How to treat Parkinson’s disease in 2013

Department of Neurology, Norfolk and Norwich University Hospital NHS Trust.
Clinical medicine (London, England) (Impact Factor: 1.49). 02/2013; 13(1):93-6. DOI: 10.7861/clinmedicine.13-1-93
Source: PubMed


Parkinson's disease is a common, progressive, debilitating disease with substantial physical, psychological and social implications. Pharmacological management is complex and should be individualised according to the needs of the patient. In early disease, treatment is generally highly effective, but medication becomes increasingly inadequate in controlling motor fluctuations and dyskinesias as the disease progresses. Non-motor symptoms, especially depression and dementia, require a holistic, multidisciplinary approach to maximise quality of life for patients and their carers. For the future, the ideal solution remains neuroprotection and restoration. Progress has been hampered by the lack of animal models that reflect the widespread brain pathology presumed to cause both motor and non-motor symptoms of PD in humans. Currently, agents are undergoing clinical trials in early, mildly affected patients, such as the plant-derived substance PYM50028 (Cogane), which promotes expression of endogenous neural growth factors and has shown promise in vitro and in animal models. Gene-therapy trials in progress rely on the viral vectors used to deliver the enzymatic machinery required for dopamine synthesis to the striatum. As PD progresses, adequate control of motor symptoms depends increasingly on continuous drug delivery, and greater physiological stimulation of dopamine receptors may help to prevent the development of LIDs and motor fluctuations. Efforts thus are afoot to develop better delivery systems for levodopa, and a new sustained-release formulation is in development.

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Available from: Paul F Worth
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    • "Parkinson's disease (PD) is a common progressive, disabling neurodegenerative disorder with onset of motor and non-motor features (Müller, 2012), namely with substantial physical, psychological , and social implication (Worth, 2013). "
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    ABSTRACT: Objectives: To evaluate the effect of deep brain stimulation of the subthalamic nucleus (STN-DBS) on alexithymia, a deficit in affective regulation, comparing patients with Parkinson’s disease (PD) submitted to STN-DBS (DBS group) to PD patients not yet treated with STN-DBS (pre-DBS group) and to healthy participants (C group). Methods: We recruited 27 consecutive STN-DBS PD patients, 38 consecutive pre-DBS patients and 27 healthy participants. Patients were assessed for alexithymia (Toronto Alexithymia Scale), depression, [beck depression inventory (BDI)], and cognitive functions (reasoning, memory, attentional, and executive tests). Results: The DBS patients performed worse than the pre-DBS patients in the corsi’s block-tapping test, in the phonemic fluency task and in the Frontal Assessment Battery. Around 30% of DBS (29.6%) and pre-DBS (31.6%) patients resulted alexithymic, compared with 14.8% in the C group. The results pointed out significantly higher alexithymia scores in both the DBS and pre-DBS groups compared with the C group, while no difference emerged between the DBS and pre-DBS groups. Pre-DBS group showed a significantly higher BDI score than the C group, while DBS group did not. Conclusion: Although the results suggest that STN-DBS does not affect alexithymia, both the DBS and pre-DBS patients reported higher prevalence (about 30%) of alexithymia than did healthy subjects (14.8%).
    Full-text · Article · Oct 2014 · Frontiers in Psychology
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    • "Dopamine-induced activation of D 1 -and D 2 -class receptors plays a critical role in a plethora of physiological effects in the central nervous system and periphery (Baik, 2013; Beaulieu & Gainetdinov, 2011; Missale et al., 1998; Zeng et al., 2004). Hypo-and hyperstimulation of D 1 -and D 2 -class subtypes have been strongly implicated in the phenotypic expression of several neuropsychiatric and peripheral disorders, and hence, dopamine receptors represent important therapeutic targets (Beaulieu & Gainetdinov, 2011; Boyd & Mailman, 2012; Bozzi & Borrelli, 2013; Brunelin, Fecteau, & Suaud-Chagny, 2013; Cuevas, Villar, Jose, & Armando, 2013; Harris & Zhang, 2012; Huot, Johnston, Koprich, Fox, & Brotchie, 2013; Leggio et al., 2013; Missale et al., 1998; Worth, 2013; Zeng et al., 2004; Zhang, Xiong, Zhen, & Zhang, 2009). Constitutive activities of 5-HT 2C receptor, m-opioid receptor, and CB 1 receptor have been shown to modulate the mesolimbic dopamine system to potentially influence mood, reward, and food intake, respectively (see review Meye, Ramakers, & Adan, 2014). "
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    ABSTRACT: Parkinson's disease (PD) is a neurodegenerative condition of unknown etiology. This article is devoted to special genotoxicological testing of a new substance with antiparkinsonian activity. It was assessed using Allium cepa-test system. As a result of study of the effect (1R, 2R, 6S)-3-methyl-6-(prop-1-en-2-yl) cyclohex-3-ene-1,2-diol in cell model object (Allium cepa) we revealed two distinctive features of the effects of substance-itotoxic effect and no increase in the frequency of genetic disorders with increasing concentration of the substance. In general, the tested substance seems safe.
    Full-text · Article · Jan 2013 · World Journal of Medical Sciences
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