World Parkinson Coalition.July 2015
The session was moderated by Jon Palfreman, PhD author of Brain Storms: The Race to Unlock the Mysteries of Parkinson's Disease and included distinguished faculty members: Dr. Peter LeWitt (USA), Dr. Walter Maetzler (Germany) and Dr. Etienne Hirsch (France).
Below is a summary of the session written by moderator, Jon Palfreman, PhD, co-host of the current WPC podcast program, the Portland Countdown.
Since levodopa was introduced in the late 1960s, scientists have been seeking ways of delivering the medicine in a continuous stable manner to enable patients to stay on more of the time, and yet avoid troublesome dyskinesias. Peter LeWitt discussed some of the exciting cutting edge products now entering trials: from gastric retention drug formulations (which lodge in the stomach just above the critical absorbing region of upper GI tract and dissolve slowly over 8–10 hours delivering a steady dose of levodopa) to subcutaneous patches (which infuse a liquid form of the drug into the bloodstream), from rapidly acting inhalable rescue therapies to Duodopa (a technology that continuously infuses carbidopa-levodopa gel through a surgically fitted tube in the jejunum).
Walter Maetzler spoke about the limitations of the Unified Parkinson’s Disease Rating Scale or UPDRS, a clinical rating scale which is currently the most often used scale for the assessment of Parkinson’s symptoms. As a way of rating the severity of Parkinson’s, it’s highly subjective. As Maetzler explained, two neurologists will sometimes give different scores for the same patient on the same subtest. Results can
also vary dramatically depending on how recently patients have taken L-dopa and the time of day. About a decade ago, scientists began speculating about capturing a more authentic picture of Parkinson’s disease (PD), an objective monitoring system that can measure the ups and downs of people with Parkinson’s in their daily life. Since then, such technology has got smaller faster and cheaper. Researchers and technologists
have developed tiny wearable sensors (e.g. for wrist, waist, and ankle), and fashioned algorithms to extract meaningful metrics from the data. Walter Maetzler spoke about his hopes that already running projects, including the European system he is involved, SENSE PARK, will lead to a more patient centered and personalized form of assessment of PD symptoms, and ultimately to a more individualized treatment for PD.
Etienne Hirsch spoke about the importance of coming up with therapies that addressed the emerging consensus that PD is not primarily a motor disorder centered on dopamine. Today, we know it involves many debilitating non-motor and non-dopaminergic symptoms, including cognitive impairment, falls, loss of
smell, sleep disorders and pain. Research has shown that falls, for example, are associated with damage to the neurons in the pedunculopontine nucleus (PPN). Neurons in this region require not dopamine but a different neurotransmitter—acetylcholine. In developing interventions, Etienne Hirsch argued that researchers
should identify and target clinical and genetic subtypes of patients, so as to maximize the chance of success.
If you found this interesting, please save the date for the WPC Scientific Update 2015, from October 6 - 8, 2015