Video Games Created for Parkinson’s Rehab Can Help in Strengthening Limbs, Study Suggests

 NOVEMBER 20, 2019    BY MARISA WEXLER 

Video games carefully designed to improve the upper limbs — including grip strength, dexterity, and coordination — may be a rehabilitation aid for people with Parkinson’s disease (PD), a small study in patients suggests.

The study, “Leap motion controlled video game-based therapy for upper limb rehabilitation in patients with Parkinson’s disease: a feasibility study,” was published in the Journal of NeuroEngineering and Rehabilitation.

Rehabilitation is an important therapy approach in addressing motor symptoms in PD. In recent years, video games that use virtual reality technologies have grown in interest in this field — the basic idea being that these games, which involve the player moving their body as a means to play, allows for rehab-like tasks to be done in a more fun and engaging setting.

However, common commercial systems — like the Nintendo Wii, Playstation Move, and Kinect plus XBOX 360 — aren’t especially well-suited for Parkinson’s rehabilitation; they tend to move too quickly or be too difficult. The need, instead, is for “specific serious” video games, which the researchers defined as, “games designed for a primary purpose other than that of pure entertainment, and which promote learning and behavior changes for PD patients.”

For the study, 23 people (11 male, 12 female; average age 66.65) with PD were recruited from a Parkinson’s association based in Madrid. All had disease stages of 2, 3, or 4 based on the Hoehn and Yahr scale (a 0–5 scale, with higher stages correlating with more advanced disease).

Patients were divided into two groups; 11 completed upper limb-focused conventional physical therapy as a control group, while 12 played serious video games designed by the researchers. Both groups had two 30-minute sessions of their respective therapy each week for six weeks.

These video games utilized the Leap Motion Controller System (LCM), which tracks an individual’s hands as the means of controlling the game, without the need for additional sensors or controllers. “This system presents important advantages over other motion capture systems, namely thanks to its portability, ease of use, commercial availability, low cost and non-invasive nature,” the researchers wrote.

They designed six “serious” games, each of which involved performing tasks akin to what is done in conventional therapy. For instance, one involves playing a virtual piano, which necessitates flexing individual fingers. In another game, players must move virtual blocks into a particular order, requiring the player to reach for different blocks. The researchers noted that “different interventions can be designed by combining two or more games that focus on a specific pathology and patient population.”

Both before and after the six-week intervention, participants underwent a battery of tests assessing physical abilities.

Both groups showed significant improvements in grip strength on both sides of the body.

Scores on the Purdue Pegboard Test (PPT, which measures coordination and dexterity) improved significantly in both groups. But in the control group, only the more affected side of the body showed a significant improvement, whereas significant improvements were seen on both body sides in the video game group.

Although both groups’ scores before the intervention were similar, PPT scores in the video games group were significantly higher than in the conventional therapy group after the respective interventions.

Significant improvements on the Box and Blocks Test (BBT, another coordination test) were also seen in both groups, but only on the more heavily impaired side of the body.

Both groups reported high subjective satisfaction with their therapy. “Furthermore,” the researchers wrote, “compliance to the interventions was excellent (100%) and no adverse side-effects were observed for both groups.”

This study has some limitations, the researchers noted: it was done in quite a small sample size, and only on people with mild-to-moderate PD. As such, more studies are needed to validate its findings.

“The LMC system and the serious games designed and used in this study represent a rehabilitation tool that may benefit certain PD patients for the improvement of coordination, speed of movements and fine dexterity in [upper limb] interventions,” the researchers concluded.

https://parkinsonsnewstoday.com/2019/11/20/video-games-created-pd-rehabilitation-help-strengthen-limbs-study-suggests/

Potential New Biomarkers for Parkinson’s Disease Could Change Trajectory of Diagnosis and Treatment

19 Nov 2019

World Federation of Neurology: November 19, LONDON— A groundbreaking presentation coming out of the XXIV World Congress of Neurology (WCN 2019) in Dubai, UAE, highlighted several significant advances in Parkinson’s research.

We are beginning to understand Parkinson’s disease mechanisms and found that the prodrome period occurs much earlier than we had previously expected—years, even decades prior to the onset of motor symptoms.

Prof. Patrik Brundin, director of the Center for Neurodegenerative Science at Van Andel Institute.  

The early signs and symptoms include REM sleep behaviour disorder, constipation, depression, hyposmia, anxiety and excessive daytime sleepiness.

Brundin is this year’s Fulton Award Lecture honoree. In his Fulton Award Lecture, “The Battle to Beat Parkinson’s,” Prof. Brundin discussed how these signs and symptoms may one day be used as new biomarkers to diagnose Parkinson’s disease earlier, which may, in turn, broaden treatment options.

We’ve never in history known as much about the disease as we do now.
It’s a quantum leap from 15-20 years ago.

Prof. Brundin

Roughly 10% of cases are familial, caused by genetic mutations, while the other 90% of cases are sporadic and may be triggered by a combination of genetic predisposition, environmental factors and lifestyle. Still, insights into how and when the disease originates and progresses are critical in developing new, more effective treatment options.

New therapies are being tested now, including vaccinations, nerve blockers and surgeries. The clinical trials include GLP-1-related therapeutic approaches, anti-inflammatory approaches, alpha-synuclein-related approaches, mitochondrial therapeutic approaches, and iron chelation/chaperone approaches, many of which involve repurposing existing medications as possible therapies for Parkinson’s.

“The primary question when it comes to treatment is if we can restore lost functions in advanced patients where the damage is already done,” says Prof. Brundin. “Research into transplants of nerve cells derived from stem cells shows promise in this regard, and is beginning to enter the clinical arena.”

WCN 2019 was attended by 4,000 of the most elite neurologists and specialists from 126 countries. For additional breaking news, please visit www.wfneurology.com

---

About the World Federation of Neurology The World Federation of Neurology represents 120 member neurological societies around the globe whose mission is to foster quality neurology and brain health worldwide by promoting neurological education and training with an emphasis on under-resourced areas of the world. The WFN supports the spread of accurate research and clinical information in the pursuit of improvements in the field of neurology. With support from member organizations, the WFN unifies the world to give patients better access to brain health. For more information, please visit the WFN web site atwww.wfneurology.org. Media Contact Yakkety Yak Contact Ashley Logan, Yakkety Yak LLC press@yakketyyak.com https://wfneurology.org/2019-11-19-wfn

Key Genetic Regulators of Parkinson’s Disease Identified

 November 20, 2019

Genetic studies have advanced our understanding of the pathogenesis of the inherited form of Parkinson’s disease (PD). However, those are a small fraction of the total number of cases. Approximately 80% of PD cases have no known cause, and though there are some genes that may slightly increase an individual’s risk of developing the disease, the biological impacts of these genes remain unclear.

Scientists at the Icahn School of Medicine at Mount Sinai have uncovered new molecular drivers of PD using the statistical technique known as multiscale gene network analysis (MGNA). The team performed a meta-analysis of 8 PD postmortem brain studies by employing the MGNA approach to delineate structures of gene-gene regulatory networks in the substantia nigra and identify novel regulators including genes functionally connected to previously identified PD risk genes.

The results, which may point to potential new treatments, were published today in a paper entitled “The Global Landscape of Multiscale Transcriptomic Networks and Key Regulators in Parkinson’s Disease” in Nature Communications.

“This study offers a novel approach to understanding the majority of cases of Parkinson’s,” said Bin Zhang, PhD, professor of genetics and genomic sciences at the Icahn Institute for Data Science and Genomic Technology and director of the Mount Sinai Center for Transformative Disease Modeling at the Icahn School of Medicine at Mount Sinai. “The strategy not only reveals new drivers, but it also elucidates the functional context of the known Parkinson’s disease risk factor genes.”

Zhang and his team originally developed the MGNA method to research the molecular mechanisms of Alzheimer’s disease. Since that study was published about six years ago, they have significantly improved the technique and have applied it to a variety of complex diseases from Alzheimer’s to cancer. The strategy takes into account genetic, epigenetic, transcriptomic, pathological, and clinical data from a large pool of tissue samples and identifies links between them.

This multiscale network analysis approach is a powerful way to dissect the molecular mechanisms of complex diseases like Alzheimer’s,” said Suzana Petanceska, PhD, program director of the AMP-AD Target Discovery program at the NIA, which co-funded the study.

The researchers combined data from eight different studies that included postmortem analyses of the substantia nigra—the part of the brain most affected by Parkinson’s disease. This gave the team a larger dataset from a total of 83 patients, which they then compared to 70 controls who did not have Parkinson’s.

Applying MGNA to the combined data set, the scientists identified a number of key regulators of the gene networks that had never before been associated with the disease.

Next, they teamed up with Zhenyu Yue, PhD, professor of neurology and neuroscience at the Icahn School of Medicine and the director of basic and translational research in movement disorders, to experimentally validate the findings in mice. They chose to test the effects of STMN2, a gene that the analysis identified as a key regulator of the Parkinson’s molecular network. The gene is normally expressed in neurons that produce dopamine, a neurotransmitter that is depleted in the substantia nigra of Parkinson’s patients.

To test its influence on Parkinson’s disease, Yue and his team knocked down the STMN2 gene in the substantia nigra of the mice. RNA sequencing showed that reduction of STMN2 led to upregulation of nine genes that had previously been associated with the disease. The mice developed Parkinson’s-like pathologies such as degeneration of dopaminergic neurons in the substantia nigra and an increase in the concentration of the toxic, modified α-synuclein protein, both of which are considered hallmarks of the disease. Additionally, the mice struggled with motor tasks such as maintaining balance on a rod, indicative of the disruption of their motor function control.

Despite the fact that the team was able to create a large enough sample size to apply the multiscale network analysis, the researchers emphasized that 83 patients is still a relatively small number and the results should be validated in larger studies. Still, “the work opens up a new avenue for studying the disease,” said Yue. “The new genes we identified suggest that new pathways should be considered as potential targets for drug development, particularly for idiopathic Parkinson’s cases.

https://www.genengnews.com/news/key-genetic-regulators-of-parkinsons-disease-identified/

Support grows nationwide for medical device to improve communication in Parkinson's disease

NOVEMBER 20, 2019   by Purdue University

SpeechVive, created by Jessica Huber, a professor in Purdue’s Department of Speech, Language, and Hearing Sciences, uses a reflex to improve communication in Parkinson’s disease. Credit: Purdue University

A growing number of people with Parkinson's disease are finding the ability to communicate with a wearable device developed by a Purdue University speech-language researcher and entrepreneur.

SpeechVive uses a reflex to improve communication. The device plays noise in a user's ear when they are talking, which elicits the reflex, resulting in speech that is automatically louder, clearer and lower.

"Since the wearable device elicits a reflex, the patient does not need to remember to use therapy techniques to communicate in everyday life," said Jessica Huber, a professor in Purdue's Department of Speech, Language, and Hearing Sciences, who developed SpeechVive. "When people with Parkinson's disease cannot be heard or understood, they withdraw from communication exchanges, leading to social isolation. This device makes it possible for patients to continue to communicate with their loved ones well into their disease."

SpeechVive Inc. commercialized the Purdue device to help the more than a million people in the United States who are diagnosed with Parkinson's, one of the most common degenerative neurological diseases. Veterans can receive the device through their local VA hospital as a part of their health care benefits.

"We are working to develop additional routes for individuals to obtain the device," said Huber, who is also the associate dean for research in Purdue's College of Health and Human Sciences. "I enjoy developing and testing devices and therapies that can improve the quality of life for people with Parkinson's disease.

"https://medicalxpress.com/news/2019-11-nationwide-medical-device-parkinson-disease.html

Researchers uncover new molecular drivers of Parkinson's disease

NOVEMBER 20, 2019     by The Mount Sinai Hospital

Immunohistochemistry for alpha-synuclein showing positive staining (brown) of an intraneural Lewy-body in the Substantia nigra in Parkinson's disease. Credit: Wikipedia

Scientists at the Icahn School of Medicine at Mount Sinai have uncovered new molecular drivers of Parkinson's disease using a sophisticated statistical technique called multiscale gene network analysis (MGNA). The team was also able to determine how these molecular drivers impact the functions of genes involved in the disease. The results, which may point to potential new treatments, were published today in Nature Communications.

Some cases of Parkinson's are directly caused by genetic mutations, but these cases are rare. Approximately 80 percent of cases have no known cause, and though there are some genes that may slightly increase an individual's risk of developing the disease, the biological impacts of these genes remain unclear.

"This study offers a novel approach to understanding the majority of cases of Parkinson's," said Bin Zhang, Ph.D., Professor of Genetics and Genomic Sciences at the Icahn Institute for Data Science and Genomic Technology and Director of the Mount Sinai Center for Transformative Disease Modeling at the Icahn School of Medicine at Mount Sinai. "The strategy not only reveals new drivers, but it also elucidates the functional context of the known Parkinson's disease risk factor genes."

Dr. Zhang and his team originally developed the MGNA method to research the molecular mechanisms of Alzheimer's disease. Since that study was published about six years ago, they have significantly improved the technique through funding from the National Institutes of Health (NIH)/National Institute on Aging (NIA) Accelerating Medicines Partnership—Alzheimer's Disease (AMP-AD) program and have applied it to a variety of complex diseases from Alzheimer's to cancer. The strategy takes into account genetic, epigenetic, transcriptomic, pathological, and clinical data from a large pool of tissue samples and identifies links between them.

"This multiscale network analysis approach is a powerful way to dissect the molecular mechanisms of complex diseases like Alzheimer's," said Suzana Petanceska, Ph.D., program director of the AMP-AD Target Discovery program at the NIA, which co-funded the study. "It is exciting to see that AMP-AD can provide new mechanistic insights to Parkinson's disease that could lead to new therapeutic opportunities."

Unfortunately, there are no gene expression data sets based on a sufficiently large number of informative brain samples from Parkinson's patients for the powerful MGNA to be effective. Instead, the researchers combined data from eight different studies that included postmortem analyses of the substantia nigra—the part of the brain most affected by Parkinson's disease. This gave the team a larger dataset from a total of 83 patients, which they then compared to 70 controls who did not have Parkinson's.

Applying MGNA to the combined data set, the scientists identified a number of key regulators of the gene networks that had never before been associated with the disease.

Next, they teamed up with Zhenyu Yue, Ph.D., Professor of Neurology and Neuroscience at the Icahn School of Medicine and the Director of Basic and Translational Research in Movement Disorders, whose work is supported by NIH Udall Centers of Excellence for Parkinson's Disease Research, to experimentally validate the findings in mice. They chose to test the effects of STMN2, a gene that the analysis identified as a key regulator of the Parkinson's molecular network. The gene is normally expressed in neurons that produce dopamine, a neurotransmitter that is depleted in the substantia nigra of Parkinson's patients.

To test its influence on Parkinson's disease, Dr. Yue and his team knocked down the STMN2 gene in the substantia nigra of the mice. RNA sequencing showed that reduction of STMN2 led to upregulation of nine genes that had previously been associated with the disease. The mice developed Parkinson's-like pathologies such as degeneration of dopaminergic neurons in the substantia nigra and an increase in the concentration of the toxic, modified α-synuclein protein, both of which are considered hallmarks of the disease. Additionally, the mice struggled with motor tasks such as maintaining balance on a rod, indicative of the disruption of their motor function control.

Despite the fact that the team was able to create a large enough sample size to apply the multiscale network analysis, the researchers emphasized that 83 patients is still a relatively small number and the results should be validated in larger studies. Still, "The work opens up a new avenue for studying the disease," said Dr. Yue. "The new genes we identified suggest that new pathways should be considered as potential targets for drug development, particularly for idiopathic Parkinson's cases."

More information: Nature Communications (2019). DOI: 10.1038/s41467-019-13144-yJournal information: Nature Communications 

https://medicalxpress.com/news/2019-11-uncover-molecular-drivers-parkinson-disease.html

“Moving Day” event for Parkinson’s raises $75,000 North Scottsdale team among top fundraisers

By Sonoran News -  November 19, 2019

(L-R) Carol Creekman, Captain Cathy Boss-Fessel, Kathy De Marco, Anne Prine. Unable to attend: Team members Terry McNeice and her two grandchildren.

NORTH SCOTTSDALE – On Saturday, November 9, hundreds of people gathered at Kiwanis Park in Tempe for the first annual, Valley-wide “Moving Day Phoenix” event that raised almost $75,000 to combat Parkinson’s Disease (PD). 

North Scottsdale’s Team Terravita Walkers, with seven members, raised more than $2,600 to place second in donations for the event out of 44 teams. 

The Parkinson’s Foundation charity fundraiser celebrates movement, which is proven to help manage PD symptoms. The Foundation’s mission is to make life better for people affected by PD by delivering quality care, funding cutting-edge research and providing free resources to patients and their families. 

“For me and the team, participating in Moving Day is personal,” said Terravita Walkers Team Captain Cathy Boss-Fessel. “All of us at the event have or had family members affected by PD. I walk to honor the memory of my late father, Jerry ‘Boss Man’ Boss, who lived with Parkinson’s for many years.”

“In Arizona the Parkinson’s Foundation has invested almost $400,000 in research to better understand PD and improve patient care,” said Robin Rhea, Parkinson’s Foundation development manager. “Funds raised will help support, among others, the Phoenix-based Muhammad Ali Parkinson Center, a Parkinson’s Foundation Center of Excellence.

“For everyone with PD, an accurate diagnosis is critical because treatments and resources are available to help patients live a better life with the disease. It’s also important for U.S. veterans to know that many with PD can qualify for veterans’ benefits.”

Since 2011, Moving Day events across the country have gathered more than 130,000 participants and raised nearly $22 million.

Moving Day celebrates movement with a family-friendly walk course; audience participation movement activities including boxing, exercises, dance and song; a caregivers relaxation tent and more. Sponsor booths offer free product, service and resource information. Details of the 2020 event will be announced in coming months.

Affecting nearly one million Americans and 10 million people worldwide, PD is the second most common neurodegenerative disease after Alzheimer’s. It is the 14th leading cause of death in the United States. In Arizona there are an estimated 18,000 people with PD who are age 45 or older. 

The Parkinson’s Foundation, founded in 1957, has achieved a 4-star rating from Charity Navigator, the nation’s largest and most-utilized evaluator of charities.

For more information:

Those affected by PD and related diseases such as Lewy Body Dementia can find more information about managing symptoms, caring for the caregiver, planning for hospital stays and additional resources at:

• Far North Scottsdale Parkinson’s Support Group: Meets 1st Thursday of each month at Desert Mission United Methodist Church, 7373 E. Dixileta Dr., Scottsdale, from 10:30 a.m.-noon. Contact: Kris Watts, 602-406-4921 or Kristina.watts@dignityhealth.org 

• Muhammad Ali Parkinson Center: https://www.barrowneuro.org/get-to-know-barrow/centerprograms/muhammad-ali-parkinson-center/ 

• Parkinson’s Foundation: http://www.parkinson.org/; toll-free, bi-lingual help line, 1-800-4PD-INFO (473-4636); helpline@parkinson.org

http://sonorannews.com/2019/11/19/moving-day-event-for-parkinsons-raises-75000-north-scottsdale-team-among-top-fundraisers/

Gut Inflammation May Increase Risk for Parkinson’s Disease, Review Study Suggests

NOVEMBER 19, 2019 BY PATRICIA INACIO, PHD IN NEWS.

Inflammation in the gut, a hallmark of autoimmune disorders such as inflammatory bowel disease, may contribute to an earlier risk of developing Parkinson’s disease (PD), according to a recent review of genetic, epidemiological and animal model studies.

The risk, however, is very small with only 3% to 5% of patients with IBD eventually getting a Parkinson’s diagnosis.

The review, ”Inflammatory Bowel Diseases and Parkinson’s Disease,” was published recently in the Journal of Parkinson’s Disease.

PD is characterized by a range of inflammatory processes in the brain, including the release of pro-inflammatory signaling molecules (cytokines) and infiltration of immune cells.

Increasing evidence, however, suggests that PD starts in the gastrointestinal system, with symptoms such as chronic constipation often emerging before motor symptoms develop.

“Experimental, clinical and epidemiological data suggest that intestinal inflammation contributes to the pathogenesis of PD,” the researchers wrote.

Gut infections are then thought to trigger alpha-synuclein release and subsequent aggregation, with the disease then spreading to the central nervous system (brain and spinal cord), where it promotes neurodegeneration. Alpha-synuclein is the protein that in PD becomes misfolded and forms toxic aggregates or clumps, which are the main component of Lewy bodies and greatly contribute to neurodegeneration.

“Parkinsonism is probably not just a brain disorder, but a group of diseases that may have their onset in the periphery, particularly in the gastrointestinal tract,” Tomasz Brudek, PhD, at the Copenhagen University Hospital and author of the review, said in a press release.

Inflammatory bowel disease (IBD) is triggered by prolonged inflammation of the digestive tract due to an imbalanced immune response. The two most common forms of IBD are ulcerative colitis and Chron’s disease.

Chronic inflammation of the gut is likely a predisposing factor for people to develop PD.

Genome-wide association studies (GWAS) have identified links between IBD and PD. Using GWAS, researchers analyzed the whole human genome searching for genetic changes associated with the disease. Mutations in the LRRK2 gene were found to be “a common susceptibility-factor” in both PD and Crohn’s disease, which may indicate a potential genetic link and common disease mechanisms.

An analysis of 138,511 genomes (our complete genetic “set”) from participants with European ancestry identified 17 genetic changes that occurred in both PD and autoimmune diseases, including ulcerative colitis and Crohn’s disease. Additional diseases included celiac disease, rheumatoid arthritis, type 1 diabetes, multiple sclerosisand psoriasis.

Several epidemiological studies also have shown a link between IBD and PD but with conflicting results. A meta-analysis of different population studies revealed that IBD patients had a 46% increased risk of having PD compared to controls. This association was still significant if ulcerative colitis and Chron’s disease patients were analyzed separately; those with Crohn’s had a 28% increased risk of PD, while those with ulcerative colitis had a 30% increased risk of PD when compared to healthy controls.

However, the authors noted that only a very small proportion of IBD patients will develop PD. “While IBD patients are more likely to get PD, the risk is still very small. For a given IBD patient, the probability of not getting the diagnosis is 95%–97%,” Brudek said.

The association of Parkinson’s disease with IBD may not be due to the disease specifically, but to gut inflammation in general.

“Inflammation of the gut is only one of many symptoms on the list of changes in the gut and is associated with neural structures in PD patients. Thus, IBD might be just one of many sources of intestinal inflammation,” Brudek said.

Animal studies have shown that inflammation in the gut can lead to the death of dopaminergic neurons — those that are mainly affected in Parkinson’s disease — supporting a link between gastrointestinal inflammation as a factor contributing to PD.

A recent study using a PD mouse model showed that alpha-synuclein aggregation occurred in the large intestine. This also was the case in wild-type (control) mice that were induced to develop colitis (inflammation of the gut).

When researchers induced colitis in the PD mouse model at a young age, they saw that mice went on to develop severe neurodegeneration later in life.

Several studies involving the post-mortem analysis of PD patients have reported the existence of alpha-synuclein aggregates in patients’ enteric nervous system (ENS) —  the network of nerves that innervate the gastrointestinal tract — along with the brain.

Overall, these results support the existence of “connection between the intestinal environment and the CNS, [central nervous system], the so-called ‘gut-brain axis theory’ with a bi-dircetional communication between both,” Brudek wrote.

Similar to IBD patients, the gut microbiome — the natural community of microbes living in the gut — also is altered in people with PD, with an enrichment of a pro-inflammatory microbiome signature.

“Taken together, all data, including human, animal, and microbiome studies, suggest quite strongly that individuals with an increased tendency for peripheral inflammation have a higher risk to acquire PD. Given the potentially critical role of gut pathology in the pathogenesis of PD, there is reason to suspect that IBD may impact PD risk,” Brudek said.

Brudek proposed that future studies are required to identify risk factors associated with early (prodromal) PD that will support the development of therapeutic interventions for patients at higher risk of developing the disease.

Moreover, he added, it is important that clinicians recognize early the symptoms of PD in IBD, but also in patients with other chronic inflammatory disorders.

“We should direct our focus on the immune system in all Parkinsonian disorders, and further investigate the role of systemic inflammation and the immune system as such in these neurological diseases,” he said, adding that a “clear knowledge of the mechanisms implicated in gut/immune/nervous communication could help improve the prognostic and therapeutic tools leading to better quality of life for patients, reducing the exacerbation of PD symptoms, and delaying the progression of the disease.

”https://parkinsonsnewstoday.com/2019/11/19/gut-inflammation-may-increase-risk-for-parkinsons-disease-review-study-suggests/

Review Highlights Questions That Remain for Fecal Transplant in Parkinson’s

NOVEMBER 19, 2019 BY MARISA WEXLER 

There currently is not enough data to support the use of fecal transplants as a treatment in Parkinson’s disease, a new review suggests.

Published in the Journal of Parkinson’s Disease, the review is titled “Faecal Transplantation, Pro- and Prebiotics in Parkinson’s Disease; Hope or Hype?“

The gut microbiome — the bacteria that live in the gut — have a documented impact on human health. Recent research has suggested that the gut microbiome in people with Parkinson’s disease (PD) is dysregulated and does not work properly. However, the exact changes that happen in PD are still unclear, with many studies finding conflicting results, and none able to demonstrate a cause-and-effect relationship between Parkinson’s and bacteria, one way or the other.

Fecal microbiome transplantation (FMT) is a category of procedures that aim to transplant fecal material — and, by extension, gut bacteria — from healthy individuals into sick people. The treatment is designed to put “good” bacteria back into the digestive tract, helping to replenish the bacterial balance.

In the new review, the researchers assessed the current state of evidence for the use of FMT, also called bacteriotherapy, and other gut-bacteria-targeted treatment strategies in Parkinson’s.

“FMT is an interesting option for restoring the changes in the microbiome of PD patients. It is an attractive technique because the administration is relatively simple and in general it has only a mild pattern of adverse effects,” Teus van Laar, MD, PhD, a professor at the University of Groningen, director of the Parkinson Expertise Center Groningen, and co-author of the review, said in a press release.

“However, no rigorous clinical trials have been performed yet, which leaves multiple questions open about the presumed optimal content of FMT, the route of administration, the volume of FMT and the long-term effects,” van Laar said.

There is virtually no available data on FMT in Parkinson’s, the researchers noted.

“References [in published scientific literature] to the potential use of FMT in PD are restricted to a recent Chinese case study on a PD patient with severe constipation,” they said. While this patient experienced improvement in both constipation and PD symptoms, it is virtually impossible to draw any conclusions from a sample size of one.

The researchers further noted that basic questions about using fecal transplant in PD still need to be addressed. For instance, FMT requires a “healthy’ donor” — but exactly what that means could be debated. This is especially true given that fact that the actual changes in gut microbiome that happen in PD aren’t fully understood.

Additionally, practical issues, like the best route — enema, nasogastric tube, etc. — or frequency of administration, will need to be worked out before FMT can be confidently recommended in PD.

The first clinical trial of FMT in 40 people with Parkinson’s (NCT03808389) is currently ongoing and is scheduled to be completed at the end of 2019. That trial, currently enrolling in Belgium, aims to recruit 40 Parkinson’s patients who will receive FMT from healthy donors while a control group receives autologous (self) FMT.

The results from this trial may help answer some of the questions researchers have about fecal transplant — in particular, whether it is beneficial at all for a significant portion of people with PD. However, many questions will remain unanswered following this study. For instance, the researchers noted that the inclusion criteria for Parkinson’s patients “do not in- or exclude constipation, which may complicate the interpretation of results.”

The researchers also pointed out that, while FMT is generally regarded as a low-risk procedure, there have been reported instances of serious — even fatal — complications. As such, the safety profile of fecal transplant in PD will need further evaluation.

The review also touched on other techniques used to influence gut bacteria, namely the use of probiotics and prebiotics. Probiotics are the “good” bacteria of the kind found in yogurt — though again, such definitions are highly subjective and context-dependent. Forms of fiber, prebiotics can help facilitate the growth of certain types of bacteria, rather than administration of the bacteria themselves.

Several studies have demonstrated that some kinds of probiotics — namely the bacteria groups Lactobacillus and Bifidobacterium — can help alleviate constipation in PD, the researchers said. However, whether these treatments have any effect on other symptoms of PD is currently unknown.

Prebiotics have not been tested in humans with Parkinson’s. The researchers noted that, in animal models of the disease, prebiotic treatment has “indicated beneficial effects on the PD symptoms.” Much more research will need to be done, however, to determine whether this has any bearing on human health.

“FMT is a black box with too many unanswered questions at the moment, also with respect to safety concerns,” van Laar said. “FMT or the use of pro- and prebiotics might become standard treatments in selected subgroups of PD patients in the future, but there are no good data yet in the public domain to support their use in PD patients.”

The researchers called for new studies investigating the use of such transplants in Parkinson’s.

“We hope this review will activate colleagues to start proper research on this topic as soon as possible, rather than to begin therapy without conclusive clinical data,” van Laar said.

https://parkinsonsnewstoday.com/2019/11/19/review-highlights-outstanding-questions-fecal-transplant-parkinsons/

Parkinson’s wellness center coming to Beachwood; city gets large FEMA grant

November 19, 2019  By Jeff Piorkowski/special to cleveland.com

Beachwood will welcome a Parkinson's disease wellness center in January.

BEACHWOOD, Ohio -- Sometime after the New Year, the city will welcome a Parkinson’s disease wellness center, which will move from its current Warrensville Heights location.

City Council approved Monday (Nov. 18) by a 7-0 vote a conditional use permit that will allow InMotion to move to 23905 Mercantile Road, which is located within a zoning district that permits industrial and office uses.

City Planner George Smerigan said InMotion will move into an existing 21,000-square-foot building.“They have five full-time staff members and three part-time staff members and 57 contract instructors," Smerigan said. "They help with different types of therapy. Nobody stays overnight; they just come in for the services. They say that they serve about 2,000 people annually.”

Parkinson’s disease is a progressive nervous system disorder that affects movement.

InMotion, now located at 4829 Galaxy Parkway, describes itself on its website as “a nonprofit community of specialized trainers, dedicated staffers, volunteers, clients with PD and the people who care about them.”

The city’s Planning and Zoning Commission last month gave initial approval to InMotion’s conditional use permit request.

Sizable grant for the fire department

Council also approved Monday the acceptance of a Federal Emergency Management Agency (FEMA) Assistance to Firefighters Grant in the amount of $214,335 that will go toward purchasing 30 self-contained breathing apparatus packs.The SCBAs are one of the most important pieces of equipment we have,” said Fire Chief Steven Holtzman. “We use them for anything where there are low oxygen levels. It’s (low-oxygen situations) called IDLH, which is ‘immediately dangerous to life and health’ -- any atmosphere we may come into contact that meets that (IDLH) standard, our guys are required to wear them.”

In addition to fires, the SCBAs can be useful in such matters as dangerous chemical releases where rescues are needed.

“I don’t remember us ever getting (a FEMA) grant,” Holtzman said of the Beachwood Fire Department. The grants are usually given based on a department’s need. Holtzman said that SCBAs have a life expectancy of 15 to 20 years, and the BFD’s current equipment is now 18 years old. As the SCBAs grow older, they require more frequent repair, Holtzman said.

The FEMA grants require that cities match 10 percent of the grant’s total. In this case, however, Cuyahoga County stepped in and will pay the match, meaning Beachwood will purchase the SCBAs at no cost to the city. Coming out on top

Council also voted 7-0 in passing an ordinance that will have the city, for a second straight year, enter into a contract with Entercom Communications for search engine marketing/optimization.

When key words are used in searches, the firm works to make the Beachwood city website the first seen among listings. It also provides for a person to conduct up to 150 live chats per year with people who need help while visiting the Beachwood city website.

Beachwood will pay Entercom $18,000 in 2020 for its services

https://www.cleveland.com/community/2019/11/parkinsons-wellness-center-coming-to-beachwood-city-gets-large-fema-grant.html