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Health Information Five Things You Should Know About ... Parkinson's Disease

From advanced research to empowering fitness programs, the outlook for people with Parkinson's disease is improving.

Brought into the limelight by actor Michael J. Fox, Parkinson's disease affects the body’s ability to control movement. The most prominent signs of Parkinson's disease result from damage to brain cells that produce a neurochemical called dopamine. Dopamine helps people have smooth, coordinated muscle movements by relaying messages to the parts of the brain that control these movements.

Damage to dopamine-producing cells can induce symptoms, such as tremors, stiffness and slowness. "The early signs tend to be subtle and intermittent, and then they become more progressive until it is clear that something is wrong," says Kathleen Shannon, MD, a neurologist who specializes in movement disorders at Rush University Medical Center.

The damage to brain cells is not limited to those producing dopamine. Other symptoms such as depression, anxiety, cognitive impairment, constipation and fatigue result from damage to other brain regions and are the focus of more recent research.

At present, Parkinson's disease is a chronic disease with no known cure. While symptoms can be managed with medication, they continue to worsen. The good news? Shannon predicts that in the next decade there will be significant breakthroughs in treating Parkinson's disease and slowing the progression of the disease.

In fact, according to the National Institute of Neurological Disorders and Stroke, current advances in Parkinson's research have already raised realistic hopes of being able to halt the progression of the disease, restore lost function and even prevent it entirely. While the timeframe for this is hard to predict — it could be within five to 10 years — one thing is certain: hope is on the horizon. Here, Shannon shares five things to know about Parkinson's disease.

Early detection may improve future treatments. One of the big pushes in Parkinson’s research today is detecting the disease before such characteristic movement symptoms, like tremor, surface. Research suggests that dopamine begins to decline six to 10 years before any neurological symptoms appear and that damage to other nervous system regions may occur even earlier. Very early signs of Parkinson's disease that may appear before evident motor deterioration include the following:

  • Loss of sense of smell, which begins about four to six years before movement dysfunction.
  • Chronic constipation, which can begin up to 12 years before motor symptoms.
  • Physically acting out dreams at night, a sleep disorder that is known as REM behavior disorder, can begin up to decades before any motor symptoms.

While these symptoms do not always signify Parkinson's disease, people should discuss these issues with a physician. By studying groups of people with early signs, researchers are developing treatments that target different parts of the brain that could slow, or even halt, the progression of the disease. "Our goal is to find ways to prevent people from developing movement problems, and we're getting to a point where that is an achievable goal," Shannon says.

Standard treatments are being tweaked. Since the late 1960s, levodopa (a medication that the brain converts to dopamine) has been the most effective treatment for addressing motor symptoms of Parkinson's disease. The problem for some patients, however, is levodopa does not provide the constant flow of dopamine necessary for smooth function throughout the day. "People sometimes get into a pattern of good function when the medication is working well, alternating with bad function when the medication is not working well," Shannon says. "That unpredictability makes it hard to live a normal lifestyle."

New research is focused on developing treatments that will give people a more steady flow of dopamine and decrease fluctuations. "There is a lot of work going on to fine-tune brain cells to receive dopamine so the response is better," says Shannon. "The Michael J. Fox Foundation and some of the drug companies are very interested in this area of research."

One common side effect of not having steady levels of dopamine is dyskinesia (involuntary movements). To address this issue, Christopher Goetz, MD, director of the Parkinson's Disease and Movement Disorders Program at Rush, is working on a multi-center clinical trial of topiramate (a seizure medication) as an add-on to amantadine (a medication used for treating dyskinesia) to improve control of dyskinesia. This study is funded by the Michael J. Fox Foundation, and Rush is both a participating site and the coordinating site for the study.

Additionally, Leo Verhagen, MD, PhD, a neurologist at Rush, is participating in a study involving an investigational agent for dyskinesia. The study will include people who are taking amantadine as well as those who are not taking amantadine for dyskinesia.

Surgical intervention decreases fluctuations. People who respond well to medications, but struggle with fluctuations throughout the day may be eligible for deep brain stimulation (DBS), a surgical treatment in which a neurostimulator delivers tiny electrical signals to areas of the brain that control movement.

"DBS is not dopamine, and it does not cause the release of dopamine. But the stimulation is constant, so it reproduces the effect of having constant dopamine," says Shannon. "For people who do well with DBS, it is a miraculous improvement."

While DBS is rarely a substitute for medication, it is a good option for otherwise healthy people who have periods where their medications aren't working.

Exercise can improve function. In addition to its well-known effects of slowing down cognitive decline and boosting heart and lung function, exercise can help improve gait, balance, tremor, flexibility, grip strength and motor coordination in people with Parkinson's disease. Ongoing studies are also looking at how exercise may, in fact, influence the progression of the disease.

Beneficial exercises include treadmill training, biking, dance, tai chi, yoga, and strength and flexibility training.

Five years ago, Rush partnered with Hubbard Street Dance Center to create a dance class for Parkinson's patients. Today, Hubbard Street Dance's Parkinson’s Project is a popular weekly class for people with Parkinson's disease, their loved ones and their caregivers. The program uses contemporary dance techniques, along with live music, to help patients improve their balance, dexterity or an overall mobility. Equally as important, the class is a warm, welcoming community that provides emotional support to its participants.

Managing your mood is crucial. Living with a chronic, progressive disease can take a serious emotional toll on patients and their loved ones. Depression and anxiety are common symptoms of Parkinson’s disease, with up to 60 percent of people who have the disease experiencing mild or moderate depressive symptoms.

"Depression becomes the real driver of quality of life for people with Parkinson's disease," says Shannon. "You can adjust people's motor function all day long with medication or surgery, but if you can't improve their mood, then they have a poor quality of life."

Some patients benefit from psychological counseling and/or taking medications to help improve their mood. Support groups — such as the group hosted by Rush Oak Park Hospital the second Saturday of each month — can also help people with Parkinson's disease learn how to live changed, yet still full lives.

"We work with our patients to find medications and other strategies that will improve their quality of life at every stage of the disease, targeting the symptoms that matter most to them and their families," says Shannon.


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Please note: All physicians featured in Discover Rush Online are on the medical faculty of Rush University Medical Center. Some of the physicians featured are in private practice and, as independent practitioners, are not agents or employees of Rush University Medical Center.

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May 2013


 

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