The new treatments for Parkinson’s tremors (and more)

from Cesare Peccarisi

Deep brain stimulation can complement drugs in controlling the disease. And the techniques for early diagnosis are refined

Significant progress has been made in the treatment of Parkinson’s in recent years (here the Corriere Salute forum). A leap forward, for example, is represented by the possibility it has shown deep brain stimulation
known by the acronym DBS from English Deep brain stimulation – explains Alfredo Berardelli, Professor of Neurology at the University La Sapienza, Rome -. In 1997 the US Food & Drug Administration approved it for the control of tremor in Parkinson’s and essential tremor.

Essential tremor and Dbs

What is the difference between Parkinson’s and essential tremor? The essential tremor – clarifies Berardelli, who is also president of the Italian Society of Neurology – causes shaking during movement and not accompanied by other Parkinson’s symptoms, such as slowing down, muscle stiffness, and balance disturbances. Those with essential tremor happen to be unable to drink a coffee without spilling it, while the Parkinsonian can do so because his hands tremble when resting, when he grabs a cup they calm down

Is Dbs an Alternative to Medicines? In 2002 it was discovered that by stimulating certain brain areas with DBS it was possible to control the symptoms of Parkinson’s on which the drugs were no longer able to act and the following year it was also approved for the dystonia
, a condition in which the muscles contract in a disorderly manner and the patient seems to twist on himself, the expert points out. Many considered it the last resort. 2016 was the year of the turning point with his approval in association with drugs in those with persistent motor complications even for only four years. Over time, Dbs has become more and more accurate and, being able to treat younger and younger subjects without age-related complications, it has become a safe and up-to-date solution.

Telemedicine

Thanks to telehealth it can now also be driven remotely and there is also an Italian version by Professor Alberto Priori of the University of Milan that adapts to the motor needs of the moment. With a good selection of patients and in state-of-the-art Centers if associated with drugs more effective than drugs alone. The evolution of the treatment, however, that towards multidisciplinary centers where on the same day you can be seen by the neurologist, neurosurgeon, psychiatrist or internist. Often relatives of sufferers ask whether hereditary Parkinson’s.

The causes and prevention

Can you predict in advance if you will get sick? The illness it has both genetic, environmental and above all subjective causes– Berardelli specifies -. It is necessary to focus more and more on the characteristics of each individual because in theory this allows us to predict the evolution of the disease and of the response to drugs. We have identified the likely final cause of the disease, ie the structural change of a protein that we all have in the brain for memory. Is called synuclein and it can transform: it changes structure, accumulates and suffocates the dopaminergic neurons (those that “suffer” in Parkinson’s, ed), triggering the disease. Why it changes has not yet been understood, but to find alpha synuclein (other than normal) indicates if someone will get sick we already know how to detect it, for example in saliva.

Meanwhile, experiments are underway for what we could call “Vaccine” for Parkinson’s, a monoclonal antibody directed against this mutated protein, similar to that created for the coronavirus. This may be the best therapy and, with the pandemic-induced accelerations in pharmaceutical production, it could come within a year.

The news in drugs

Is there any news for drugs? The neurotransmitter deficiency causes the disease dopamine
produced by neurons in certain areas of the brain. They have been fine-tuned injected, sublingual or nasal spray rescue treatments for patients who suddenly freeze for the so-called freezingbut the reference drug remains the levodopa
than a laboratory-created dopamine substitute. The first time the patient takes it he is fine, so much so that we talk about a “therapeutic honeymoon”.

After a few years the effect subsides. Twenty years ago we had an unfounded fear of it causing damage to neurons and it was thought that the dyskinesias, the strange involuntary movements that at a certain point appear above all on the tongue, mouth and face were a consequence. Today we know that levodopa is non-neurotoxic and using it early and at the right doses does not worsen the course of the disease.

Levodopa and its effects

Does the duration of the effect of levodopa depend on the dosage at which it is used? To delay the use of levodopa, even drugs have been created that squeeze the neurons that produce dopamine, the dopamine agonists, to the last drop. Gianni Pezzoliformer director of the Parkinson’s Center of the Institutes of Perfection in Milan, who was one of the first to verify in the field the groundlessness of the false prejudices on levodopa by going to treating patients in sub-Saharan Africa who have long since disappeared in the West -. There was no levodopa there, but there were so-called de novo or nave patients with long years of illness and never treated who opened our eyes. We understood that here we were trying to delay the use of levodopa because we were giving too much, while at the right doses the best drug.

We also made mistakes with dopamine-agonists – adds Professor Berardelli -. If suspended abruptly cause discontrol of impulses turning patients into innocent gamblers or in serial shoppers from compulsive shopping for an irrepressible urge to psychological compensation from too much dopamine. Winning at gambling or filling the wardrobes increases dopamine and the Parkinsonian thus found a way to quench this dopaminergic thirst that we had given him.

May 4, 2022 (change May 4, 2022 | 21:24)

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The new treatments for Parkinson’s tremors (and more)


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