Navigating Parkinson's Disease: Advances in Prevention and Treatment

Parkinson's disease presents a significant neurological challenge, characterised by its progressive nature and profound impact on movement and overall quality of life. At OT&P Healthcare, we understand the importance of staying informed about the latest developments in treatment and prevention strategies. This blog post aims to shed light on innovative approaches to managing Parkinson's disease, focusing on cutting-edge treatments aligning with our commitment to enhancing health and promoting healthy ageing.

Advances in Treatment

Stem Cell Research

Stem cells have the potential to develop into many different cell types, offering hope for regenerating damaged nerve cells in Parkinson's patients and offering potential for regenerating the damaged neurons responsible for the symptoms of Parkinson's. Recent advancements in stem cell therapy have shown promise in laboratory settings, with ongoing clinical trials exploring their efficacy in humans. This research aims to restore neurological function and improve patients' quality of life, marking a significant step forward in treating Parkinson's disease.

A notable development in this area was presented at the International Congress of Parkinson's Disease and Movement Disorders in Copenhagen¹last August 2023, by a collaborative effort between pharmaceutical giants. They shared results from a clinical trial where an innovative therapy, aimed at introducing dopamine-producing cells developed from stem cells into the patient's body, was tested. This approach has been well received, with the treatment showing not only a good safety profile but also significant improvements in symptoms for participants over a period of 12 months. These promising findings have paved the way for further research, with plans for a more extensive Phase 2 study to further investigate the therapy's potential.

This ongoing exploration into stem cell therapy embodies a significant leap towards restoring neurological function and enhancing the quality of life for those afflicted with Parkinson's disease, marking a critical advancement in the battle against this and potentially other neurodegenerative diseases.

Novel Medications and Therapies

In addition to stem cell research, new medications and therapies are being developed to manage the symptoms of Parkinson's disease better and slow its progression. These include drugs designed to increase dopamine levels in the brain and innovative therapies like deep brain stimulation, which involves implanting electrodes in the brain to help control movement symptoms. 

Semaglutide (GLP-1 receptor agonist) 

A recent study² published in December 2023, has shown that semglutide medications like Ozempic and and Wegovy, often used for obesity, might also help people with Parkinson's disease because of its ability to fight inflammation in the body. This medication is part of a group known as GLP-1RAs, which work by mimicking a natural hormone in our body.

The research found that these GLP-1RAs can calm inflammation, which is not only a problem in type 2 diabetes but also in diseases like Parkinson's where the brain becomes inflamed. Interestingly, the way these drugs work isn't by acting directly on the immune system but rather through certain receptors in the brain. This means they can reduce harmful inflammation throughout the body by influencing the brain's control over these processes.

In more detailed terms, the study showed that activating a specific target in the brain with GLP-1RAs could decrease a harmful substance called TNF-α³  which plays a big role in inflammation. This effect helps to lessen symptoms in severe conditions like sepsis, where the body has an extreme response to infection causing widespread inflammation and damage to tissues, including the lungs. 

Dopamine Agonists

Dopamine agonists are a cornerstone in the treatment of Parkinson's disease, offering symptomatic relief by mimicking the action of dopamine in the brain. These medications are particularly effective in the early stages and can be used in conjunction with other treatments as the disease progresses.

Recent advancements in dopamine agonist treatments have brought about innovative approaches to managing Parkinson's disease, further enhancing the therapeutic landscape. Notably, the development of staccato apomorphine⁴  represents a significant leap forward. This aerosol-based formulation simplifies the administration of dopamine agonists, particularly beneficial for patients experiencing tremors, making self-administration of medication challenging. By offering an easier, more accessible method of delivery, staccato apomorphine ensures that patients can receive their medication promptly, potentially improving the management of off-episodes and enhancing overall quality of life.

MAO-B Inhibitors

MAO-B inhibitors slow the breakdown of dopamine in the brain, providing symptom relief and potentially delaying the progression of Parkinson's disease. They represent a critical strategy in comprehensive disease management, especially beneficial when started early.

Additionally, some studies suggest that MAO-B inhibitors may have neuroprotective effects, potentially slowing the progression of Parkinson's disease, although this aspect is still under research. One notable study, the ADAGIO trial⁵ , specifically examined the effects of the MAO-B inhibitor rasagiline on disease progression in early Parkinson's disease patients. By preserving more dopamine in the brain and possibly protecting against further neuronal damage, MAO-B inhibitors not only alleviate symptoms but may also contribute to a better long-term outlook for patients with Parkinson's disease. The findings from the ADAGIO trial hint at the potential for these inhibitors to modify the course of the disease beyond mere symptom management.

Deep Brain Stimulation (DBS)

DBS is a surgical treatment option for patients with advanced Parkinson's disease, where medication alone does not effectively control symptoms. It involves implanting electrodes in the brain to regulate abnormal impulses, significantly reducing motor symptoms and improving quality of life.

There have been incredible advancements⁶ in the technological aspects of DBS surgery, significantly enhancing the precision and effectiveness of the procedure for patients with advanced Parkinson's disease. Innovations include the use of higher field strength MRI for direct visualization of brain targets and the integration of structural, functional, and connectivity imaging to improve anatomical modelling and electrode placement. Additionally, the development of novel electrode designs and implantable pulse generators has made the surgery more accurate, potentially leading to better outcomes for patients. These technological advances in DBS surgery promise to offer improved quality of life for a broader range of patients by making the procedure more precise and less invasive.

Physical and Occupational Therapy

Physical and occupational therapy are essential in managing Parkinson's disease. They focus on maintaining mobility, balance, and daily living skills. Tailored exercise and therapy programs are vital for enhancing physical function and promoting independence.

A 2023 study⁷ has shown that long-term medication use for Parkinson's doesn't always work as well over time and can cause side effects. This is why therapies that don't involve medication are becoming more important. These therapies include things like physical exercises, walking on a treadmill, following music or dance routines, talking therapies, working with an occupational therapist, exercises in water, and even martial arts. They help improve symptoms of Parkinson's that medication or surgery can't always address, especially for symptoms that are tough to treat.

The advancements in treatments for Parkinson's disease are bringing renewed hope to patients and their families. From stem cell research and novel medications to innovative therapies and enhanced surgical techniques, the landscape of Parkinson's disease management is evolving, offering new possibilities for improved quality of life and a brighter future for those affected by the condition.

References

1. Parkinson’s UK. (2023). Positive results announced from early stage stem cell therapy trial. [online] Available at: https://www.parkinsons.org.uk/news/positive-results-announced-early-stage-stem-cell-therapy-trial.  (Accessed: 14 March 2024). 

2. Chi Kin Wong, McLean, B.A., Baggio, L.L., Koehler, J.A., Hammoud, R., Nikolaj Rittig, Yabut, J.M., Seeley, R.J., Brown, T.J. and Drucker, D.J. (2024). Central glucagon-like peptide 1 receptor activation inhibits Toll-like receptor agonist-induced inflammation. Cell Metabolism, 36(1), pp.130-143.e5. doi:https://doi.org/10.1016/j.cmet.2023.11.009.

3. Jang, D., Lee, A-Hyeon., Shin, H.-Y., Song, H.-R., Park, J.-H., Kang, T.-B., Lee, S.-R. and Yang, S.-H. (2021). The Role of Tumor Necrosis Factor Alpha (TNF-α) in Autoimmune Disease and Current TNF-α Inhibitors in Therapeutics. International Journal of Molecular Sciences, 22(5). doi:https://doi.org/10.3390/ijms22052719.

4. Beaney, A. (2023). Trials to watch: Pipeline Parkinson’s drugs could revolutionise treatment. [online] Clinical Trials Arena. Available at: https://www.clinicaltrialsarena.com/features/trials-to-watch-parkinsons-disease/. (Accessed: 14 March 2024).

5. Poewe, W., Hauser, R.A. and Lang, A. (2014). Effects of rasagiline on the progression of nonmotor scores of the MDS-UPDRS. Movement Disorders, 30(4), pp.589–592. doi:https://doi.org/10.1002/mds.26124.

6. Schulder, M., Mishra, A., Antonios Mammis, Horn, A., Boutet, A., Blomstedt, P., Chabardes, S., Flouty, O., Lozano, A.M., Neimat, J.S., Ponce, F.A., Starr, P.A., Krauss, J.K., Marwan Hariz and Jin Woo Chang (2023). Advances in Technical Aspects of Deep Brain Stimulation Surgery. Stereotactic and Functional Neurosurgery, [online] 101(2), pp.112–134. doi:https://doi.org/10.1159/000529040.

7. Dhamija, R., Saluja, A. and Goyal, V. (2022). Multi-Modal rehabilitation therapy in parkinson’s disease and related disorders. Annals of Indian Academy of Neurology, [online] 0(0), p.0. doi:https://doi.org/10.4103/aian.aian_164_22.