait was slightly off, and it was, a couple married 30 years this December thought it was due to past orthopedic issues: surgery from neck, shoulder, and wrist injuries accrued during his playing career.

If his voice was less facile than normal for a man known for rapid-fire sentences, that, too, the Gibsons figured, was somehow related to issues destined to be short-term.

Kirk Gibson checks his phone before Thursday's game at Comerica Park. (Photo: Robin Buckson, Detroit News)

Gibson now says he can identify over past months signs he was dealing with something quite different. He doesn't care to elaborate, but the implication is changes, perhaps ominous, were occurring even last year as he wrapped up a four-year tenure as Arizona Diamondbacks manager.

How he fares during this reunion with FSD's booth is not a deep concern, Gibson said. The voice therapy has been working. More important, his Opening Day anxiety has waned.

And his sense of humor is back.

"I told Mario," he said, glancing teasingly at his partner, "I'll still have some Parky moments.

"We were talking last night (Wednesday) about dancing. I said I'm not a dancer. And I certainly don't want to be a dancer with Parkinson's."

Comfortable at the ballpark

Medication is part of his new regimen, as well. Gibson doesn't care to discuss particulars, but prescriptions appear to be helping to a point that new advances in surgery, he said, aren't in the immediate picture.

"I'm in attack mode," he said. "I got some news that was out of the norm, and this has become my new norm.

"And, actually, I've felt pretty decent. Just trying to stay active. In fact, my golf game was coming along well till I threw out my back last week. I find that things you maybe took for granted you even more appreciate now."

Part of what inspires him is his return to baseball. Simply to be back at Comerica Park, he said, even as a civilian sitting in the front-row, season box seats in right field that he and JoAnn regularly buy, has been his best and most important therapy.

"I came down last week and Chris Chelios (former Red Wings star now a Wings assistant coach) sat with us," Gibson said. "Just me, and JoAnn, and Chris, and crazy as it seems, it was a hurdle I had to overcome.

"I realized again that there's just something comfortable about being in the ballpark. And people have been unbelievable to me.

"Since that day (diagnosis announcement, April 28), the way people have been reaching out to me has been overwhelming and emotional. And the Tigers have really helped with the process.

"All the people at Fox (FSD), along with Mario and Rod, who have been the greatest teammates I could ever have, everybody's been incredible."

Gibson says he can now see an opportunity offered, paradoxically, by a disease and his public profile.

"Looking ahead, how do you stop the progression of this disease?" he asked, hoping a measure of enlightenment might come from a full dose of Gibson-style resolve to live his life fully. "How do you find a cure?

"I'm meeting with a lot of people and I want a bigger role in awareness. I've really put together a good team."

Gibson was an All-American football player at Michigan State before he turned to baseball, which allows him to slip easily into coach / manager speech. His past life is obvious in references to "teams" he is building and to being "highly motivated" to make his Parkinson's experience not only something he can endure, but make, to the extent possible, a triumph.

"People have just got to bear with me," he said, glancing again, with a knowing grin, at his partner Impemba.

lynn.henning@detroitnews.com

http://health.einnews.com/article/274189582/cIpurGUTCxExyvT9

Parkinson’s and depression drugs can alter moral judgment, study shows

Trial showed healthy people given a Parkinson’s drug became more selfish, while people given a serotonin-boosting drug were more protective of others

Common drugs for depression and Parkinson’s can sway people’s moral judgments about harming others, according to research that raises ethical questions about the use of the drugs.

The study found that when healthy people were given a one-off dose of a serotonin-boosting drug widely used to treat depression they became more protective of others, paying almost twice as much to prevent them receiving an electric shock in a laboratory experiment. They also became more reluctant to expose themselves to pain.

Serotonin map of brain could lead to better targeted antidepressants

The scientists also found that the dopamine-enhancing Parkinson’s drug, levodopa, made healthy people more selfish, wiping out the normal tendency to prefer to receive an electric shock themselves, while sparing those around them.

Molly Crockett, a psychologist at the University of Oxford who led the work, said the finding that a single exposure to the drugs had such a noticeable impact on behaviour challenged the idea that we have stable moral values.

“Patients [taking these drugs] are tracked in terms of how their symptoms improve, but not necessarily in terms of how their behaviour changes,” she said. “In the treatment of Parkinson’s, some patients go on to develop compulsive gambling and compulsive sexual behaviour. The drugs have consequences that reach out into the world beyond the patient.”

She added that it was unclear whether the effects seen in the study would be replicated in patients. An alternative possibility is that the drugs could bring the behaviour of patients “back to baseline” by stabilising their psychological state.

“The central message is we need to have more research into how these drugs affect behaviour, both in healthy people and in people taking them for disorders,” she said.

In the study, published in the journal Current Biology, 175 participants took part, with 89 assigned to receive the anti-depressant citalopram or a placebo and 86 given either levodopa or a placebo.

The participants were also randomly designated as “deciders” or “receivers” and anonymously paired up. All participants were given mildly painful electric shocks matched to their pain threshold so that the intensity was not intolerable. Deciders were told that shocks to receivers would be at the receiver’s own pain threshold.

 On average, people given a placebo were prepared to pay around 35p per shock to prevent harm to themselves and 44p per shock to prevent harm to others. Those on citalopram, the seratonin-based drug, were far more harm-averse, willing to pay an average 60p per shock to prevent harm to themselves and 73p per shock to prevent harm to others. Overall, they delivered around 30 fewer shocks to themselves and 35 fewer shocks to others than those on placebo.

People given levodopa, however, were not willing to pay any more to prevent shocks to others than to prevent shocks to themselves. On average, they were prepared to pay approximately 35p per shock to prevent harm to themselves or others, meaning they delivered on average 10 more shocks to others during the experiment than the placebo group.

“The dopamine drug made people more selfish,” said Crockett. “Most people show this pattern where they think it’s worse to harm other people than to harm oneself. That’s abolished by the drug.”

The researchers suggest that in future it may be possible to give people a simple test to assess whether their decision-making behaviour has been radically altered by a drug, as well as asking them about whether their mood and symptoms have improved.

“We’re not transforming someone from a healthy person into a criminal or anything like that,” Crockett said. “But in aggregate we make decisions multiple times a day and they can shape our lives.”

                 

http://www.theguardian.com/science/2015/jul/02/parkinsons-and-depression-drugs-can-alter-moral-judgement-study-shows?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Serotonin map of brain could lead to better targeted antidepressants

Researchers hope to discover how the activity of serotonin in the brain is involved in different mental illnesses

By understanding the biology of serotonin, drugs could be developed that only target cells relevant to a particular mental disorder – reducing side-effects. Photograph: Mark Thomas/Alamy

Haroon Siddique

Research that aims to map the activity of serotonin in the brain could revolutionise the use of antidepressants and behavioural therapy for people with mental illnesses.

The neurotransmitter serotonin has long been associated with mood, with drugs that boost the chemical in the brain helping to alleviate the symptoms of common illnesses such as depression and anxiety, but scientists lack a deep understanding of how it mediates different mood disorders.

By understanding the biology of serotonin, the hope is that drugs can be created that only target cells relevant to a particular disorder and behavioural therapies can be made more effective, reducing the need for antidepressants.

Dr Jeremiah Cohen, an assistant professor at the Johns Hopkins Brain Science Institute in Baltimore, said: “The ultimate aim is to understand the biology of mood and how groups of cells in the brain connect to produce our emotional behaviour. Most antidepressants operate broadly in the entire serotonin system. What we hope to do with this map is use drugs that are available or design new drugs that will target only the components of that system relevant to a particular disorder.”

The use of antidepressants in England has soared since the late 1990s, raising concerns in some quarters about over-prescription. Researchers from the Nuffield Trust and the Health Foundation found that 40m prescriptions for antidepressants were made in 2012, compared to 15m in 1998. Doctors write prescriptions for more than one in 10 adults in developed countries, with Iceland, Australia, Canada and European Nordic countries leading the way, according to 2013 data from the Organisation for Economic Co-operation and Development. More than 10% of American adults have used antidepressants.

Antidepressants that are better targeted could also avoid some of their common side-effects such as insomnia and sexual dysfunction, because the drugs could be designed to only affect the part of the brain involved in mood, said Cohen.

He is one of four researchers chosen by the charity MQ: Transforming Mental Health to share £900,000 to carry out mental health research. The effectiveness of selective serotonin reuptake inhibitors (SSRIs) as antidepressants strongly suggests that serotonin transmitter pathways are involved in illnesses such as depression and anxiety but little is known about the biology of the chemical. “Almost by accident scientists discovered that drugs that work on serotonin can affect mood,” said Cohen. “We are working with a blunt system and we need to refine it.”

He will build on preliminary studies of serotonin neurons in mice while the animals perform “reward and punishment” tasks. By monitoring their behaviour during the tasks, he and his colleagues will be able to map how the neurons participate in well-known responses that are analogous to human behaviours. He said that scientists have long been interested in mapping mood in the brain by dissecting the behaviour of serotonin neurons but in the past they have not had the technology to do it. “In neuroscience we are where physics was with Galileo and Newton,” he said. “It’s basic stuff. An observer might say we should know that [already], it seems like such an obvious thing we want to understand.”

MQ chief executive Cynthia Joyce said: “Whether medication or psychological therapy, it is vital that people receive the most effective mental healthcare that works for them. Dr Cohen’s research addresses a long-standing gap in our understanding of mental illness. Excitingly, it has the potential to help us to achieve better, more personalised treatments for millions of people.”

http://www.theguardian.com/science/2015/jan/05/serotonin-map-brain-antidepressants-mental-illnesses

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

NHS England approves routine commissioning for Parkinson’s treatment Duodopa®

3 July, 2015 11:07 AM

AbbVie welcomes the decision by NHS England to approve Duodopa® (Levodopa-carbidopa intestinal gel – LCIG) for routine commissioning for the first time and to publish a clinical commissioning policy. Doctors in England will now be able to prescribe the treatment as an option for those people with advanced Parkinson’s who they consider to be suitable, in line with the new policy.

There is no cure for Parkinson’s but symptoms of the condition can be controlled with the right treatment. Given the progressive nature of the condition, timely access to the right treatments is vital as there is often a ‘window of opportunity’ for treatments to work best.

LCIG has only been available on the NHS in England over the last eight years through an individual funding request (IFR) for each patient. This was typically time-consuming for clinicians and resulted in inconsistent access across England. Matt Regan, UK General Manager at AbbVie said: “Patients have been waiting a long time for this decision, it’s very positive news for people living with Parkinson’s. There should now be consistent access to this medicine and we urge the NHS to ensure the policy is implemented quickly and smoothly.”

Around 127,000 people are living with Parkinson’s in the UK. (1) It leads to a loss of the chemical dopamine in the brain, which controls movement and balance. (1) The digestive system is also often affected meaning that the absorption of oral medication can become less effective over time. (3) LCIG is administered directly through the intestine, bypassing the stomach, and may be prescribed for some people with Parkinson’s who have tried other combinations of medicines but do not have satisfactory control of their motor symptoms (movement and balance). (4)

Professor K Ray Chaudhuri, Consultant Neurologist and Professor in Neurology/Movement Disorders at Kings College and Kings College Hospital, Parkinson's Centre of Excellence, London welcomes the policy: “This new policy represents a positive step forward in the management of Parkinson’s. To date, access to Duodopa® has been highly variable and severely restricted, in spite of its wide availability in most European countries. Clinicians, patients and their carers can now realistically consider this as a treatment option when Parkinson’s symptoms advance and become unmanageable by other therapies. There is a real need to offer people further treatment options at the advanced stage.”

Parkinson’s is a progressive neurological condition and symptoms can become more difficult to control. Difficulties in controlling body movement and balance can severely impact quality of life, self-esteem and the ability to undertake basic activities like dressing, walking or moving around the house. At this stage of disease, standard treatments may no longer provide patients with adequate symptom control and access to other options may be required. (5)

References

1 NHS Choices. Parkinson’s Disease http://www.nhs.uk/Conditions/Parkinsons-disease/Pages/Introduction.aspx. Last accessed June 2015.

2 Worth P. When the going getshttp://www.nhs.uk/Conditions/Parkinsons-disease/Pages/Introduction.aspx tough: how to select patients with Parkinson’s disease for advanced therapies. Pract Neurol 2013;0:1–13.

3 Fernandez et al. Levodopa—carbidopa intestinal gel in advanced Parkinson’s disease open-label study: Interim results. 2013;19(3):339–45.

4 Electronic Medicine Compendium. Duodopa Summary of Product Characteristics. http://www.medicines.org.uk/emc/medicine/20786/SPC/Duodopa+intestinal+gel/. Last accessed June 2015.

5  Parkinson’s UK. Advanced Parkinson’s. http://www.parkinsons.org.uk/content/advanced-parkinsons. Last accessed June 2015.

http://www.hospitalpharmacyeurope.com/editors-pick/nhs-england-approves-routine-commissioning-parkinson’s-treatment-duodopa®?