31st March 2008 - New book

Life in the Balance : A physician's memoir of life, love, and loss with Parkinson's Disease and Dementia

Thomas Graboys, Peter Zheutlin

At the age of 49, Dr. Thomas Graboys had reached the pinnacle of his career and was leading a charmed life. A nationally renowned Boston cardiologist popular for his attention to the hearts and souls of his patients. He had a beautiful wife, two wonderful daughters, and a thriving private practice. Today, Graboys is battling a particularly aggressive form of Parkinson’s disease and progressive dementia, and can no longer see patients. Despite the physical, mental and emotional toll he battles daily, Graboys continues by telling his story so that others may find comfort, inspiration, or validation in their own struggles. His is not a sugar-coated story with a silver lining; brutally honest and direct, this is an unflinching memoir of a devastating illness.  Click here for more details 

30th March 2008 - New research

ADVERSE EVENTS AFTER DBS SURGERY

Movement Disorders [2008] 23 : 343-349 (A Videnovic, L Verhagen Metman) Complete abstract

DBS is a surgical method of treating Parkinson's Disease that uses electrodes implanted into the brain. For more information go to Deep Brain Stimulation. Traditionally, the two most common sites in the brain used in surgery are the subthalamic nucleus (STN) and the globus pallidus interna (GPi).  The authors analysed reports of adverse events from over a thousand patients who had undergone DBS surgery. The most common adverse events were, in order : weight gain, then confusion, then speech difficulties. Neither part of the brain that was used had clearly fewer adverse events than the other.  Adverse events related to DBS surgery are common, but the study authors concluded that their true prevalence cannot be accurately determined with current reporting methods. For more information go to the Complete article  The most common adverse events were :

Procedure related events (% of STN / % of GPi) : Mental status / behaviour (mostly confusion) 18% / 9%, Infection 2% / 3%, ICH-symptomatic 2% / 4%, Misplaced electrode 2% / 2%, Speech disturbance 2% / 4%, Infarction 1% / 2%.

Stimulation or progression related events (% of STN / % of GPi) : Weight gain 37% / 18%, Dysarthria (speech disorder) 13% / 12%, Eye opening apraxia 11% / 0%, Gait ignition failure 0% / 17%.

Hardware-related events (Combined % of STN and GPi) : One or more events 9%, Infection 2%, Malfunctioning 1%, Lack of benefit 1%.

29th March 2008 - New research

HEAD INJURY CAUSING PARKINSON'S DISEASE

American journal of neuroradiology [2008] 29 (2) : 388-391 (Hähnel S, Stippich C, Weber I, Darm H, Schill T, Jost J, Friedmann B, Heiland S, Blatow M, Meyding-Lamadé U.) Complete abstract

Parkinsonism Related Disorders [2008] Mar 24; [Epub ahead of print] (Spangenberg S, Hannerz H, Tuchsen F, Mikkelsen KL.) Complete abstract

A few years after the end of his boxing career during which he was the three time world heavyweight world champion, Muhammad Ali was diagnosed with Parkinson's Disease. It has been widely both claimed and denied that he had developed Parkinson's Disease due to blows to the head he received as a boxer. In boxing, the head is hit at a high speed and with great force. This can lead to shear movement between different brain tissues, resulting in microhemorrhages.

In the “Heidelberg Boxing Study” high-resolution MRI data were used to search for tiny changes in the brains of amateur boxers and a comparison group of non-boxers. These changes were suggested as the most likely precursors for later severe brain damage in Parkinson’s Disease. Microhemorrhages were found in some of the boxers, while in the comparison group of non-boxers there were no such changes. However the difference between the two groups was found to be statistically insignificant. So there was no evidence that boxing causes Parkinson's Disease.     

Another study assessed the association between severe head injury and Parkinson's disease. Everybody in Denmark who was older than 20 at the beginning of 1981 was followed for the next three years for hospitalisation due to previous head trauma, and for hospital contacts due to Parkinson's Disease for the following 20 years. The number of observed cases of Parkinson's Disease among people at hypothetical risk due to previous head injury was even less than would be generally expected. So contrary to what is widely assumed, the study provides no support at all for severe head injury among adults being a risk factor for Parkinson's disease.

28th March 2008 - New research

PESTICIDE EXPOSURE DOUBLED IN PARKINSON'S DISEASE

BMC Neurology [2008]8:6 (28 March 2008) (Dana B Hancock, Eden R Martin, Gregory M Mayhew, Jeffrey M Stajich, Rita Jewett, Mark A Stacy, Burton L Scott, Jeffery M Vance, William K Scott) Complete study

A study of more than 300 people with Parkinson's Disease found that they were more than twice as likely to report heavy exposure to pesticides over their lifetime as family members without Parkinson's Disease.

The strongest associations were between people with Parkinson's who had been exposed to herbicide and insecticide chemicals such as organochlorides and organophosphates. No links were found between Parkinson's disease and drinking well-water or living or working on a farm. People tended to be those who used a lot of pesticides in their homes and in their hobbies. There were not many people who routinely used pesticides for their occupation. There are several pesticides known to cause Parkinson's Disease, as well as other toxic causes. For more information go to Toxic causes of Parkinson's Disease.

26th March 2008 - New research

THE MAIN CAUSE OF DEATH IN PARKINSON'S DISEASE

Parkinsonism Related Disorders [2008] Mar 19; [Epub ahead of print] (Nobrega AC, Rodrigues B, Melo A.) Complete abstract

The main cause of death due to Parkinson's Disease is respiratory infection. The reduced function of the respiratory muscles in Parkinson's Disease causes respiratory infections to be particularly dangerous. This study assessed whether Silent laryngeal penetration or Silent aspiration (SLP/SA) increases the likelihood and seriousness of respiratory infections in Parkinson's Disease. Silent Aspiration is when fluid or solids are sucked into the airway when breathing in, and when there is no coughing to quickly rid it. Silent Laryngeal Penetration is when material enters the top of the airway and is subsequently removed during the swallowing.

People with Parkinson's Disease who produced excessive saliva during the day were evaluated. Of those in which Silent laryngeal penetration or silent aspiration (SLP/SA) was observed, most developed respiratory infection. Some of them died of it. The authors claim that the results suggest that patients with Parkinson's disease with diurnal sialorrhea (excessive saliva during the day) and SLP/SA have an increased risk of respiratory infections, which is the main cause of death in Parkinson's Disease patients. The data support a greater emphasis on preventive measures regarding these issues in order to improve survival in people with Parkinson's disease.

25th March 2008 - New research

RESTLESS LEGS SYNDROME IN PARKINSON'S DISEASE

Movement Disorders [2007] 22 (13) : 1912-1916 (Gomez-Esteban JC, Zarranz JJ, Tijero B, Velasco F, Barcena J, Rouco I, Lezcano E, Lachen MC, Jauregui A, Ugarte A.) Complete abstract

Restless legs Syndrome is characterized by an urge to move your legs, and to a lesser extent  your arms. It tends to be worse at night. For more information go to Restless Legs Syndrome. This study explored the frequency of Restless Legs Syndrome in Parkinson's Disease.

It focused on the clinical differences between patients with and without Restless Legs Syndrome (RLS). They used specific scales : Unified Parkinson's Disease Rating Scale (UPDRS I-IV), quality of life (Parkinson's Disease Questionnaire, PDQ 39), sleep symptoms (Parkinson's Disease Sleep Scale, PDSS), and diurnal hypersomnia (Epworth Sleepiness Scale). Over 20% of people with Parkinson's Disease were found to also suffer from Restless Legs Syndrome (RLS). RLS was found to be far more common in women. More than two thirds of those with RLS were women. Those with RLS suffered more from lack of sleep, and body discomfort. Although RLS is frequent in patients with Parkinson's Disease, it does not appear to affect the quality of life by any other means.

24th March 2008 - New research

CLONED CELLS RID PARKINSON'S DISEASE IN MICE

Nature Medicine [2008] Mar 23; [Epub ahead of print] (Viviane Tabar, Mark Tomishima, Georgia Panagiotakos, Sayaka Wakayama, Jayanthi Menon, Bill Chan, Eiji Mizutani, George Al-Shamy, Hiroshi Ohta, Teruhiko Wakayama & Lorenz Studer) Complete abstract

Researchers are claiming that therapeutic cloning has been used to successfully treat Parkinson's Disease in mice. In therapeutic cloning, the nucleus of a cell is inserted into an egg with the nucleus removed. This cell then develops into an embryo from which stem cells can be harvested and used as a treatment. In this study, stem cells were developed into dopaminergic neurons, the cells whose reduced activity causes Parkinson's Disease. Researchers see this as a means of creating a person's own embryonic stem cells. For more information go to the Complete article.

Despite what has been widely reported, the mice did not actually have Parkinson's Disease. They were not rid of all artificially induced Parkinson's Disease symptoms either. The researchers did not check for persistent effects, as the mice were assessed for less than three months. Stem cell surgery operations are already being carried out almost every day involving Parkinson's Disease. Yet they have not rid anyone of Parkinson's Disease. Stem cell surgery is based on the assumption that people with Parkinson's Disease are suffering a massive loss of dopamine producing cells. Despite this being widely claimed, no research has ever shown this to be true.


                                                                                                                                                                                  23rd March 2008 - New research

HOW ALPHA-SYNUCLEIN EXACERBATES PARKINSON'S DISEASE

Neurochemical Research [2008] Mar 21; [Epub ahead of print] (Liu D, Jin L, Wang H, Zhao H, Zhao C, Duan C, Lu L, Wu B, Yu S, Chan P, Li Y, Yang H.) Complete abstract

Alpha-Synuclein is the main component of Lewy Bodies. Lewy Bodies can remove damaged elements from the cells involved in Parkinson's Disease. For more information go to Alpha-Synuclein.

It has been claimed that alpha-synuclein is involved in the cause of Parkinson's disease. Parkinson's Disease normally occurs when the formation of dopamine is insufficient. Previous studies have shown that alpha-synuclein is involved in the regulation of dopamine, possibly by reducing the formation of tyrosine hydroxylase. Tyrosine hydroxylase is responsible for the formation of L-dopa.  This study found that alpha-synuclein did not interfere with the formation of tyrosine hydroxylase. However, alpha-synuclein was still found to reduce the activity of tyrosine hydroxylase, and by that means, reduce the formation of L-dopa and dopamine. The reduced dopamine formation this leads to can enable alpha-synuclein to exacerbate the symptoms of Parkinson's Disease.

21st March 2008 - New research

NEW GENETIC FORM OF PARKINSON'S DISEASE

American Journal of Human Genetics [2008] Apr 11; [Epub ahead of print] (Corinne Lautier, Stefano Goldwurm, Alexandra Dürr, Barbara Giovannone, William G. Tsiaras, Gianni Pezzoli, Alexis Brice, Robert J. Smith) Complete study

According to this study, mutations in the gene, known as GIGYF2, appear to be directly linked to the development of Parkinson’s in people with a family history of the disease. GIGYF2 was found to be located right in the centre of a chromosomal region called PARK 11, a region that was initially identified through a genetic analysis of families with Parkinson’s disease. The researchers identified seven different forms of GIGYF2 mutations occurring in 12 different people, which was approximately 5% of those in the study.

All of them had relatives with Parkinson's Disease. Eight of these patients had at least one parent with Parkinson’s, one had both parents affected, and three had one sibling affected. When available, relatives with Parkinson’s were also sampled. Researchers found they carried the same mutation, which led to single amino acid substitutions in the protein encoded by the GIGYF2 gene. None of the mutations were observed in those that did not have Parkinson's Disease. For more information go to the Complete article.

20th March 2008 - News report

NEUPRO BEING WITHDRAWN FROM USE

Neupro (rotigotine), is a dopamine agonist formulated in a transdermal delivery system. For more information go to Neupro. Belgian drugmaker UCB said on Thursday it was recalling its Parkinson's patch Neupro in the United States and some batches from Europe. UCB said the recall decision was not the result of contamination or toxicity but that the clinical performance of some samples on the market was not as required. "As a result, there will be an out-of-stock situation with Neupro in the United States by late April 2008.

In the European Union and most other regions, Neupro supply is sufficient," it continued. A spokeswoman said it was not clear how long UCB would be out of stock in the U.S.A.. As supplies will soon run out in the U.S.A., UCB is strongly advising healthcare professionals and patients not to abruptly stop their therapy, and that dosing should be gradually reduced instead under medical supervision in order to avoid certain complications. For more information go to Complete article. The manufacturers have detailed which patches are still likely to work in the meantime. For full details go to Neupro.

19th March 2008 - New research

ON WHICH SIDE OF THE BODY DO SYMPTOMS FIRST APPEAR ?

Parkinsonism Related Disorders [2008] Mar 15; [Epub ahead of print] (Yust-Katz S, Tesler D, Treves TA, Melamed E, Djaldetti R.) Complete abstract

The prevalence and predictive factors of which side of the body symptoms first appear in Parkinson's Disease has hardly been investigated. The aim of this study was to assess whether right handedness or left handedness determined the side of the body on which symptoms first appeared by assessing over 300 people with idiopathic Parkinson's disease. The dominant hand was recorded in each case, as were right-left differences in tremor, bradykinesia, and rigidity. Around 85% of patients were found to have initiated symptoms on one side of the body rather than the other.

In right handed patients, the initial symptoms appeared on the right side in 47% of patients, and on the left hand side in 38% of patients, with 15% of patients having symptoms appearing on both sides simultaneously. In left handed patients, the initial symptoms appeared on the right side in 36% of patients, and on the left hand side in 52% of patients, with 22% of patients having symptoms appearing on both sides simultaneously. So there is a tendency for symptoms to begin on the side that people use most, but only a tendency. This tendency is clearly nowhere near as strong as had been previously assumed.

18th March 2008 - News report

nuropro - for the detection of parkinson's disease

Power3 Medical Products have started a 300 patient clinical validation study of its NuroPro diagnostic test for Parkinson’s disease and Alzheimer’s disease. The study includes 100 Alzheimer’s disease patients, 100 Parkinson’s disease patients and 100 controls. The NuroPro test is based on Power3’s discovery of a group of 59 proteins in the blood that demonstrate significant differences in blood serum concentration for patients with Alzheimer’s Disease and Parkinson’s Disease. In blood serum, these protein biomarker combinations, when measured by blood serum proteomics, could lead to a far more effective diagnosis and treatment of Parkinson’s Disease and Alzheimer's Disease. Power3 expects to launch NuroPro at the end of 2008. For more information go to the Complete article. 

The test is based on proteomic technology. A small sample of blood is drawn from a vein. When a blood sample is collected and stored in a tube without anticoagulant, it forms a clot after 30-60 minutes. The liquid portion remaining is the blood serum. This serum sample is then frozen and transported to the Power3 Medical CLIA certified laboratory, utilizing pre-approved carriers/delivery service, where sample preparation and analysis begins. Power3’s statistical model evaluates the quantitative information of the protein biomarkers and automatically assigns a probability score. This indicates to the physician the patient has a Neurological disease or is disease-free. For more information go to NuroPro.

17th March 2008 - New book

Proud Hands : Personal Victories with Parkinson's    

Publisher's description : Parkinson's disease affects many areas of a person's daily living, but does not need to become the whole story of a person's life. That is why Teva Neuroscience and the American Parkinson Disease Association (APDA) have partnered to showcase the many inspirational things people living with PD accomplish every day. "Proud Hands" is filled with personal photos and stories from people across the nation sharing messages of hope and encouragement. The coffee table book is a unique collection from people with diverse backgrounds and ages. All proceeds from the sale of this book go directly to the APDA to support research, people living with PD, their caregivers and Parkinson's education.  Click here for more details 

16th March 2008 - New research

HOW MANY PEOPLE ARE SUITABLE FOR DBS SURGERY ?

Parkinsonism Related Disorders [2007] 13 (8) : 528-531 (Morgante L, Morgante F, Moro E, Epifanio A, Girlanda P, Ragonese P, Antonini A, Barone P, Bonuccelli U, Contarino MF, Capus L, Ceravolo MG, Marconi R, Ceravolo R, D'Amelio M, Savettieri G.) Complete abstract

DBS is a surgical method of treating Parkinson's Disease that uses electrodes implanted into the brain. For more information go to Deep Brain Stimulation. Researchers estimated the percentage of people with Parkinson's Disease that are suitable for subthalamic nucleus (STN) deep brain stimulation (DBS). They used the Core Assessment Program for Surgical Intervention Therapies in PD (CAPSIT-PD), which examines patients in a "practically defined off state" after overnight 12-hour drug withdrawal and again in the on state after their usual morning dose of L-dopa.

They found that out of 641 Parkinson's Disease patients only less than 2% fulfilled strict criteria in order to be eligible. When the researchers applied more flexible criteria, the percentage of eligibility increased. Yet the number of those that were eligible was still less than 5%. Most patients - 60% of them - were ineligible because they did not satisfy multiple questionnaire items. Items related to disease severity were responsible for the largest number of those people being excluded from eligibility.

15th March 2008 - New research

THE SENSE OF SMELL IN PARKINSON'S DISEASE

Arquivos de Neuropsiquiatria [2007] 65 (3A) : 647-652 (Quagliato LB, Viana MA, Quagliato EM, Simis S.) Complete abstract

The purpose of the study was to characterize the olfactory dysfunction (loss of of sense of smell) in Parkinson's Disease patients using the University of Pennsylvania 12 smell identification test (UPSIT). People with Parkinson's Disease were compared to a group of people without Parkinson's Disease. The sense of smell in Parkinson's Disease was shown to be clearly less.

The mean UPSIT score was only 5.7 in those with Parkinson's Disease, but 9 in those that didn't have it. Patients who initially had resting tremor, and those that currently have tremor, rigidity and bradykinesia had a significantly worse sense of smell. There was a negative relationship between patients' age and Parkinson's Disease stage with the UPSIT scores. There was no relationship between olfactory scores, and the age at the initial Parkinson's Disease symptoms, and no relationship with the disease duration. Among Parkinson's Disease patients, 80% had a loss of sense of smell. So loss of sense of smell gives an indication of Parkinson's Disease coming or existing. However, as 20% of people with Parkinson's Disease do not lose their sense of smell at all, it is not a reliable means of diagnosis.

14th March 2008 - New research

COMPULSIONS IN PARKINSON'S DISEASE

Neurologist [2008] 14 (2) : 89-99 (Stamey W, Jankovic J.) Complete abstract

This research examined the medical literature over a period 28 years concerning impulse control disorders in Parkinson's Disease. Pathologic gambling emerged as one of the most prominent impulse control disorders. Hypersexuality, compulsive shopping and other manifestations of obsessive-compulsive disorder may also dominate. Affected patients may display a pattern of self-escalation of dopaminergic drug dosing, which may lead to a state of drug dependency. Those patients most commonly affected by impulse control disorders, such as pathologic gambling and hypersexuality, are males who develop Parkinson's Disease at a younger age, and those with a previous history of mood disorders, or alcohol abuse, or obsessive-compulsive disorder. Dopaminergic drugs, particularly certain dopamine agonists, play an important role in triggering these symptoms. 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 and with sexual arousal,  the use of certain dopamine agonists can especially lead to unwanted compulsions or sexual arousal.

13th March 2008 - New research

NEW TEST FOR DETECTING PARKINSON'S DISEASE

Brain [2008] 131 (2) : 389-396 (M.Bogdanov, W.R.Matson, L.Wang, T.Matson, R.Saunders-Pulman, S.S.Bressman, M.F.Beal) Complete study

Due to faulty diagnosis, a huge number of people diagnosed with Parkinson's Disease do not actually have it. This is because diagnosis is usually based solely on a review of symptoms.

Clinical trials are also hindered because of difficulties in the assessment of symptoms. New research has shown a test that profiles molecular biomarkers in blood that could become the first accurate diagnostic test for Parkinson's disease. It relies on changes in dozens of small molecules in serum. These "metabolomic" alterations form a unique pattern in people with Parkinson's disease.  No one molecule was definitive, but a pattern of about 160 compounds emerged that was highly specific to Parkinson's patients. These included low uric acid, and increased glutathione. More work needs to be done to validate the findings. A test that would be used routinely by doctors is still a few years away.  For more information go to the Complete article.

12th March 2008 - New research

DIETARY URATE REDUCES RISK OF PARKINSON'S DISEASE

American Journal of Epidemiology [2008] Mar 7; [Epub ahead of print] (Gao X, Chen H, Choi HK, Curhan G, Schwarzschild MA, Ascherio A.) Complete abstract

Urate is a substance that is consumed in the diet, especially in certain fish (herring, mackerel, anchovies, sardines), and parts of animals (liver, beef kidneys, meat extracts). For more information go to Urate.

The authors examined whether a diet that increases plasma urate levels is also related to a reduced risk of Parkinson's disease. The study population comprised nearly 50,000 men. After 14 years of follow-up, the authors documented 248 cases of Parkinson's Disease. A higher dietary intake of urate was associated with a lower risk of Parkinson's Disease. This association remained strong and significant after adjustment for various factors. These data support urate as a potentially protective factor in Parkinson's Disease, and suggest that dietary changes that increase plasma urate levels may contribute to lower risk of Parkinson's Disease. The researchers do not explain why this association exists.

11th March 2008 - History

PARKINSON'S DISEASE IN ANCIENT CHINA

In China, descriptions and treatments of Parkinson's Disease date back nearly 2500 years. The Yellow Emperor's Internal Classic was titled with the name of the Yellow Emperor around 425-221 BC. The Yellow Emperor's Internal Classic Plain Questions is a 24-volume section of the Yellow Emperor's Internal Classic that collected clinical experiences of Chinese practitioners up to that period.

Volume 22 describes symptoms of tremor and stiffness. Volume 5 describes symptoms compatible with limitation of movement, postural disturbances, stiffness, and tremor as follows : A person appears with crouching of the head and with staring eyes, bending the trunk with shoulders drooped, with difficulty turning and rocking the low back, inability of the knees to flex and extend, with the back bowed, failure to stand for long periods, and tremor while walking.
                                                                                                                                  Written during the 6th Dynasty (AD 220-228), the book "Hua's Zhong Zang Classic" (chapter 37) contains a section titled "Thesis on Muscular Palsy". The author vividly describes festinating gait as he "walks fast and fast just as if running involuntarily, and unable to slow down."

During the Tang dynasty, Sun Simiao (AD 581-682) wrote a book entitled "Essential Prescriptions Worth a Thousand Gold". Volume 8 recommends a prescription of "Jinya wine" for those who for several years feel heavy, just as if being pulled by a string when raising an arm, a foot, or the body, to those who find it difficult to turn around, to walk without dragging the legs; and to those who cannot avoid getting into a running pace.

10th March 2008 - History

PARKINSON'S DISEASE IN MEDIEVAL CHINA

During the Jin Dynasty, Zhang Zihe (1151-1231) reported a case in "Ru Men Shi Qin" in which a 59 year old man had tremor in his jaw, hands and feet for 3 years. He failed to hold things and to eat by himself. His mouth stayed open, with a blank stare. He was depressed and attempted suicide, but he was unable to hang himself because of his tremulous hands. Zhang advocated diaphoresis using Fangfeng Tongsheng San, then inducing vomiting, expelling wind, and promoting circulation of qi through herbs, and nourishing by food. After treatment for several months, his condition improved, his feet were not as heavy as before, the tremor was less, and he was able to walk and to hold a comb, towel, spoon and chopsticks.
                                                                                                                                                                           During the Ming Dynasty, Sun Yikui (1522-1619) first classified a condition dominated by tremor in his book Chi Shui Xuan Zhu. He wrote of shaking from the elbows down, of the head, foot, and hand. He wrote that "the tremor is rare in the young and occurred after middle age, particularly in the elderly." He emphasized that the tremor syndrome is very difficult to treat, except for the case of Mr Ma from the Xin stockade village with good response to medication ... as reported by Zhang Zihe. Mr Ma's manifestations included symptoms of tremor, stiffness, and immobility. Therefore, it is likely that that he referred mainly to Parkinson's Disease when he described the tremor syndrome in the elderly.

During the Ming Dynasty, Wang Kentang (1549-1613) compiled a 44-volume book entitled "Standards for Diagnosis and Treatment". He advocated the use of an antitremor pill, which was  a mixture of gastrodia tuber and scorpion (for calming the liver-wind and alleviating the spasm); large-leaf gentian, olematis root, Ledebouriella root, schizonepeta herb, and wild ginger herb (for expelling pathogenic wind and removing dampness); prepared and dried rehmannia, Chinese angelica root, peony root, atractylodes rhizome, and astragalus root (to replenish "qi" and to nourish the blood); and chuanxiong (to promote blood circulation and the flow of qi). This antitremor pill was used not only for tremor, but also for stiffness (ie, relieving spasm and removing dampness). These medicinal components are still used for Parkinson's Disease in China.

Modern pharmacological studies of Zhang's Fangfeng Tongsheng San have found mechanisms of action that could explain its effects on movement disorders. These include herbs containing scopolamine (Ledebouriella root), anticholinergic compounds including peony root and licorice root, and products with antioxidant and freeradical scavenging effects. Jinya wine and the antitremor pill contain the same herbs as Zhang's Fangfeng Tongsheng San (ie, Chinese angelica root, peony root) and gastrodia as a main element. Gastrodia is particularly interesting because it contains gastrodin, which has been shown to increase dopamine levels in guinea pigs and to inhibit monoamine oxidase type B activity in aging mice. Furthermore, gastrodia appears to promote differentiation of mesenchymal stem cells of rats into neuron-like cells and possesses potential neuroprotective effects.

9th March 2008 - New research

THE BLOOD BRAIN BARRIER AND PARKINSON'S DISEASE

Parkinsonism Related Disorders [2008] Mar 4; [Epub ahead of print] (Bartels AL, van Berckel BN, Lubberink M, Luurtsema G, Lammertsma AA, Leenders KL.) Complete abstract

The blood brain barrier prevents unwanted chemicals passing from the blood in to the brain. It has been claimed that Parkinson's Disease was due to a defective blood brain barrier. The blood brain barrier tends to decline in function as people age. So it was suggested that toxic substances known to be able to cause Parkinson's Disease were able to cause symptoms due to being more readily able to pass the blood brain barrier.

In this study, this theory was assessed by comparing the function of the blood brain barrier in people with Parkinson's Disease, and in people that did not have Parkinson's Disease. A range of methods were used to assess the level of blood brain barrier function. Although there was greater variability in people that had Parkinson's Disease, the blood brain barrier in people with Parkinson's Disease was not found to be decreased. Therefore, people with Parkinson's Disease are no more prone to the effect of toxic substances than anyone else.

7th March 2008 - New research

THE EFFECT OF DUODOPA ON Parkinson's disease

Neurodegenerative Diseases [2008] 5 (3-4) : 244-246 (Antonini A, Mancini F, Canesi M, Zangaglia R, Isaias IU, Manfredi L, Pacchetti C, Zibetti M, Natuzzi F, Lopiano L, Nappi G, Pezzoli G.) Complete abstract

L-dopa in tablet form causes considerable fluctuations in L-dopa levels in the body. Duodopa is an infusion of L-dopa and carbidopa that is delivered directly in to the intestines. This ensures a continuous and even flow of L-dopa that can be adjusted according to the patient's individual needs. Treatment involves an operation to make a small opening in the abdomen so that a tube can be passed into the bowel. The tube is then connected to a portable pump that is worn during the day and which feeds L-dopa/carbidopa directly into the bowel. For more information go to Duodopa.

Researchers assessed the effectiveness of duodenal levodopa infusion on quality of life as well as motor features in patients with advanced Parkinson's Disease. Patients were assessed for up to 2 years, who were on continuous duodenal levodopa / carbidopa infusion through percutaneous endoscopic gastrostomy. They found a significant reduction in "off" period duration, as well as dyskinesia severity. There was significant improvement in the 39-item Parkinson's Disease Quality of Life Questionnaire as well as in the Unified Parkinson's Disease Rating Scale.  Only a few patients withdrew due to adverse events.

6th March 2008 - New research

Parkinson's disease drugs and the risk of gambling

European Journal of Neurology [2008] Feb 26; [Epub ahead of print] (Imamura A, Geda YE, Slowinski J, Wszolek ZK, Brown LA, Uitti RJ.) Complete abstract

Recent case-series studies indicated that drugs used to treat Parkinson's disease, especially Pramipexole, which is marketed as Mirapex, is associated with gambling.  Patients with Parkinson's Disease without any history of gambling, but who has started gambling, were matched with Parkinson's Disease patients who didn't gamble at all.

Combined therapy with Pramipexole and L-dopa did not increase the risk of gambling when compared to the use of Pramipexole on its own. However, the use of Pramipexole was significantly associated with increased risk of gambling. Patients with Parkinson's Disease who has started gambling were more likely to have been taking Pramipexole than any other drugs. L-dopa and dopamine agonists all have a dopaminergic effect. However, no reason is given why Pramipexole has any greater effect on gambling than any other dopamine agonists, or why dopamine agonists make people more inclined to gamble than L-dopa. Previous research showed that gambling is one of several compulsions caused by taking dopamine agonists. 

5th March 2008 - New book

Parkinson's Disease in THE OLDER PATIENT

Jeremy Playfer and John Hindle (Editors)      

Publisher's description : Parkinson’s Disease in the Older Patient has been fully revised, updated and expanded to include new treatments and entirely new chapters. Detailed information on the aetiology and pathogenesis of the condition, drug and surgical treatments, sleep disturbances, quality of life, and carers is now included, along with the more prevalent older patient issues such as neuropsychiatric disturbances, speech and swallowing problems, balance and falls, and autonomic disturbances. The updates also include new advice on the management and services in primary care, linked to the recent NICE guidelines. This new edition is recommended for all those involved in the treatment of Parkinson's Disease patients. Click here for more details 

4th March 2008 - News report

unfertilized STEM CELLS TO BE USED IN parkinson's disease

International Stem Cell Corporation announced that its human parthenogenetic stem cell lines will be used in Germany in studies aimed at creating specific cell types to treat human neural diseases such as Parkinson's disease. ISCO's human parthenogenetic stem cells are created from unfertilized human eggs, yet they share with conventional human embryonic stem cells the ability to differentiate into all tissue types. They are also the first step in solving one of the major obstacles to stem cell therapy, which is the rejection of implanted cells by the patient's own immune system.

So cells derived from this line will not be immune rejected after transplantation into millions of individuals of differing sexes, ages and racial groups. They aim to make their cell lines and intellectual property easily available, and thereby become a supplier of stem cells for use by patients across the world. Their intention is to distribute their human parthenogenetic stem cell lines to as many qualified researchers as possible. For more information go to the Complete article. Despite stem cell surgery already taking place around the world, nobody has been rid of Parkinson's Disease after having it.

 

3rd March 2008 - New research

istradefylline - a non-dopamine approach to parkinson's disease

Annals of Neurology [2008] Feb 27; [Epub ahead of print] (Lewitt PA, Guttman M, Tetrud JW, Tuite PJ, Mori A, Chaikin PC, Sussman NM) Complete abstract

Istradefylline (KW-6002), in dosages of 40mg per day was studied in people with Parkinson's Disease being treated for Parkinson's Disease, who were experiencing prominent wearing-off motor fluctuations. Istradefylline is a fairly new type of drug for use in Parkinson's Disease that is similar in its action to Caffeine. Istradefylline acts independently from the formation of dopamine. It is a selective adenosine A(2A) receptor antagonist. This means that Istradefylline reduces the effect of adenosine.

As adenosine has a largely inhibitory effect in the central nervous system, Istradefylline reduces that inhibition. This reduction in adenosine's inhibitory effects indirectly enables an  increased activity of dopamine. The reduction in "off" time found after using Istradefylline was nearly two hours. Istradefylline was also found to be relatively safe, because the adverse effects when using Istradefylline were generally mild. There was also no dyskinesia as a result of taking it. The FDA have still not approved its use because of several concerns. For more information go to the Complete article.

2nd March 2008 - New research

the long term effects of parkinson's disease

Movement Disorders [2008] Feb 28; [Epub ahead of print] (Hely MA, Reid WG, Adena MA, Halliday GM, Morris JG.) Complete abstract

After 20 years follow-up of newly diagnosed patients with Parkinson's disease, 74% of them had died. Drug induced dyskinesia and end of dose failure were experienced by most patients, but the main problems related to the features of the disease that were not L-dopa responsive.

Dementia is present in 83% of 20-year survivors, and is highly related to age. Only one of the survivors lived independently. Nearly half of them were in nursing homes. Excessive daytime sleepiness was noted in 70%. Falls had occurred in 87%, freezing had occurred in 81%, fractures in 35%, symptomatic postural hypotension in 48%, urinary incontinence in 71%, moderate dysarthria in 81%, choking in 48%, and hallucinations in 74%. 

1st March 2008 - History

shakespeare and parkinson's disease

William Shakespeare (1564-1616) shows in his plays an astonishing knowledge of contemporary medicine. Over 700 quotations are said to be found in his work dealing with medical matters. Extracts from his plays, show that William Shakespeare was well aware of the clinical picture of elderly people with motor difficulties and tremor. In "Richard II (Act II, Scene III), the aging Duke of York describes a loss of arm movement when he says : "How quickly should this arm of mine, now prisoner to the palsy". In Troilus and Cressida (Act I, Scene II), Ulysses talks in his monologue about Achilles, whom he considers old and of no use.

He clearly connects "Palsy" with the shaking of tremor when he says : "And with a palsy fumbling on his gorget, Shake in and out the rivet." In "King Henry VI, part 2" (Act IV, scene VII) there is another reference to tremor. When Dick asks "Why dost thou quiver [shake], man ?", the response from Lord Say is "It is the palsy, and not fear, provokes me." It appears that Lord Say also has head tremor, when Jack Cade says : "I'll see if his head will stand steadier on a pole". Shakespeare, and probably his audience, were very familiar with the "palsy" and its symptoms. This term most likely was then used for a clinical picture we today would recognize as Parkinson's Disease.