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JUNE 2008   

 

28th June 2008 - New research

ONE OF THE WORLD'S LOWEST PREVALENCES OF PARKINSON'S DISEASE

Movement Disorders [2008] Jun 25; [Epub ahead of print] (Dotchin C, Msuya O, Kissima J, Massawe J, Mhina A, Moshy A, Aris E, Jusabani A, Whiting D, Masuki G, Walker R.) Complete abstract

The prevalence of Parkinson's Disease varies worldwide from 7 to 407 people per 100,000. For more information go to Prevalence of Parkinson's Disease. The prevalence of Parkinson's Disease appears to be low in sub-Saharan Africa, but little data exists. So the authors conducted a study of the prevalence of Parkinson's Disease in rural Tanzania.

Crude prevalence rates were found to be very low : 30/100,000 (for men), 11/100,000 (for women) and 20/100,000 (overall). This makes Tanzanian women the second least likely group of people in the world to develop Parkinson's Disease. This is despite rural Tanzania having very low levels of healthcare. It is in stark contrast to the U.S.A., where, despite extensive healthcare, people are 30 times more likely to develop Parkinson's Disease. Tanzanian women also have the world's lowest ratio of women to men having Parkinson's Disease, with the women being nearly a third less likely to develop Parkinson's Disease than men. No explanation is given for such low prevalence rates of Parkinson's Disease amongst Tanzanian women.

 

26th June 2008 - New research

THE PREVALENCE OF PATHOLOGICAL GAMBLING IN PARKINSON'S DISEASE

Journal of Gambling Studies 2008 Jun 17; [Epub ahead of print] (Crockford D, Quickfall J, Currie S, Furtado S, Suchowersky O, El-Guebaly N.) Complete abstract

Pathological gambling has often been identified in people with Parkinson's Disease treated with dopamine agonists. When somebody takes dopamine agonists such as Ropinirole (Requip) and Pramipexole (Mirapex), they disproportionately stimulate the D3 dopamine receptor, far more than L-dopa does. This causes arousal in the limbic system, which is where the D3 dopamine receptor is primarily located. Given that the limbic system is connected with the pleasure centre,  the use of certain dopamine agonists can especially lead to compulsions such as gambling.

This study was undertaken to establish the prevalence of pathological gambling in Parkinson's Disease. The prevalence was found to be nearly 10% of people with Parkinson's Disease. This meant that pathological gambling was more than 5 times more likely than in people that didn't have Parkinson's Disease. The increased prevalence of pathological gambling in the Parkinson's Disease group was related to dopamine agonist use and also younger age. Most people suffering from pathological gambling reported that their gambling increased after diagnosis and starting treatment.

 

25th June 2008 - New research

DYSKINESIA IS RELATED TO WEIGHT

European Journal of Neurology [2008] 15 (5) : 493-496 (Sharma JC, Ross IN, Rascol O, Brooks D.) Complete abstract

L-dopa dose per kilogram body weight is reported to be a significant factor for dyskinesia in Parkinson's disease. This study investigated this hypothesis. Analysis of L-dopa therapy patients revealed that people with dyskinesia had received significantly higher L-dopa dose, and also had a higher L-dopa dose per kilogram body weight.

The most significant factor was the higher L-dopa dose per kilogram body weight. Younger age was the factor that was the second most related to dyskinesia. Gender, absolute L-dopa dose, weight on its own, disease duration, and initial motor Unified Parkinson's disease rating score were not significant. Higher L-dopa dose per kilogram body weight is an independently significant factor for developing dyskinesia. This relationship should be considered as an important factor when aiming to prevent and manage dyskinesia, because those of a lower weight will be far more prone to dyskinesia.

 

24th June 2008 - New research

CHRONIC PAIN IN PARKINSON'S DISEASE

Mvement Disorders [2008] Jun 10; [Epub ahead of print] (Negre-Pages L, Regragui W, Bouhassira D, Grandjean H, Rascol O) Complete abstract

Pain is a frequent, but poorly studied symptom of Parkinson's Disease. This survey aimed to assess the prevalence of chronic pain in Parkinson's Disease, to describe Parkinson's Disease patients with chronic pain, and to record analgesic consumption. 62% of people with Parkinson's Disease were found to suffer from chronic pain. 26% of people with Parkinson's Disease had pain unrelated to Parkinson's Disease ("non-PD-pain", caused mainly by osteoarthritis), while 39% had chronic pain related to Parkinson's Disease ("PD-pain").

In this last group, Parkinson's Disease was the sole cause of pain in the majority, whilst the others suffered from indirectly aggravated pain of another origin, which was mainly osteoarthritis. Parkinsonian patients with "PD-pain" were younger at Parkinson's Disease onset, had more motor complications, more severe depressive symptoms than those without pain or with "non-PD pain." "PD-pain" was more intense, but was less frequently reported to doctors, and was associated with less frequent analgesic consumption than "non-PD-pain." Pain was twice more frequent in Parkinson's Disease patients than in patients without Parkinson's Disease. Chronic pain is frequent but underreported in Parkinson's Disease.

 

15th June 2008 - New book

PARKINSON'S DISEASE AND MOVEMENT DISORDERS

TN Mehrotra

A concise, practical overview of Parkinson's Disease and other movement disorders and their management. It lays out disease epidemiology and pathology, symptoms and signs, features, approaches, fluctation function, pharmacokinetic strategies, and a detailed description of the disease through subjective treatment at various levels. Includes the latest information on the diagnosis and treatment of Parkinson's Disease. Focuses on the long-term care of patients suffering from movement disorders. Begins with a historical perspective on the evolution of treatment for movement disorders. Discusses special issues of the disease such as sleep, depression and dementia, and young onset. Click here for more details.

 

13th June 2008 - History

AN ESSAY ON THE SHAKING PALSY

James Parkinson

Although Parkinson's Disease has been known of for thousands of years, the first formal description of Parkinson's Disease was in "An essay of the Shaking Palsy", which was written in 1817 by James Parkinson. Parkinson's Disease was eventually named after James Parkinson.

James Parkinson systematically described the medical history of six individuals who had symptoms of the disease. Unusually for such a description, he did not actually examine all these patients himself but observed them on daily walks. The purpose of his essay was to document the symptoms of the disorder, which he described as "Involuntary tremulous motion, with lessened muscular power, in parts not in action and even when supported; with a propensity to bend the trunk forwards, and to pass from a walking to a running pace : the senses and intellect being uninjured." For the full text go to "An Essay on the Shaking Palsy,"

 

11th June 2008 - New review

PARKINSON'S DISEASE ORGANISATIONS

Most countries have one or more organisations specifically for assisting people with Parkinson's Disease in those countries. The web sites or the contact details of most of the national Parkinson's Disease organisations are on the  World Parkinson Disease Association web site, or on the web site of the European Parkinson's Disease Association. The U.S.A. has four major organisations : the American Parkinson Disease Foundation, the Parkinson's Disease Foundation, the National Parkinson Foundation, and The Michael J.Fox Foundation. For links to all the national and international Parkinson's Disease organisations around the world, go to Parkinson's Disease organisations  If you would like details for a particular country that is not listed, please e-mail mail@viartis.net.

 

9th June 2008 - New review

CARBON MONOXIDE AS A CAUSE OF PARKINSON'S DISEASE

Carbon monoxide toxicity is frequent due to the formation of carbon monoxide by very common means such as gas cookers and exhaust fumes. However, despite carbon monoxide toxicity often being cited as a cause of Parkinson's Disease, it rarely actually results in Parkinson's Disease. It normally requires the person having gone in to a coma as a result of the carbon monoxide poisoning before symptoms of Parkinson's Disease develop.

Common means : Motor vehicle exhaust fumes, cigarette smoke. It also forms when fuels like coal, paraffin, natural gas, oil or wood, and especially natural gas, do not burn completely in appliances such as heaters, furnaces, stoves, water heaters, and ovens.

Means of toxicity : Carbon monoxide causes hemoglobin, which transports oxygen, to turn in to carboxy-hemoglobin, which does not transport oxygen. Oxygen is required for the formation of L-dopa. So carbon monoxide may cause Parkinson's Disease symptoms by interfering with the availability of oxygen to the brain. However, the precise means by which it causes Parkinson's Disease has still not been proven.

Symptoms : A Parkinsonian state with behavioural and cognitive impairment but could walk, or progressed further to an akinetic-mute state, and were bed-bound [1]. Parkinson's Disease symptoms such as tremor and rigidity were experienced in only a small number of people [2]. Delayed onset of Parkinsonsim in some people from which they recovered [3]. In a small proportion of people, Parkinsonian symptoms occurred, such as gait disturbance, impaired mentality, urinary incontinence, and mutism. The most frequent signs were short-step gait, hypokinesia, masked face, increased muscle tone (rigidity), glabella sign, grasp reflex, and retropulsion. Intentional tremor was occasionally found, but resting tremor could not be seen [4].

 

8th June 2008 - New research

OLFACTORY MUCOSA IS A SOURCE OF STEM CELLS

Stem Cells [2008] Jun 5; [Epub ahead of print] (Murrell W, Wetzig A, Donnellan M, Feron F, Burne T, Meedeniya A, Kesby J, Bianco J, Perry C, Silburn P, Mackay-Sim A.) Complete abstract

It has been claimed for years that stem cells could replace the cells that are supposed to be lost in Parkinson's Disease. The main hindrance to stem cell research being carried out has been the ethical objections to the type of
cells often used, because some have involved the use of early forms of human life.

This research showed that stem cells can be grown from the olfactory mucosa instead - even in people with Parkinson's disease. The olfactory mucosa are in the olfactory organ (inside the nose).  For more information go to Olfactory mucosa. These cells proliferated and generated dopaminergic cells in vitro. They also generated dopaminergic cells when transplanted into the brain. The authors claim that this suggests that people with Parkinson's Disease could use their own olfactory mucosa to provide their own source of stem cells in order to be used in themselves.

However, no published research has ever shown that there is massive cell loss in Parkinson's Disease. Studies that claim this have instead shown that there is a reduced ability to produce dopamine in the existing cells. So the scientific theory behind the use of stem cells, of any kind, in Parkinson's Disease has always been fundamentally flawed. This is why despite stem cell operations now taking place around the world, never have they resulted in the ridding of Parkinson's Disease.

 

5th June 2008 - News release

NEUPRO HAS TO BE REFRIGERATED

Neupro (rotigotine), is a dopamine agonist formulated in a transdermal delivery system. For more information go to Neupro. A lot of Neupro recently had to be withdrawn from use in the U.S.A.. The manufacturers have now announced that they will submit a variation to the EMEA (European Medicines Evaluation Agency) to implement a full cold-chain storage and distribution system for Neupro in Europe. UCB will also be replacing current Neupro supply in Europe with product that has been refrigerated since manufacture. Refrigerated storage of Neupro substantially reduces the development of crystals, which can result from the manufacturing process.

Crystallisation in the patch can lead to a change in its appearance and could reduce its clinical efficacy, but it is of no clinical relevance in most instances. All Neupro supply should be stored in a refrigerator. There is no need for patients to transport Neupro patches in special containers, or to store it in a freezer compartment. In agreement with the EMEA, and in order to prioritise the supply of Neupro for existing patients, new patients will not be initiated on Neupro. Therapy must not be discontinued abruptly, because abrupt withdrawal of dopamine agonists has been associated with a syndrome resembling neuroleptic malignant syndrome or akinetic crises. For more information go to the Complete article.

 

4th June 2008 - New book

Monkeys in the Middle

Nick Nelson

"Monkeys in the Middle : How One Drug Company Kept a Parkinsons Disease Breakthrough Out of Reach". Some claimed it was a miracle drug. Others called it the cure. A drug known simply as "GDNF" seemed to be reversing the effects of Parkinson's disease. The miracle ended in 2004 when Amgen halted clinical trials of GDNF and denied access to the drug, due to the results of toxicity studies. Nick Nelson recounts the story of the patients who took on the world's biggest biotechnology company for the right to continue using GDNF. Click here for more details. Despite the claims of being cured, some of the patients claiming the greatest benefit had actually been taking a placebo. A subsequent and more recent independent clinical trial showed no benefit from the use of GDNF.

 

3rd June 2008 - New research

functional electrical stimulation (FES)

Neuromodulation [2008] 11 (2) : 143-149 (G.E.Mann, S.M.Finn, P.N.Taylor) Complete abstract

The use of electrical impulses to stimulate weak or paralyzed muscles, called Functional Electrical Stimulation (FES), is often used to help stroke or multiple sclerosis patients to walk. For more information go to Functional electrical stimulation. Many people with Parkinsonís are prone to tripping and falling because they have difficulty picking up their feet consistently. They also can have difficulty with  starting and maintaining walking. This study aimed to investigate the effect of Functional Electrical Stimulation (FES) on walking ability in people with Parkinson's disease.

People with idiopathic Parkinson's disease received electrical stimulation for eight weeks to the common peroneal nerve to improve heel strike and provide sensory stimulus during walking. An immediate improvement was demonstrated with FES on distance and average stride length during a short walk during the treatment period, but not on the number of steps and walking speed during a longer walk. A training effect was observed for all measures of walking ability. Fewer falls and episodes of freezing occurred during the treatment period. The number of falls returned to pre-treatment levels when treatment was stopped.

 

2nd June 2008 - News release

NTF (Neurotrophic Factor Cells)

Trophic factors are proteins that support and protect cells. A number of them have been reported to act on dopaminergic neurons, the cells whose reduced activity causes Parkinson's Disease. Consequently, it has been claimed that they are potential therapeutic candidates for Parkinson's Disease. BrainStorm Cell Therapeutics is a leading developer of adult stem cell technologies and therapeutics. BrainStorm's NTF cells are generated from adult human bone marrow derived stem cells. Brainstorm announced that, in a pre-clinical study, Parkinson's Disease symptoms in rats improved following transplantation of Neurotrophic Factor Cells (NTF). The levels of dopamine were also increased. This is the second study completed using BrainStorm's cells that has produced similar results.

According to BrainStorm, "The study indicates that our cells show survival, integration and clinical efficacy. When considering the advantages of using adult stem cells, which are easy to harvest, autologous, do not create tumor problem and do not present the moral / religious issues that are often discussed with embryonic stem cells, we remain optimistic that we will soon be able to embark on clinical trials in Parkinson's disease."  For more information go to the Complete article. However, the rats did not actually have Parkinson's Disease. Their symptoms were induced using a toxin. Also, the symptoms were only reduced rather than rid. When previously successful tests on GDNF, another trophic factor, were later carried out on a larger scale in humans, they failed to have any effect at all. 

 

1st June 2008 - New research

DOING WITHOUT PARKINSON'S DISEASE DRUGS

Journal of Neurology Neurosurgery and Psychiatry [2008] 79 (6) : 716-718 (Asimakopoulos P, Caslake R, Harris CE, Gordon JC, Taylor KS, Counsell C.) Complete abstract

Although L-dopa is the most widely used form of treating Parkinson's Disease, no substance interferes with a person's capacity to produce their own dopamine than L-dopa. Although dopamine agonists are commonly used to treat Parkinson's Disease by stimulating dopamine receptors, they eventually become counterproductive by making the dopamine receptors progressively less sensitive. Due to the counterproductive after effect of common Parkinson's Disease drugs, the issue of whether to adopt a "wait and watch" strategy or to initiate drug therapy soon after diagnosis in Parkinson's disease has been the subject of debate.

People who remained untreated were compared with patients who had been treated for Parkinson's Disease, by assessing their progress after two years. Two common symptom questionaires were used - the Unified Parkinson's Disease Rating Scale (UPDRS)) and self-reported health status (Parkinson's Disease Questionnaire (PDQ-39). There was no significant deterioration in PDQ-39 score in either group. Given the lack of significant deterioration in the PDQ-39 in untreated patients, the author's believe that delaying the start of treatment remains a credible approach.

 

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