Parkinson's Disease: The Cutting Edge
Experts explain how new research and new drugs offer Parkinson's disease patients more options than ever -- and exciting new treatments to come.
By Colette Bouchez
Reviewed By Brunilda Nazario
Some famous faces have recently focused our attention on the progressive neurological disease known as Parkinson's disease. Most notable among them are Pope John Paul II, actor Michael J. Fox, and former Attorney General Janet Reno.
But now, doctors say some cutting-edge treatments may soon take center stage. Among the new discoveries: a transdermal skin patch for round-the-clock symptom control; two new surgical procedures for treating advanced disease; and a brand new way of diagnosing Parkinson's disease long before the movement disorder begins to show its signs.
"It's vital for patients and their families to know that we are moving forward every day, and every day we are learning more about this illness," says Michael Kaplitt, MD, PhD, director of Movement Disorders Surgery at Weill Cornell Medical Center/New York Presbyterian Hospital in New York City.
A progressive neurological disease affecting some 500,000 Americans, Parkinson's disease involves the early death of nerve cells that manufacture dopamine. This is a chemical transmitter that stimulates muscles to move in a smooth and coordinated way.
When levels of dopamine are depleted, other brain chemicals become dominant, causing an imbalance that further encourages a lack of muscle control, or sometimes a rigidity that prevents muscle movement. The symptoms can sometimes be felt body-wide.
"In the beginning this can include mild problems, such as a sense of fatigue and restlessness accompanied by small tremors in the hands, arms, and feet; as the disease progresses a patient will have difficulties orchestrating movement in all muscle groups, which can affect walking and even speaking," Kaplitt tells WebMD.
Kaplitt says that by the time symptoms appear, over 70% of the dopamine-producing cells are no longer working, making reversal of the disease impossible.
"It would be safe to say that basically all of our treatments right now are focused on relieving symptoms and not restoring brain function," says Roger Albin, MD, professor of neurology at the University of Michigan and chief of neuroscience research at the Ann Arbor Veterans Affairs Medical Center.
But Albin says many of the newest treatments can dramatically alter the quality of life and even help people who suffer from Parkinson's live longer.
For many years, the only treatment Parkinson's patients could rely on were medications designed to help the brain produce more dopamine, act like dopamine, or reduce the breakdown of dopamine within brain cells. While the drugs are effective, many have troubling side effects, including offering only sporadic muscle control. Most, say experts, lose their effectiveness as the disease progresses.
Now, doctors say there is a way to overcome many of these problems with the addition of a cutting-edge treatment known as deep brain stimulation (DBS). It is used only in people whose symptoms cannot be controlled adequately with medication. Doctors use waves of electrical current to affect the way brain cells communicate, and in doing so can help a number of Parkinson's medications work far more effectively for much longer periods of time.
The treatment inactivates regions of the brain that cause tremor and Parkinson's disease symptoms, thereby blocking abnormal nerve signals.
"By sending small pulses of electrical stimulation into the brain we can create a kind of 'noise' that dampens down the flow of abnormal information between brain cells," says Kaplitt. Ultimately, it helps rebalance some of the brain chemistry involved in movement, allowing medications to work better and more effectively.
The treatment itself involves surgery during which an electrode is implanted into the area of the brain where dopamine is made. That electrode is attached to lead wires buried under the skin and connected to a source of electricity outside the body.
"We can then turn it up or down and adjust the flow of 'noise' to suit every patient's individual needs and the stages of disease," says Kaplitt.
Although in research for about nine years, Kaplitt says DBS has only recently stepped into the limelight as an effective treatment and that many Parkinson's patients are still not aware of just how helpful it can be.
Because the surgery is done primarily to increase the effectiveness of current medications, those already responding well to drug therapy are not candidates.