Pumped Up about Promising new Parkinson’s Pump

parkinson-disease60Parkinson’s disease, as many of our readers know is a chronic, progressive neurological disease that causes sufferers to lose control of body movements, resulting in tremors, muscle stiffness, loss of balance and a host of other problems. Currently, there is no cure for Parkinson’s disease and treatment options are limited. Therapy is directed at treating the symptoms that are most bothersome and for this reason, there is no standard or “best” treatment for that applies to every patient.

Treatment approaches include medications and surgery (deep brain stimulation) as well as general lifestyle modifications (rest and exercise), physical, occupational and speech therapy.

levodopaAmong the drug-related therapies, levodopa is considered one of the most effective for relieving the symptoms of Parkinson’s disease. It helps reduce tremor, stiffness, and slowness and helps improve muscle control, balance, and walking. Levodopa does not slow the disease process, but it improves muscle movement and delays severe disability. So far, levodopa, which had been used to treat Parkinson’s since the 1970’s, has only been available in pill form.

But a new Cleveland Clinic study finds that using a pump to administer a gel form of levodopa directly into the small intestine is much more effective.

Neurologist Hubert Fernandez, MD, who led the study, says, “The levodopa pump decreased or improved what we call the ‘bad time’ in Parkinson’s patients by up to four hours per day.” The levodopa can control this ‘bad time’ — the tremors, muscle spasms and other movement disorders that makes it difficult for Parkinson’s patients to function on a daily basis.

parkinsons-gel-drug-pump-190x155This is an amazing finding,” says Fernandez. “We know of no other oral therapy that will improve the bad time in Parkinson’s by an average of four hours daily.”

The levodopa pump is external. It sits in a pouch under the patient’s shirt and provides a steady dose of the drug. The levodopa gel is administered directly into the small intestine, where most of the drug is absorbed. The constant dose makes the body’s movements more controlled and predictable, making it easier for people with the disease to plan and go about their day without worrying that the drug’s effects will wear off.

The biggest advantage of the levodopa is its efficacy,” Dr. Fernandez says. “We’re trying to deliver it on a continuous basis so the patients don’t need to take it every hour.” parkinsons gel pump

69-year-old Bob Van Housen has been living with Parkinson’s disease for over 12 years.  Prior to enrollment in the study he was having to take up to five levodopa pills every three hours to control his symptoms. Even then, his symptoms progressed to the point where it was hard to keep up.  “He was ‘off’ for at least seven hours,” said Van Housen’s wife, Carol. “Seven hours is a long time to not be able to function every day.”

The couple often had to cut their trips together short and limit their social outings outside of the house. Van Housen says that being part of the trial at Cleveland Clinic has been life-changing. “We can predict better how I’m going to feel and how I’m going to act and can plan trips and work around those times when I otherwise would have been problematic.”

The gel pump which is not yet available in the United States is currently under review by the Food and Drug Administration. Let’s hope it doesn’t hit any hurdles along the way, so others with Parkinson’s can avoid the roller-coaster of symptoms and enjoy the type of benefits that Bob has experienced.

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T-A T-A to A-T?

SRxA’s Word on Health is delighted to share news that could change the lives of the 500 or so children and families in the US, dealing with a rare and deadly disease.  The breakthrough, announced this week in the online edition of Nature Medicine, suggests that scientists may have found a way to prevent and possibly reverse the most debilitating symptoms of ataxia telangiectasia (A-T) a rare, progressive childhood degenerative disease that leaves children, unable to walk, and in a wheelchair before they reach adolescence.

As regular readers of this blog know, A-T is a cause close to our hearts, and the courage of these children and their families inspire us daily.

Karl Herrup, chair of the Department of Cell Biology and Neuroscience and his colleagues at Rutgers have discovered why this genetic disease attacks certain parts of the brain, including those that control movement coordination, equilibrium, muscle tone and speech.

When the team examined the brain tissue of young adults who died from A-T, they found a protein (HDAC4) in the nucleus of the nerve cell instead of in the cytoplasm where it belongs. When HDAC4 is in the cytoplasm it helps to prevent nerve cell degeneration; however, when it gets into the nucleus it attacks histones – the small proteins that coat and protect the DNA.

What we found is a double-edged sword,” said Herrup. “While the HDAC4 protein protected a neuron’s function when it was in the cytoplasm, it was lethal in the nucleus.”

To prove this point, Rutgers’ scientists analyzed mice, genetically engineered with the defective protein found in children with A-T, as well as wild mice. The animals were tested on a rotating rod to measure their motor coordination. While the normal mice were able to stay on the rod without any problems for five to six minutes, the mutant mice fell off within 15 to 20 seconds.

However, after being treated with trichostation A (TSA), a chemical compound that inhibits the ability of HDAC4 to modify proteins, they found that the mutant mice were able to stay on the rotating rod without falling off – almost as long as the normal mice.

Although the behavioral symptoms and brain cell loss in the engineered mice are not as severe as in humans, all of the biochemical signs of cell stress were reversed and the motor skills improved dramatically in the mice treated with TSA. This outcome proves that brain cell function could be restored.

Neurological degeneration is not the only life-threatening effect associated with A-T. The disease, which occurs in an estimated 1 in 40,000 births, causes the immune system to break down and leaves children extremely susceptible to cancers such as leukemia or lymphoma. There is no known cure and most die in their teens or early 20s.

Herrup says although this discovery does not address all of the related medical conditions associated with the disease, saving existing brain cells and restoring life-altering neurological functions would make a tremendous improvement in the lives of these children.

 “We can never replace cells that are lost,” said Herrup. “But what these mouse studies indicate is that we can take the cells that remain in the brains of these children and make them work better. This could improve the quality of life for these kids by unimaginable amounts.”

A-T families are cautiously excited by the news. The A-T Children’s Project facebook page notes “This is certainly hopeful news, and we look forward to the results from further studies.”

We certainly do. A cure cannot come soon enough.

Bigger is better – when it comes to stroke prevention

Brain aneurysm is a condition in which a blood vessel in the brain weakens and bulges.

While the sufferer is often unaware of their existence there is a risk that the vessel wall will rupture and result in a brain bleed or hemorrhagic stroke.

Approximately 5% of the US population will develop a brain aneurysm, most commonly women between the ages of 35 and 60.

And while the risk of rupture is only 1%, approximately 30% of such patients die within 24 hours and an additional 25-30% die within four weeks.

The traditional treatment for both ruptured and unruptured aneurysms involves clipping. During the procedure, surgeons open the skull, expose the brain and place a tiny metal clip on the abnormal blood vessel.

A less invasive technique known as endoscopic coiling, has been available since the mid-1990s. This involves inserting a catheter into the femoral artery and guiding it to the location of the aneurysm, where it is packed with platinum coils to prevent blood flow into the affected area.

Despite the introduction of coiling the outcomes of treatment of unruptured brain aneurysms, have remained stagnant over the last 10 years.

Now a new study published in the journal Stroke, suggests that this less than impressive result can be explained by the dramatic proliferation of procedures being performed at lower-volume community hospitals, where outcomes are inferior.

The research team of neurologists, neurosurgeons and neuro-anesthesiologists at NewYork-Presbyterian Hospital and Columbia University Medical Center compared hospital discharges for unruptured intracranial aneurysms (UIAs) in two time periods: 2005 to 2007 and 1995 to 2000.

They found that since 1995, there has been a six-fold increase in the treatment of UIAs by coiling at smaller community hospitals.

This isn’t a problem with technology but rather the way it has been delivered,” says study co-author Dr. Robert A. Solomon, neurosurgeon-in-chief at NewYork-Presbyterian Hospital. “Endoscopic coiling has been hugely helpful for the vast majority of patients, and it has actually been shown to have the potential for better outcomes relative to open surgery. It just hasn’t improved the overall picture, at least in New York state, where we focused our study.”

The authors say the increased popularity of coiling in smaller community hospitals may stem from the perceived ease of doing the procedure as well as cost concerns, with poor outcomes the result of technical shortcomings or errors in judgment.

Boosting overall outcomes, the authors say, will take a return to greater centralization of care at academic medical centers.  “Centers that offer comprehensive cerebrovascular care with both surgical and endovascular capabilities are best equipped to make treatment decisions based on what’s best for the patient,” says Dr. Solomon.

As a woman in the at-risk age group, should I ever need to clip or coil I’ll be sure to go comprehensive!

Stop Brain Shrinkage

Did you resolve to eat healthier this year? If so, SRxA’s Word on Health brings you a couple of very good reasons to stick with it.

According to a study published in the December 28, issue of Neurology, people with diets high in vitamins and omega 3 fatty acids are less likely to have the brain shrinkage associated with Alzheimer’s disease.

People who ate diets high in omega 3 fatty acids and in vitamins B, C, D, E also had higher scores on mental thinking tests than people with diets low in those nutrients.  Omega 3 fatty acids and vitamin D are primarily found in oily fish. The B vitamins and antioxidants C and E are primarily found in fruits and vegetables.

Conversely, the study showed that people with diets high in trans fats were more likely to have brain shrinkage and lower scores on the thinking and memory tests than people with diets low in trans fats. Trans fats are primarily found in packaged, fast, fried and frozen food, baked goods and margarine spreads.

The study included over 104 people, with very few risk factors for memory and thinking problems. Blood tests were used to determine the levels of various nutrients in the blood of each participant. Participants also took tests of their memory and thinking skills and underwent MRI scans to measure their brain volume.

The nutrient biomarkers in the blood accounted for a significant amount of the variation in both brain volume and thinking and memory scores. For the thinking and memory scores, the nutrient biomarkers accounted for 17% of the variation in the scores. Other factors such as age, number of years of education and high blood pressure accounted for 46% of the variation and, the nutrient biomarkers accounted for 37% of the variation seen in brain volume.

These results need to be confirmed, but obviously it is very exciting to think that people could potentially stop their brains from shrinking and keep them sharp by adjusting their diet,” said study author Gene Bowman, ND, MPH, of Oregon Health & Science University.

Although the average age of study participants was 87, we’re going to start heeding this advice now. Salmon salad anyone?