Health: A multi-pronged approach

April 20, 2018

With April 11 marking World Parkinson’s Day, Suvi Mehonen discovers there are reasons to be hopeful.

 

 

Professor Simon Lewis will never forget the field study he conducted 18 years ago when he was working as a neurology research registrar in Cambridge, England, and he visited the homes of 200 people living with Parkinson’s disease. 


The difficulties these patients faced were heartbreakingly clear as he witnessed their loss of movement, and saw how weary they were as he sensed their fear and confusion. 


“Half of all Parkinson’s patients experience freezing of gait where, without warning, their feet stick to the ground, often causing them to fall,” Lewis tells me. “Ninety per cent of patients have sleep-wake disturbances, 40 per cent of patients get depression, 80 per cent will develop dementia and 70 per cent will suffer from hallucinations and delusions.”


Lewis, now a consultant neurologist at the Royal Prince Alfred Hospital, Professor of Cognitive Neuroscience at the University of Sydney and director of the Parkinson’s disease Research Clinic at the Brain and Mind Centre, is totally committed to making a positive difference for sufferers of Parkinson’s. 


“My goal is to be able to offer more effective treatments to slow the disease and relieve symptoms,” he says. 


Parkinson’s disease—a combination of movement disorders including tremor, muscle rigidity, impaired balance and slowness of movement, as well as associated neurological problems—is estimated to affect approximately 10 million people around the world  and cause over 100,000 deaths annually. 


In a paper released this year in The Medical Journal of Australia Lewis argues that, just as the cause of Parkinson’s appears to be multifactorial, the best way to tackle the disease is through a combination of approaches.


“Research has highlighted many processes that appear to be going awry in the dying brain cells, so it is not clear that correcting one of these on its own would be enough,” he told me. “For example, a medication that clears abnormal proteins might need to be supplemented with agents that reduce inflammation, increase cellular energy supplies or remove toxic chemicals. We are now used to the idea of combining therapies, for example in treating cancers and HIV.”


In his paper Lewis outlines a number of avenues that are currently being explored in the search for a cure. The observation that Parkinson’s disease is less common in smokers and caffeine drinkers has led to trials involving nicotine and caffeine supplementation. Likewise, there are lower rates in asthma sufferers who use medications such as Ventolin—an observation that Lewis says should lead to future disease-modifying trials. 


The possibility that excessive clumping of alpha-synuclein (a protein found in the brain) may contribute to Parkinson’s disease has led to efforts to try to develop a vaccine to stimulate the immune system to reduce alpha-synuclein levels. 


Electrolyte and mineral modifying agents may also potentially help, Lewis says, while hope has been raised by Exenatide, an injectable drug used for diabetes. A trial published in The Lancet last year showed an improvement in motor scores in patients with Parkinson’s disease who used this medication. 


Other approaches that Lewis believes show promise include stem cell therapy, photobiomodulation (using red and near-infrared light), fasting diets and alteration of the gut microbiome.  


Professor John Mitrofanis, medical scientist and Professor of Anatomy at the University of Sydney, agrees that much remains to be discovered about Parkinson’s disease and that more research is needed. 


“I think there may well be multiple causes,” says Mitrofanis. “The disease appears to come from lots of angles and there seem to be different subtypes so treatments should reflect this.”


Despite the challenges ahead there is hope. 


“It is true to say that there has never been a more exciting time in the pursuit of an effective treatment to slow, stop or reverse Parkinson’s disease. Disease-modifying trials are rapidly spreading around the world,” Professor Lewis states at the end of his paper.

 

For more information about Parkinson’s disease, or to find resources and support, visit www.healthdirect.gov.au/parkinsons-disease

 

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