The Future of Research in Parkinson’s Disease

Until recently, there has been no “biomarker” to establish a diagnosis of Parkinson’s, which is mainly clinical. Patients typically have tremor, slowness of movement, stiffness, and postural instability. New biomarkers are now available, including a DaTscan. It can differentiate Parkinson’s from essential tremor but not from other Parkinson’s-like diseases. A similar scan uses an isotope labeled fluorodopa.

There is more understanding of the genetic basis of Parkinson’s. Single-gene disorders account for less than 10% of all cases. New research has shown a growing number of “susceptibility genes,” which can increase the risk.

Intensive research is focused on neuroprotective or disease-modifying drugs for Parkinson’s, including isradipine; inosine, which elevates urate and may act as an antioxidant; AZD-3241; RP103, which increases brain-derived neurotrophic factor; pioglitazone and similar medications used for diabetes and others. Other promising drugs have not proven helpful in research. They include a neurotrophic factor and neurturin. Further, a new gene delivery system using LentiVector gene technology shows so far only slight improvement and is considered highly experimental. Vaccines and immunotherapy with monoclonal antibodies targeting alpha-synuclein are being studied as well.

New treatment options include improvements in the delivery of levodopa using skin patches, pumps, inhalers. One is likely to be available commercially. It has been studied for 30 years, and it uses a levodopa-carbidopa intestinal gel infusion, but this requires a puncture through the abdomen into the small intestine. A new drug termed pimavanserin was found to be safe, effective, and well tolerated in research in treating levodopa-induced psychosis. This will probably be available as well.

In short, researchers are optimistic about the future of Parkinson’s treatment.

Dr. Jack Florin, MD
Neurologist

To schedule an appointment send us an email or call us at (714) 738-0800

Connect with me on LinkedIn
Visit our Facebook page!
Visit our website for more information.

Controlling Agitation in Alzheimer’s Patients

Sundowner’s syndrome” is well recognized. Anxiety, delusional thinking, and sometimes aggressive behavior are usually triggered by patients’ misperceiving stimuli. Caregivers are trained to use techniques of distraction. Often, they do not work.

Drugs tested for treating psychiatric symptoms in Alzheimer’s include antidepressants for depression and irritability, antianxiety drugs (benzodiazepines) for anxiety and restlessness, and antipsychotic medications for hallucinations, delusions, agitation. These all have potential serious side effects and should be used with great caution.

A drug called Nuedexta, already approved to treat pseudobulbar affect, has been studied in treating agitation with Alzheimer’s, and results are promising.

Dr. Jack Florin, MD
Neurologist

To schedule an appointment send us an email or call us at (714) 738-0800

Connect with me on LinkedIn
Visit our Facebook page!
Visit our website for more information.

Concussions Are Underreported

A study was just completed assessing concussion knowledge in high school football players. As you might expect, they have limited knowledge about concussions and tend to underreport symptoms. Forty-three percent said they had hidden a concussion to stay in the game, and 22% said they would do so in the future. Educating these athletes is a critical unmet need.

Research into sideline testing is ongoing, and there is a new test from the University of Pittsburgh. It involves the vestibulo-ocular system, responsible for integrating vision, balance, and movement. Still another research area in monitoring is helmet telemetry to determine the force and angle of impact for head hits. This will be useful if it is correlated with sideline test scores and symptoms.

There are guidelines as to when to return a concussed athlete to contact sports. There are none during the transition back into a classroom setting. This area is termed “return to learn” and is often overlooked.

Lastly, we know that professional football players have high risk of cognitive impairment. It is not clear if this is the case with high school or college athletes. More research is ongoing.

Dr. Jack Florin, MD
Neurologist

To schedule an appointment send us an email or call us at (714) 738-0800

Connect with me on LinkedIn
Visit our Facebook page!

Can Treatment Alter The Natural History Of MS?

Most MS researchers believe that it can, but there are few studies that confirm this impression.

More than 4,000 patients were followed for about 6 years, and those who were treated had lower disability scores than a natural history cohort. The reduction was 25% to 40% depending on the type of measurement. Improvement in quality of life measures showed an even greater difference of 40% to 45%. The lead author, Dr Jacqueline Palace, a neurologist at the University of Oxford in the UK, observed that if this effect is sustained over 20 years, treatment would be “cost-effective,” using a predefined target of about $50,000 per quality-adjusted life-year.

Dr. Jack Florin, MD
Neurologist

To schedule an appointment send us an email or call us at (714) 738-0800

Connect with me on LinkedIn
Visit our Facebook page!

Are There Neuroprotective Drugs for Parkinson’s?

The shorter answer is none is proven. Azilect may have some of these properties. Some researchers are not convinced. There is disappointing news of the failure of yet another Parkinson’s disease modifying or neuroprotective clinical trial using pioglitazone, already being used for diabetes. On the other hand, a drug called isradipine is starting to be studied in a new clinical trial. This is looking for disease-modifying activity.

There are 3 new drugs to treat symptoms. Droxidopa is approved for neurogenic orthostatic hypotension, a common problem in Parkinson’s. With this, patients’ blood pressure falls with standing, and this may cause dizziness or even faints.

Levodopa-carbidopa intestinal gel, branded as Duodopa, will become available in Canada in April and probably in the United States later in 2015 or early 2016. It requires a tube in the intestine to infuse levodopa continuously but has been shown to reduce motor fluctuations.

A truly extended release levodopa-carbidopa tablet may be superior to all other levodopa pills such as Sinemet and Stalevo, being longer acting and thus reducing fluctuations. It is branded Rytary, not yet available but being reviewed by the FDA, with a decision expected by January of 2015.

Dr. Jack Florin, MD
Neurologist

To schedule an appointment send us an email or call us at (714) 738-0800

Connect with me on LinkedIn
Visit our Facebook page!