When singer Neil Diamond announced in January that he would stop touring after being diagnosed with Parkinson’s disease, it brought new attention to the neurodegenerative disorder that can bring many different kinds of symptoms.
While there isn’t a cure, there are several means of treating the effects of the disease, from drugs to exercise.
And there are a lot of promising areas of research, according to Dr. Lisa Shulman, professor of neurology at the University of Maryland School of Medicine, director of the University of Maryland Parkinson’s Disease & Movement Disorder Center and a neurologist specializing in Parkinson’s disease and other movement disorders at the University of Maryland Medical Center.
What is Parkinson's and what causes it?
Parkinson’s disease is a type of neurodegenerative disorder. This means an area of a person’s brain is injured, and the injury progresses over time. In Parkinson’s disease, the part of the brain that controls movement is affected. Changes also have been found outside the brain in other regions of the body, even in the gastrointestinal tract.
We don’t yet have a clear answer for what causes Parkinson’s disease. We know that genetics play a part. But of the thousands of people living with Parkinson’s, the majority do not have other family members with the disease. Like many chronic conditions, genetics make a person vulnerable to Parkinson’s disease but not necessarily at high risk for developing it.
What does it do to a person over time?
Parkinson’s affects the brain’s ability to produce dopamine, which regulates movement and emotional responses. Most people associate Parkinson’s with a tremor, which many, but not all, people experience. It also causes a slowing down of movement, stiffness and loss of dexterity.
In addition to motor problems, Parkinson’s may cause cognitive changes, including problems with attention and multitasking. It may cause sleep disturbance, balance problems, constipation, fatigue and depression. Parkinson’s progresses very gradually; loss of balance and cognitive problems usually emerge many years after onset.
Levodopa and other medicines that boost the dopamine system are effective for motor symptoms including tremor, slowness and stiffness. When it comes to non-motor symptoms, we have a whole toolbox of medications. Options are available to treat depression, anxiety, constipation and sleep. For many people, the most disabling parts of Parkinson’s disease are balance and cognitive problems, but effective treatments for these problems are yet to be discovered.
The last 20 years have brought important surgical options to treat Parkinson’s disease. Deep brain stimulation (DBS) surgery has become a standard of care to treat motor fluctuations. An electrode is placed deep inside the brain in a targeted area. The electrode is connected to a stimulator that is placed under the skin in the upper chest, similar to a pacemaker. DBS requires one or two burr holes in the skull, and electrodes are passed through the brain. It produces effects that are similar to taking levodopa medication and the effects are continuous. The complication rate is low; however, because it is a device, there can be complications, such as connection problems (electrodes and wires) and need for battery replacement.
Do non-pharmacologic treatments such as exercise slow progression of the disease?
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One of the most important discoveries in the last 15 years has been that physical activity clearly benefits people with Parkinson’s. Both aerobic and muscle-strengthening exercises — treadmill, resistance, cycling, boxing, dancing and tai chi, to name a few — have all been shown effective and can improve walking. Aerobic exercise improves endurance, while resistance improves muscle strength — so people should be doing both. It is important to keep the heart rate up for 30 to 45 minutes to reap the benefits. With muscle strengthening, the goal is to progressively increase the weights over time.
This is a promising time for Parkinson’s disease research because many novel approaches are being tested. For people with a recent Parkinson’s diagnosis, we are currently investigating an antibody that breaks down abnormal protein deposits in the brain. The hope is that this approach will prevent or delay disease progression. The University of Maryland Medical Center is one of the centers participating in this clinical trial.
MRI-guided focused ultrasound is a new approach that is simpler than DBS surgery. It is classified as surgery, but doesn’t involve cutting or implanted wires. Instead, a small lesion is made deep in the brain with ultrasound. As with DBS, the focused ultrasound procedure helps improve tremor, dyskinesia and motor fluctuation when medication isn’t effective. It potentially has fewer side effects than DBS. The procedure is currently FDA-approved for another medical condition called essential tremor, but not yet for Parkinson’s disease. We are conducting clinical trials at the University of Maryland Medical Center to investigate focused ultrasound for Parkinson’s.