Understanding Parkinson's Disease: An Interview with Jon Palfreman

Award-winning journalist Jon Palfreman, author of Brain Storms: The Race to Unlock the Mysteries of Parkinson's Disease, discusses the science behind this mysterious disease

By Sabrina Stierwalt, PhD. | September 27, 2015

Scientific American presents Everyday Einstein by Quick & Dirty Tips. Scientific American and Quick & Dirty Tips are both Macmillan companies.

When award-winning science journalist Jon Palfreman investigated a group of drug addicts who mysteriously ended up with Parkinson's-like symptoms after a bad batch of heroin—the story that would end up launching his career—he never imagined that more than 25 years later he would be diagnosed with the disease himself. Today there are roughly 1 million Americans living with Parkinson’s and about 60,000 new cases each year. In this interview, Jon discusses his new book, Brain Storms: The Race to Unlock the Mysteries of Parkinson's Disease, detailing the scientific history of a search for a cure, as well as his own experience with Parkinson's.

Jon offers advice for translating the uncertainties that often come with medical advice and suggests how we can try to reconcile those odds with our need for concrete answers. He explains our best chances at beating Parkinson's, including approaches that attempt to modify the disease as well as those that work to treat the symptoms.

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He also offers three suggestions on how those living with Parkinson's, as well as their family and friends, can understand such a complex disease and thus offer the best support:

1) Embrace your fellow patients who share your diagnosis for they are your new tribe. Connect with the Parkinson's community because you will find inspiration there. Jon tells the stories of a British surveyor who walked the coastline of Great Britain to raise money for Parkinson's research and of a New York ballet dancer who teaches dance classes for Parkinson's patients.When award-winning science journalist Jon Palfreman investigated a group of drug addicts who mysteriously ended up with Parkinson's-like symptoms after a bad batch of heroin—the story that would end up launching his career—he never imagined that more than 25 years later he would be diagnosed with the disease himself. Today there are roughly 1 million Americans living with Parkinson’s and about 60,000 new cases each year. In this interview, Jon discusses his new book, Brain Storms: The Race to Unlock the Mysteries of Parkinson's Disease, detailing the scientific history of a search for a cure, as well as his own experience with Parkinson's.

"Biomedical research sits at the intersection of truth and hope. Patients and biomedical researchers have to have hope that sometime in the future, things will get better."        - Jon Palfreman

Jon offers advice for translating the uncertainties that often come with medical advice and suggests how we can try to reconcile those odds with our need for concrete answers. He explains our best chances at beating Parkinson's, including approaches that attempt to modify the disease as well as those that work to treat the symptoms.

He also offers three suggestions on how those living with Parkinson's, as well as their family and friends, can understand such a complex disease and thus offer the best support:

1) Embrace your fellow patients who share your diagnosis for they are your new tribe. Connect with the Parkinson's community because you will find inspiration there. Jon tells the stories of a British surveyor who walked the coastline of Great Britain to raise money for Parkinson's research and of a New York ballet dancer who teaches dance classes for Parkinson's patients.

2) Exercise, exercise, exercise. For people with Parkinson's disease keeping mobile is not only important for staying positive but also likely staves off cognitive impairment.

3) Pay close attention to your own body and don't ignore it. You know yourself best and are with your body every day while your doctor may see you only once every 4-6 months.

Have you ever had to deal with a difficult diagnosis? How did you become empowered as a patient? You can weigh on my Facebook page, or follow me on Twitter, where I’m @QDTeinstein. If you have a question that you’d like to see on a future episode, send me an email at everydayeinstein@quickanddirtytips.com.

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Jon Palfreman, PhD, is a professor emeritus of journalism at the University of Oregon. He is an Emmy, duPont, and Peabody Award-winning journalist, a Nieman Fellow, and the recipient of the Victor Cohn Prize for Excellence in Medical Science Reporting. In addition to producing more than forty primetime documentaries for the BBC and PBS, Palfreman is a coauthor of The Case of the Frozen Addicts and The Dream Machine. He lives in Lexington, Massachusetts.

Brain Storms, The Race to Unlock the Mysteries of Parkinson's Disease, is available now from Amazon, Barnes & Noble, Books-A-Million, Indiebound, and Apple.

- See more at: http://www.quickanddirtytips.com/education/science/understanding-parkinsons-disease-an-interview-with-jon-palfreman#sthash.WBoloVq1.dpuf

http://health.einnews.com/article/288542636/MbWvCw1vMyJQ9iTx

Raising Awareness of Parkinson's Disease

Posted: Sun 5:41 PM, Sep 27, 2015

Loss of smell, trouble sleeping, constipation, and shaking...Those are all signs of Parkinson's Disease. 

Well September is Parkinson's Awareness Month. Those from First Settlement Physical Therapy teamed up with a local Parkinson's support group to conduct a one-day awareness event.

Community members who attended could receive information on the disease along with participating in various exercises to test their motor skills. 

"Parkinson's is a really interesting disease as the people who have it have it for a prolonged period of time. So they are able to find support systems throughout their local areas and it's very helpful for them," said Amanda Schell, a Physical Therapist from First Settlement Physical Therapy.

One local man runs a support group for those with Parkinson's and to educate others about the disease. "We know the importance of movement. We are walking the side walks and just taking whatever pace we, is comfortable for us and the distance that's comfortable for each of our people," said Larry Ice who attended the event Sunday.

If anyone is interested in joining the local support group for Parkinson's Disease, they meet the second Saturday of each month at the Vienna library. 

http://health.einnews.com/article/288593463/hfq2ajR4JLgoasSj

Impax Receives Positive CHMP Opinion for NUMIENT™ (Levodopa and Carbidopa) Modified-Release Capsules for the Symptomatic Treatment of Adult Patients with Parkinson's disease

PR Newswire

AMSTERDAM, Sept. 25, 2015

AMSTERDAM, Sept. 25, 2015 /PRNewswire/ -- Impax Laboratories, Inc. (NASDAQ: IPXL) today announced that the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency has adopted a positive opinion recommending that NUMIENT (IPX066), a modified-release oral capsule formulation of levodopa-carbidopa, be granted approval for the symptomatic treatment of adult patients with Parkinson's disease. The European Commission (EC) will now consider the CHMP positive opinion in its decision of whether to grant marketing authorization for NUMIENT in Europe. The review of this application is being conducted under the centralized licensing procedure as a therapeutic innovation, and the final decision will be applicable in all 28 member states of the European Union, as well as Iceland, Liechtenstein and Norway.

"The positive opinion from the CHMP recommending the approval of NUMIENT is a significant step forward to providing a new treatment option to patients in Europe suffering from Parkinson's disease," said Fred Wilkinson, President and Chief Executive Officer of Impax. "We are committed to realizing the full potential of this important franchise and we look forward to the European Commission's decision in the coming months."

"We continue to have discussions with potential partners to help commercialize NUMIENT in Europe. If approved, we will work quickly to bring NUMIENT to patients," concluded Mr. Wilkinson.

The CHMP's positive opinion is based on results from three Phase 3 controlled clinical studies which assessed the safety and efficacy of NUMIENT in patients with early (levodopa-naive) and advanced Parkinson's disease in the U.S. and in Europe. Refer to the "Summary of the Three Phase 3 Controlled Clinical Studies" for additional information.

About Parkinson's disease

Parkinson's disease is a chronic neurodegenerative movement disorder affecting approximately 7 to 10 million people globally[1]. There is currently no known cure for Parkinson's disease.

About NUMIENT

If approved in Europe, NUMIENT will be indicated for the symptomatic treatment of adult patients with Parkinson's disease. NUMIENT is not for use in patients with hypersensitivity to the active drug substances or excipients in NUMIENT, narrow-angle glaucoma, phaeochromocytoma, a previous history of neuroleptic malignant syndrome (NMS) and/or non-traumatic rhabdomyolysis, or in patients using nonselective monoamine oxidase inhibitors (MAO) inhibitors, which must be discontinued 2 weeks prior to starting to use NUMIENT.

Summary of the Three Phase 3 Controlled Clinical Studies

In APEX-PD, a trial that enrolled and randomized 381 levodopa-naive patients, the study met its primary efficacy endpoint of mean change from baseline in the sum of Unified Parkinson's Disease Rating Scale (UPDRS) Part II (activities of daily living) score and UPDRS Part III (motor examination) score for NUMIENT versus placebo at end of study.

In ADVANCE-PD, a trial of 393 randomized patients with advanced Parkinson's disease having "off" time, the results showed treatment with IPX066 (NUMIENT) reduced the percentage of "off" time (36.9% to 23.8%) from baseline versus immediate-release levodopa-carbidopa (36.0% to 29.8%) during waking hours to end of study, representing almost 1.2 hours of additional "off" time improvement. IPX066 (NUMIENT) also increased "on" time without troublesome dyskinesia during waking hours by 1.9 hours compared with an increase of 0.8 hours following treatment with immediate-release levodopa-carbidopa. Less "off" time was primarily related to more "on" time without troublesome dyskinesia.

In ASCEND-PD, a trial of 91 randomized patients with advanced Parkinson's disease having "off" time, compared IPX066 versus levodopa-carbidopa plus entacapone (LCE). Patients entered the study with a baseline "off" time of 36.1% (5.9 hours), and at the end of the randomized IPX066 treatment phase, patients had "off" time of 24.0% (3.8 hours) during waking hours compared to 32.5% (5.2 hours) for LCE (p<0.0001), representing 1.4 hours of additional "off" time improvement.

Summary of the NUMIENT Safety Profile

The most frequently reported adverse reactions in the 978 patients exposed to NUMIENT during the entire clinical program were nausea, occurring in approximately 12% of all patients; dizziness, headache, and dyskinesia, each occurring in approximately 8% of all patients; and insomnia, occurring in approximately 6% of all patients. Serious events of gastrointestinal haemorrhage (uncommon) and of allergic oedema (uncommon) were reported in the clinical studies with NUMIENT.

About Impax Laboratories, Inc.

Impax Laboratories, Inc. (Impax) is a specialty pharmaceutical company applying its formulation expertise and drug delivery technology to the development of controlled-release and specialty generics in addition to the development of central nervous system disorder branded products. Impax markets its generic products through its Impax Generics division and markets its branded products through its Impax Specialty Pharma division. Additionally, where strategically appropriate, Impax develops marketing partnerships to fully leverage its technology platforms and pursues partnership opportunities that offer alternative dosage form technologies, such as injectables, nasal sprays, inhalers, patches, creams and ointments. For more information, please visit the Company's Web site at: www.impaxlabs.com.

"Safe Harbor" statement under the Private Securities Litigation Reform Act of 1995:

To the extent any statements made in this news release contain information that is not historical; these statements are forward-looking in nature and express the beliefs and expectations of management. Such statements are based on current expectations and involve a number of known and unknown risks and uncertainties that could cause the Company's future results, performance, or achievements to differ significantly from the results, performance, or achievements expressed or implied by such forward-looking statements. Such risks and uncertainties include, but are not limited to: fluctuations in revenues and operating income; the Company's ability to successfully develop and commercialize pharmaceutical products in a timely manner; reductions or loss of business with any significant customer; the substantial portion of the Company's total revenues derived from sales of a limited number of products; the impact of consolidation of the Company's customer base; the impact of competition; the Company's ability to sustain profitability and positive cash flows; any delays or unanticipated expenses in connection with the operation of the Company's manufacturing facilities; the effect of foreign economic, political, legal, and other risks on the Company's operations abroad; the uncertainty of patent litigation and other legal proceedings; the increased government scrutiny on the Company's agreements with brand pharmaceutical companies; product development risks and the difficulty of predicting FDA filings and approvals; consumer acceptance and demand for new pharmaceutical products; the impact of market perceptions of the Company and the safety and quality of the Company's products; the Company's determinations to discontinue the manufacture and distribution of certain products; the Company's ability to achieve returns on its investments in research and development activities; changes to FDA approval requirements ; the Company's ability to successfully conduct clinical trials; the Company's reliance on third parties to conduct clinical trials and testing; the Company's lack of a license partner for commercialization of IPX066 outside of the United States; impact of illegal distribution and sale by third parties of counterfeits or stolen products; the availability of raw materials and impact of interruptions in the Company's supply chain; the Company's policies regarding returns, allowances and chargebacks; the use of controlled substances in the Company's products; the effect of current economic conditions on the Company's  industry, business, results of operations and financial condition; disruptions or failures in the Company's information technology systems and network infrastructure caused by third party breaches or other events; the Company's reliance on alliance and collaboration agreements; the Company's reliance on licenses to proprietary technologies; the Company's dependence on certain employees; the Company's ability to comply with legal and regulatory requirements governing the healthcare industry; the regulatory environment; the effect of certain provisions in the Company's government contracts; the Company's ability to protect its intellectual property; exposure to product liability claims; risks relating to goodwill and intangibles; changes in tax regulations; the Company's ability to manage growth, including through potential acquisitions and investments;  the integration of the acquired business of Tower Holdings, Inc. and Lineage Therapeutics Inc. by the Company being more difficult, time-consuming or costly than expected, operating costs, customer loss and business disruption (including, without limitation, difficulties in maintaining relationships with employees, customers, clients or suppliers) being greater than expected following the acquisition, the retention of certain key employees of the acquired business being difficult, the Company's and the acquired business's expected or targeted future financial and operating performance and results, the combined company's capacity to bring new products to market, and the possibility that the Company may be unable to achieve expected synergies and operating efficiencies in connection with the acquisition within the expected time-frames or at all, the restrictions imposed by the Company's credit facility and indenture; the Company's level of indebtedness and liabilities and the  potential impact  on cash flow available for operations; uncertainties involved in the preparation of the Company's financial statements; the Company's ability to maintain an effective system of internal control over financial reporting; the effect of terrorist attacks on the Company's business; the location of the Company's manufacturing and research and development facilities near earthquake fault lines; expansion of social media platforms and other risks described in the Company's periodic reports filed with the Securities and Exchange Commission. Forward-looking statements speak only as to the date on which they are made, and the Company undertakes no obligation to update publicly or revise any forward-looking statement, regardless of whether new information becomes available, future developments occur or otherwise.

References

[1] Parkinson's Disease Foundation website http://www.pdf.org/en/parkinson_statistics

Company Contacts:

Mark Donohue

Investor Relations and Corporate Communications

(215) 558-4526

www.impaxlabs.com

To view the original version on PR Newswire, visit:http://www.prnewswire.com/news-releases/impax-receives-positive-chmp-opinion-for-numient-levodopa-and-carbidopa-modified-release-capsules-for-the-symptomatic-treatment-of-adult-patients-with-parkinsons-disease-300149147.html

http://health.einnews.com/article/288260057/p-sbYg4qG6XVHuvr

Psychosis, hallucinations often part of Parkinson's

Posted September 25, 2015 - 1:07pm

By Jan Hogan

View staff writer

What if your father reported seeing cats playing everywhere in the house, and then got upset because he "forgot" to feed them? Imagine if police were called repeatedly to your parent's home because your father was convinced that strangers had attacked your mother.

Las Vegas resident Susan — who asked that her last name not be used — and her mother spent years caring for her father, Gary, who lived with psychosis as a result of Parkinson's disease. He was diagnosed in the early 1990s.

At first, it was little things — Gary thought he saw a water leak in the bathroom and tried to repair a toilet that had nothing wrong with it. He broke it. He tried also to fix the lawnmower he perceived to be defective and busted it, too.

Then, a tumble escalated things.

"In August 2013, my dad fell and hit his head," Susan said. "... He ended up in the hospital and was there three weeks. After that was when the hallucinations went into full effect. It was scary and crazy. He saw naked people in the shower or in their bed, and he'd ask my mother, 'Why are you hanging out with weirdos?' "

One time, her mother was taking a nap and woke to find a policeman standing over her, concerned. Gary had called the police, claiming someone had sexually assaulted her.

"It seems most of the hallucinations (that Parkinson's patients experience) are motivated by illegal activity — stealing, poisoning, assaults," Susan said. "It's not easy to talk about even with the doctor."

Many people equate Parkinson's to tremors and stiffness given that it is a motor disorder. Yet, Parkinson's disease psychosis — known as PDP — will affect more than half of Parkinson's patients during the course of their illness.

"What happens is that they have to figure out the cocktail of your medications. How much of this medication can we give you to give you your motor skills back versus how much of a hallucination issue are you willing to deal with?" Susan said. "Do you want to walk or do you want to see things?"

Gary died in April 2014. He was 74.

Dr. Jeffrey L. Cummings, director of the Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W. Bonneville Ave., said the back part of the brain is engaged when patients see things that are not there.

"It's the part of the brain responsible for vision," he said, "so we believe these people are really seeing these things. They are figures that the brain produces, in the same way that I see you sitting here now. The credible accrual of scientific information supports the concept that when we see a stroke in that part of the brain, that hallucinations occur. In MRIs, that's the area activated."

The hallucinations are highly idiosyncratic to each individual, Cummings said.

"I don't believe we have scientific insights into why one person will see a naked person and another will see their long-dead mother standing in the doorway," he said. "We have no real insight into why one person sees one thing and another will see (something else)."

He said it's often very difficult for patients to be candid about seeing hallucinations, especially if they realize it is a highly unusual experience, something out of the norm.

When the patient doesn't perceive their experiences as possible hallucinations, how can a caregiver help that person understand that this is their brain showing things that are not there?

Maegan Caldrone, director of therapy operation at HealthSouth Desert Canyon Rehabilitation Hospital, 9175 W. Oquendo Road, weighed in.

"The caregiver can continue to educate the patient on what the neurologist has told them about the hallucinations and making sure to repeat that message to the patient so they understand it's part of the disease process," she said. " ... another thing we do at HealthSouth is the speech therapist is able to work with the Parkinson's patient and really elaborate about the hallucinations and what thoughts they may be having. The therapist can help them process through those thoughts and identify which ones are real and what ones are kind of unrealistic thoughts."

Why don't people like to admit to hallucinations?

"It speaks of mental illness," said Cummings, "and therefore it's frightening to people who think they may be institutionalized or labeled crazy. These are the fears they have, so it's very important for the doctor to approach this as a neutral topic (and say), 'We often see patients put on these drugs will see unusual experiences. Like, for instance, a dog in the road. Have you had any unusual experiences?' So you get the, 'It's due to the drug,' approach."

Depression also is common with Parkinson's disease. One form is psychotic depression in which hallucinations can occur. They're usually not vision-related, so the doctor interviews the patient to find out if he's hearing people saying accusatory things, such as, "Your life isn't worth living"; "You are responsible for that traffic accident"; or "If you had been a better son, your mother would still be alive.' "

"They'll have these auditory hallucinations," Cummings said. "... If they see something, that's much more what we see in Parkinson's psychosis. But it takes some experience to tease these things out."

Cummings is overseeing the clinical trials for Parkinson's patients taking the drug Pimavanserin, made by ACADIA Pharmaceuticals Inc. The drug has completed phase three trials and has shown to be effective for reducing hallucinations while not impacting motor control such as other Parkinson's medications.

"We're really excited about (the drug). It's the first time a drug has had a compelling effect," Cummings said.

He said the trial medication showed a nearly 50 percent reduction in hallucinations without the impaired motor skills of other drugs. Cummings said seeing the results from the clinical trial was encouraging.

"Very often with a trial," said Cummings, "one part will be positive, and one part will be negative, and you have to kind of interpret them. That wasn't the case with Pimavanserin. The data really lined up in a way we would like to see most trials line up. And it's the magnitude of (the effect), that's what we're seeking here. We really want to help our patients improve by a lot. You don't have very many of these ecstatic moments where the data line up the way this one did."

The company plans to file for FDA approval by end of 2015.

Visit my.clevelandclinic.org/services/neurological_institute/lou-ruvo-brain-health.

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NEW TECHNIQUE NEGOTIATES NEURON JUNGLE TO TARGET SOURCE OF PARKINSON'S DISEASE

23 September 2015London, UK

 

Press release

Researchers from Imperial College London and Newcastle University believe they have found a potential new way to target cells of the brain affected by Parkinson's disease.

The new technique is relatively non-invasive and has worked to improve symptoms of the disease in rats.

Parkinson's disease causes progressive problems with movement,posture and balance. It is currently treated with drugs, but these have severe side-effects and can become ineffective after around five years. The only treatment subsequently available to patients is deep brain stimulation, a surgical technique where an electrical current is used to stimulate nerve cells in the brain.

As well as being an invasive treatment, it has mixed results - some patients benefit while others experience no improvement or even deteriorate. Researchers believe this is because the treatment is imprecise, stimulating all types of nerve cells, not just the intended target.

The new study, published in the journal Molecular Neurodegeneration, examined a less invasive and more precise alternative, designed to target and stimulate a particular type of nerve cell called cholinergic neurons. These are found within a part of the brain called the pedunculopontine nucleus, or PPN.

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"This paper will help us understand how deep-brain stimulation works, but more importantly it is a step towards offering less invasive treatment options to patients with Parkinson's and other neurodegenerative disorders."  

Dr Joanna Elson, at the

Institute of Genetic Medicine at Newcastle University

"If you were to peer inside the PPN, it is like a jungle with a massive variety of nerve cells that behave differently and have different jobs to do," said Dr Ilse Pienaar, Honorary Lecturer in Neuroscience at Imperial College London

Scientists already suspect that cholinergic neuron cells are involved in Parkinson's disease. This is because in post mortem studies of patients? brains, about half of these cells have perished, for reasons that are currently unknown.

The researchers from Imperial College London and Newcastle University worked with rats that had been treated to recreate the symptoms of Parkinson's disease. They used a harmless virus to deliver a specially-designed genetic 'switch' to the cholinergic neurons. The rats were then given a drug that was designed to activate the 'switch' and stimulate the target neurons.

Following the treatment the rats made an almost complete recovery and were able to move normally.

Dr Pienaar adds: "This study confirms that cholinergic neurons are key to the gait problems and postural instability experienced by advanced Parkinson's disease patients. It also suggests that it's possible to target those cells that remain to compensate for those that are no longer functioning effectively, possibly due to weak communication between nerve cells. If we can transfer this technique into people, we believe this could help patients regain mobility.

"At the moment, neurosurgeons are attempting to target specific areas with deep brain stimulation, but it is a blunt tool with correspondingly mixed results. We think we have found a way to target only the cholinergic neurons within an area such as the PPN."

Dr Joanna Elson at the Institute of Genetic Medicine at Newcastle University added: "The structure we studied is complex, very complex. Despite this complexity and the intricacy of the techniques and the brain region analysed, the results are exciting because of the potential to advance patient treatment. 

"This paper will help us understand how deep-brain stimulation works, but more importantly it is a step towards offering less invasive treatment options to patients with Parkinson's and other neurodegenerative disorders."

The researchers believe the technique could transfer into people in the next five to ten years. They also think their technique could have wider potential. Dr Pienaar said: "Parkinson's disease patients experience a complex set of symptoms and we hope to use the same method to understand how different cells within the brain contribute to the disease."

Dr Pienarr held a Junior Research Fellowship at Imperial during this work. She was also by the Rosetrees Trust and the British Pharmacological Society.   

Pharmacogenetic stimulation of cholinergic pedunculopontine neurons reverses motor deficits in a rat model of Parkinson's disease, by Ilse S. Pienaar, Sarah E. Gartside, Puneet Sharma, Vincenzo De Paola, Sabine Gretenkord, Dominic Withers, Joanna L. Elson and David T. Dexter is published in Molecular Neurodegeneration on 23 September 2015, DOI: 10.1186/s13024-015-0044-5

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Background

About Imperial College London

Imperial College London is one of the world's leading universities. The College's 14,000 students and 7,500 staff are expanding the frontiers of knowledge in science, medicine, engineering and business, and translating their discoveries into benefits for society.

Founded in 1907, Imperial builds on a distinguished past - having pioneered penicillin, holography and fibre optics - to shape the future. Imperial researchers work across disciplines to improve global health, tackle climate change, develop sustainable energy technology and address security challenges. This blend of academic excellence and its real-world application feeds into Imperial's exceptional learning environment, where students participate in research to push the limits of their degrees. 

Imperial nurtures a dynamic enterprise culture, where collaborations with industrial, healthcare and international partners are the norm. In 2007, Imperial College London and Imperial College Healthcare NHS Trust formed the UK's first Academic Health Science Centre. This unique partnership aims to improve the quality of life of patients and populations by taking new discoveries and translating them into new therapies as quickly as possible.

Imperial has nine London campuses, including its White City Campus: a 25 acre research and innovation centre in west London. At White City, researchers, businesses and higher education partners are co-locating to create value from ideas on a global scale.

www.imperial.ac.uk

Key Facts:

• Newcastle University is a Russell Group University
• Ranked in the top 1% of universities in the world (QS World University Rankings 2014)
• Ranked 16th in the UK for global research power (REF 2014)
• Ranked 10th overall in the UK and 3rd for quality of staff/lecturers in the Times Higher Education Student Experience Survey 2015
• Winner: Outstanding Leadership and Management Team and Outstanding Procurement Team, Times Higher Leadership and Management Awards 2015
• Amongst our peers Newcastle is:

1. Joint 6th in the UK for student satisfaction
2. Ranked 1st in the UK for Computing Science research impact, 3rd in the UK for Civil Engineering research power and 11th in the UK for Mathematical Sciences research (REF 2014)
3. Ranked 8th in the UK for Medical and Life Sciences research quality (REF 2014)
4. Ranked 3rd in the UK for English, and in the top 12 for Geography, Architecture and Planning, and Cultural and Media Studies research quality (REF 2014)
5. Engineering and Physical Sciences Research Council (EPSRC) top 20 strategic partner

• 94% of our students are in a job or further training within six months of graduating
• We have a world-class reputation for research excellence and are spearheading three major societal challenges that have a significant impact on global society. These themes are: Ageing, Sustainability, and Social Renewal
• Newcastle University is the first UK university to establish a fully owned international branch campus for medicine at its NUMed Campus in Malaysia which opened in 2011
• 90% Satisfaction level from our international students (ISB 2014)
• Newcastle University Business School is one of 20 Triple Accredited Business Schools in the UK  
  
  

Contacts

For more information please contact:

Hayley Dunning 
Research Media Officer 
Imperial College London 
e-mail:   h.dunning@imperial.ac.uk 
Tel: +44 (0)20 7594 2412

Kerry Noble 
News Editor 
Imperial College London 
Tel: +44 (0)20 7594 3415 
e-mail:   k.noble@imperial.ac.uk 
Out of hours duty press officer: +44(0)7803 886 248

AUTOANTIBODIES FOR THE DIAGNOSIS OF PARKINSON'S DISEASE

24th September 2015 - New research

For the first time a selection of blood-borne autoantibody biomarkers with a higher prevalence in early Parkinson's Disease were used to facilitate the diagnosis of early Parkinson's Disease. Antibodies are proteins produced by a person's immune system that allows their body to distinguish between "self" and "non-self" proteins. For more information go to : http://labtestsonline.org.uk/understanding/analytes/autoantibodies/tab/glance/

The sera of people with early stage Parkinson's Disease were screened with human protein microarrays containing 9486 potential antigen targets in order to identify autoantibodies that are potentially useful as biomarkers for Parkinson's Disease.

Selected, blood-borne autoantibody biomarkers with a higher prevalence in early Parkinson's Disease could distinguish early Parkinson's Disease with an overall accuracy of 88%, a sensitivity of 94% and a specificity of 85%. These biomarkers were also capable of differentiating people with early Parkinson's Disease from those with mild to moderate Parkinson's Disease with an overall accuracy of 97%. The biomarkers could also distinguish people with early Parkinson's Disease from those with other neurological disorders.

The results demonstrate, for the first time, that selected autoantibodies may prove to be useful as effective blood-based biomarkers for the diagnosis of early Parkinson's Disease.

Reference : Immunology Letters [2015] Sep 16 [Epub ahead of print] (C.A.DeMarshall, M. Han, E.P.Nagele, A.Sarkar, N.K.Acharya, G.Godsey, E.L.Goldwaser, M.Kosciuk, U. Thayasivam, B.Belinka, R.G.Nagele)

Complete abstract : http://www.ncbi.nlm.nih.gov/pubmed/26386375
http://www.viartis.net/parkinsons.disease/news/150924.pdf mail@viartis.net
©2015 Viartis 

Delayed Orthostatic Hypotension 'Not Benign'

Pauline Anderson

September 23, 2015

Orthostatic hypotension (OH) that develops more than 3 minutes after standing progresses to OH in more than half of patients and carries a similar poor prognosis, including a high mortality rate, a 10-year follow-up study suggests.

"OH itself, whether delayed or not, is not a benign condition," said lead author Christopher Gibbons, MD, associate professor, neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

"Delayed OH is a real entity and has real complications and is largely unrecognized. If patients are complaining of lightheadedness and dizziness, particularly after standing for long periods of time, clinicians should definitely consider this as a possible diagnosis."

But it's not all "doom and gloom," said Dr Gibbons. Patients in the study who progressed from DOH to OH tended to have subtle abnormalities in parasympathetic functioning, suggesting that "we might be able to identify who would be progressing."

The results were published online September 23 in Neurology.

Neurogenic OH (nOH) is defined as a blood pressure fall of at least 20 mm Hg in systolic or 10 mm Hg in diastolic within 3 minutes of standing.

Delayed OH involves the same drop in blood pressure but occurs beyond 3 minutes after being tilted upright on tilt-table testing.

Researchers reviewed the medical records and test results of 230 individuals (mean age, 59 years; 49% female), who were referred for autonomic testing in 2002–2003. These patients had reported dizziness and feeling faint while standing — for example, waiting in a long line at the grocery store — and were being tested for OH, said Dr Gibbons.

At the time, 50 of the 230 were determined to have OH, 58 had delayed OH and 122 did not have OH, so their dizziness was related to something other than blood pressure, such as chronic fatigue.

Of the original 108 patients with OH or DOH, researchers had complete follow-up on 90 patients 10 years later. Of these, 42 of 50 had OH and 48 of 58 had DOH in the initial study.

Among patients with DOH initially, 26 (54%) developed OH during the follow-up period, 15 of whom developed a neurodegenerative synucleinopathy, such as Parkinson's disease, dementia with Lewy bodies, or multiple system atrophy.

"We seem to have two groups of people — some that progressed and some that did not — and it seemed that we could differentiate those that progressed because they tended to have other things that were wrong on their autonomic testing," said Dr Gibbons.

It's important to identify these people early on, he added. "We're actually capturing people years before they have a diagnosis of Parkinson disease. That could be a really important time in preventing the disease — if we have something that works."

Non-OH Controls

Of the 122 patients without OH in the original study, researchers had 75 age- and sex-matched controls for the 10-year follow-up. The researchers didn't use healthy controls because they were trying to link the timing of the test in people for whom dizziness was and was not related to blood pressure.

"We were looking for people who were tested at the same time in the same situation and on whom we had the same follow-up clinical data," explained Dr Gibbons.

Of the patients with OH on initial testing, the 10-year mortality rate was 64%. Of the patients with DOH who did not progress, the mortality rate was 5%, but in those who progressed to OH, the mortality rate was 50%.

The 10-year mortality rate of the controls was 9%, which, according to Dr Gibbons, approaches that of the national average for the same age group.

Having diabetes was associated with an even higher increase in mortality rate. Among those with diabetes and DOH on initial testing, the mortality rate was 80% in those who progressed to OH and 25% in those who did not progress to OH. In those with diabetes alone, without OH or DOH, the 10-year mortality rate was 13%.

"There is a clear association with autonomic neuropathy, and that is one of the causes of both delayed and orthostatic hypotension," commented Dr Gibbons. "The risk of that will be related to diabetes control and other risk factors like blood pressure and lipids."

The study doesn't "tell us everything we want to know, by any means," but it provides "a very clear understanding of the risks" of DOH, commented Dr Gibbons.

Sympathetic Degeneration

In an accompanying editorial, authors suggest the study findings support the concept that synucleinopathies are prion-like disorders that spread in a stepwise, pathway-specific fashion.

DOH may indicate not only less sympathetic degeneration than OH, but perhaps the location of additional pathways affected by the neurodegenerative process, write Horacio Kaufmann, MD, Department of Neurology, New York University School of Medicine, and Giris Jacob, MD, Tel Aviv Medical Center, Israel.

"It may be time to consider staging of nOH, to capture patients who are at risk of worsening and intervene sooner," they suggest.

DOH with parasympathetic impairment may turn out to be an early biomarker of synucleinopathy, they add. They note that in the study, abnormalities in parasympathetic (vagal) function were documented at the first visit in almost all patients with DOH who progressed to early OH and all those who turned out to have synucleinopathies.

Further, they point out that most of the patients with DOH who did not progress had no other abnormalities on autonomic testing and that two thirds were taking vasoactive medications that could potentially explain their OH.

Dr Kaufmann and Dr Jacob noted several limitations to the study. For example, the number of patients was small, the data were derived from a retrospective chart review, and some information, including the cause of death among those with DOH, was missing. It's not clear, for example, whether the deaths were related to the drop in blood pressure (syncope or falls) or to other unrelated reasons caused by the underlying pathological process.

"The take-home message," they concluded, "…is that it is useful to screen for OH for longer than 3 minutes. Delayed OH may explain a number of puzzling symptoms. It can be successfully treated and early recognition may prevent falls and their complications."

No targeted funding for the study was reported. Dr Gibbons has received personal compensation for serving on scientific advisory boards of Pfizer and Grifols. Dr Jacob has disclosed no relevant financial relationships. Dr Kauffman receives research support from the National Institutes of Health.

http://www.medscape.com/viewarticle/851416