Saturday, June 1, 2013
Latest Development in the Treatment of Parkinson Disease
My wife was diagnosed with early Parkinson Disease( PD) about six months ago. Today she is taking a carbo-levodopa( Sinemet)combination, 25/100mg to control her hand tremors. Thus, any new developments that may help my wife from the unpleasant and related problems caused by PD really interest me. As you know, today there is no cure for PD. If you have not heard about PD: Parkinson's disease is a degenerative brain disorder, affects more than 1 million Americans. It destroys nerve cells in the brain that make dopamine, which helps control muscle movement. Patients experience shaking or tremors, slowness of movement, balance problems and a stiffness or rigidity in arms and legs.
A recent article written by Kathleen Doheny (HealthDay News) indicated that there are three new drugs that may offer hope to PD patients. These are: Droxidopa, tozadenant and Azilect
In one study, Hauser evaluated the drug droxidopa, which is not yet approved for use in the United States, to help patients who experience a rapid fall in blood pressure when they stand up, which causes light-headedness and dizziness. About one-fifth of Parkinson's patients have this problem, which is due to a failure of the autonomic nervous system to release enough of the hormone norepinephrine when posture changes.
Those on the medicine had a two-fold decline in dizziness and light headedness compared to the placebo group. They had fewer falls, too, although it was not a statistically significant decline.
In a second study, Hauser assessed 420 patients who experienced a daily "wearing off" of the Parkinson's medicine levodopa, during which their symptoms didn't respond to the drug. He compared those who took different doses of a new drug called tozadenant, which is not yet approved, with those who took a placebo. All still took the levodopa.
At the start of the study, the patients had an average of six hours of "off time" a day when symptoms reappeared. After 12 weeks, those on a 120-milligram or 180-milligram dose of tozadenant had about an hour less of "off time" each day than they had at the start of the study.
In another study, Hauser looked at 321 patients with early stage Parkinson's whose symptoms weren't handled well by a medicine called a dopamine agonist, typically the first drug prescribed for Parkinson's patients. During the 18-week study, Hauser assigned them to take either their usual medicine plus an add-on drug called rasagiline (brand name Azilect) or their usual medicine and a placebo.
Azilect is approved for use in patients with early stage disease as a single therapy or as an add-on to levodopa, Hauser said, but not yet as an add-on to dopamine agonists. Those taking the Azilect -- but not those taking the placebo -- improved by 2.4 points on a standard Parkinson's disease rating scale.
Each of the studies was funded by the pharmaceutical company making the particular drug: Chelsea Therapeutics paid for the blood-pressure study; Biotie Therapies Inc., supported the "wearing-off" study; and Teva Pharmaceutical Industries sponsored the Azilect study. Hauser is a consultant for all three companies.
So far the most impressive of the three studies is the use of droxidopa to prevent dizziness and fainting, said Dr. Michael Okun, national medical director of the National Parkinson Foundation and director of the University of Florida Center for Movement Disorders and Neurorestoration.
This is indeed good news for millions who are suffering from Parkinson's disease.
Personal Note: Today, after six weeks on the waiting list, my wife had finally made an appointment with a neurologist specializing in movement disorder associated with PD. To my surprise the neurologist indicated that nicotine and caffeine as well as fruits like blue berries appeared to delay the onset of PD. He also prescribe Azilect as an add-on to Sinemet. He also prescribed my wife to go to a physical therapist to minimize falls and improved gait and walking. He also recommended that she take Vitamen E and C. Finally he recommended that my wife get a brain scan (MRI), just to assure no mild stroke had occurred. One final note: My wife loves this neurologist. He is the only physician that does not tell her to quit smoking. To summarize, the current treatment for PD is three-way:medications, exercise( physical therapy) and diet.