Parkinson’s disease is the second most common neurodegenerative disease in the elderly and the most prevalent movement disorder seen in neurology clinics. Moreover, it is known that Parkinson’s disease incidence will further increase as there are far more people living beyond 65 years of age than in the past. Incidentally, Parkinson’s disease is still often overlooked as a diagnosis in younger patients. It is thought that the number of cases occurring in individuals below the age of 40 may actually be higher than the estimated two percent of the population with the disease.
The author of ‘10 Breakthrough Therapies for Parkinson’s Disease’, Dr. Michael Okun is internationally celebrated as both a neurologist and a leading researcher. He is often referred as the voice of the Parkinson’s disease patient and he has also been honored at the White House in 2015 as a Champion of Change for Parkinson’s disease. He has an international following on the National Parkinson Foundation’s Ask the Doctor web-forum.
“Consequently, there is a critical shortage of Parkinson’s disease-trained specialists,” says Dr. Okun. A remark which is true not only for the United States but also for the Middle East.
At this point it is also interesting to know that most of the studies focusing on the genetic components of Parkinson’s disease target Americans, Europeans, Asians whereas Arab populations (excluding North African Arabs) particularly Saudis remain to be explored.
“The purpose of this book is to inform, educate, and to inspire Parkinson’s disease patients, family members, as well as health care professionals and scientists. Together, we will journey toward better treatments … and one day a cure,” says Dr. Michael Okun.
Parkinson’s disease patients hope that a therapy which will slow down this progressive degenerative disease can eventually be found. Lately, a number of FDA approved drugs are being repurposed for Parkinson’s disease. This is the case with Nilotinib, this drug currently used in chemotherapy is being researched for its potential to alter the abnormal protein build-up in Parkinson disease patients. Tests are being done to determine if there are changes in the protein in spinal fluid, and whether inflammatory markers in the blood change after taking Nilotinib. This approach could slow down or stop Parkinson’s disease progression. The results of the first safety study should be available in the near future. Moreover, another scientist, Phil LoGrasso is focusing on a class of enzymes called jun-N-terminal kinsases which are important for brain cell survival. LoGrasso is presently getting industrial funds to develop a new drug based on these enzymes
An exciting recent change in the treatment approach to Parkinson disease is the development of new brain targets that have moved the field beyond the effective dopamine and dopamine agonist-based treatments.
Multiple pharmaceutical companies as well as scientists have shown a keen interest in the adenosine A2A receptor which are a group of circuits in the brain involved in the problems that result in the symptoms of Parkinson’s disease. Although the results of drug studies have been so far disappointing, it is exciting that pharmaceutical companies and scientists are beginning to look for novel therapies to treat the symptoms of Parkinson’s disease.
Many articles have also appeared in the press regarding the benefits of drinking tea and coffee.
“Consumption of coffee or tea seems to reduce the risk of developing Parkinson. Once you have been diagnosed with Parkinson’s disease, no matter how much time you spend in Starbucks, you can no longer alter your risk profile. The cat is out of the bag. Consumption of caffeine in moderate doses does however seem to benefit the motor symptoms of Parkinson’s disease,” says Dr. Michael Okun.
On the other hand, recent studies have proved that exercising regularly has meaningful benefits both in Parkinson’s specific symptoms and in quality of life. Dr. Samer Tabbal, Associate Professor of Neurology at the American University Beirut Medical Center and one of the best specialists in Parkinson’s disease in the region also stresses the importance of regular exercise and believes that exercise is an essential part of the treatment. But it is important to choose the appropriate exercise, the right frequency and the safest approach with your doctor and your physical therapist.
The author also underlines the importance of ensuring that a patient with Parkinson’s disease should be followed by both a neurologist and a primary care physician.
“In an age when patients and clinicians seek more expensive diagnostic tests, it is intriguing to consider that a simple referral to a neurologist for co-management with a primary care physician may have the biggest and most important impact on a Parkinson’s disease patient’s outcome … Perhaps an even better recommendation would be for co-management by a Parkinson’s disease specialist.”
One of the most exciting breakthrough therapies for Parkinson’s disease is the discovery of the drug L-Dopa. In the 1950s, Arvid Carlsson rescued animals with parkinsonian symptoms by treating them with a new chemical compound called L-Dopa. Carlsson’s research led to his Nobel Prize which he received in 2000. By the late 1960s, his observations were translated into humans and the drug L-Dopa became straight away one of the most remarkable treatments ever introduced for a human neurological disease. In 1988, the combination known as Sinemet (carbidopa/levodopa) was approved by the FDA, and millions of Parkinson’s disease patients have benefited enormously.
In the early 1980s, a new class of drugs known as dopamine agonists appeared on the market. These super drugs directly stimulate the brain’s dopamine receptor but it has been proved without doubt that dopamine agonists are associated with impulse control disorders. However, clinical experience and the NPF study support the idea that dopamine agonist can be a powerful adjunct to the best parkinson’s therapy.
The author also denounces the campaign referred to as “levodopa phobia” which avoids prescribing levodopa. This negative movement has denied the best clinical care for many people suffering from Parkinson’s disease. A recent article in the Lancet showed that levodopa phobia and the favoring of dopamine agonist therapy were essentially driven by aggressive pharmaceutical marketing.
Another amazing breakthrough therapy for Parkinson’s disease was initiated by the French surgeon, Alim-Louis Benabid, the day he decided to remove the lesion probe he had used hundreds of time before and replace it with a wire later referred to as a DBS lead.
DBS sets off a complex symphony of coordinated information which ultimately leads to improvement of Parkinson’s disease symptoms. DBS also stimulates neurogenesis, or the formation of new brain cells. Stimulating the growth of new brain cells has opened up the hope that this technology may unlock better treatments for neurodegenerative diseases such as Parkinson’s disease.
Finally scientists are also exploring the concept for a smart DBS system in Parkinson disease. The beauty of this approach is that the battery can be re-programmed in the same way an app is updated on a mobile phone.
A promising breakthrough for Parkinson’s disease is the testing of a vaccine designed to stop Parkinson’s disease. Many scientists believe that much of the damage in Parkinson’s disease is due to the brain’s failure to get rid of clusters of bad proteins. As these bad proteins spread, they disrupt many motor and non-motor brain circuits which lead to visible manifestations.
The idea behind the Parkinson’s vaccine is simple. Patients will receive four injections. The hope is that the injections will stimulate an immune system response that will attack bad brain proteins, ultimately clearing them out of the body.
However, patients need to know that the vaccine is still in the very early stages of testing, but the idea of boosting immunity and using immunotherapy is novel and promising. The hope is that clearing Parkinson’s-associated brain proteins will translate into disease modification. A similar approach is also being tested in other diseases such as Alzheimer’s disease, diabetes and atherosclerosis.
Finally a new field of research known as optogenetics has developed into one of the most important areas in Parkinson’s and science in general. “Opto” refers to placing light onto the brain to activate channels or enzymes that will ultimately change brain cell firing. The genetics part of optogenentics makes use of a simple virus carrier system to deliver genes to the brain.
Activating brain circuits by using both light and genetics has evolved from a science-fiction dream into a reality. The technique will undoubtedly be refined in the years to come and may explain what causes Parkinson’s disease and open the way to novel therapies.
Michael Okun believes that it is likely that the founder of optogenetics, Karl Deisseroth, will one day be awarded the Nobel Prize for his ground breaking research.
As a conclusion it must be said that there are many drugs for Parkinson’s disease in the pipeline and this can be very confusing. The best way to monitor drugs that are part of research studies is to use the website www.clinicaltrials.gov.
10 Breakthrough Therapies For Parkinson’s Disease is the sequel to Dr. Okun’s bestseller “Parkinson’s Treatment: 10 Secrets to a Happier Life”. This book takes us on a journey toward better treatments and to a cure.
“There is a hope that a new future drug will meaningfully slow disease progression,” concludes Michael Okun.

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