Parkinson’s Disease

An Overview of Conventional and

Experimental Treatments
 Background
• Parkinson’s disease is a disorder that affects
nerve cells in the part of the brain controlling
muscle movement
• Disease is progressive – signs/symptoms
worsen over time
• Eventually is disabling, but progresses gradually
• Believed to be caused by genetics,
environmental factors or a combination of the
two
 Parkinson’s Disease Stats
• First desribed by James Parkinson in 1817
• Affects ~1 million in the U.S.
• Onset typically between 50-60 years of
age, and slowly progresses with age
• Average onset is 62.4 years of age
 Neurological Basis
• “Neurodegenerative Disease” : caused by degeneration
(dysfunction and death) of neurons within the brain
(nigrastriatal pathway of the basal ganglia)
• NORMAL BRAIN FUNCTION – Basal Ganglia
• Cells in substantia nigra produce/release dopamine
• Dopamine released by SN neurons lands on neurons of other
brain centers, controlling their firing
• Main targets are caudate nucleus and putamen (striatum)
• This basal ganglia pathway is involved in regulation of
movement
 Neurological Basis
• PARKINSON’S BRAIN FUNCTION–Basal
Ganglia
• Cells of substantia nigra degenerate
• These cells can no longer produce adequate amounts of
dopamine
• Neurons of striatum, etc. are no longer well regulated,
thus do not behave in normal manner
• Results in loss of control of movements – leads to
symptoms characteristic of Parkinson’s disease
 Characteristic Symptoms
• MOTOR • NONMOTOR
– tremor – diminished sense of
– bradykinesia smell
– rigidity/freezing in – low voice volume
place – foot cramps
– lack of facial – sleep disturbance
expression – depression
– postural instability – constipation
– stooped, shuffling gait – drooling
 Conventional Treatments:
Medication
• LEVODOPA (L-DOPA)
• precursor to dopamine, converted to dopamine by
nerve cells in the brain
• Treatment with dopamine not possible, because
dopamine can’t cross blood-brain barrier
• Generally combined with carbidopa (Sinemet) –
helps levodopa get to the brain + reduces some
side effects
• Extended use often produces dyskinesias –
uncontrolled movements (writhing, twitching,
shaking) among other minor side effects
 Conventional Treatments:
Medication
• DOPAMINE AGONISTS
• not changed into dopamine, but rather act LIKE
dopamine at brain synapses where dopamine is
usually present (nigrostriatal pathways in
Parkinson’s patients)
• Used both as adjuncts to L-Dopa therapy and in
younger Parkinson’s disease patients
• Side effects similar to levodopa, but less likely to
develop involuntary movements, more likely to
cause hallucinations
 Conventional Treatments:
Medication
• MAO Inhibitors (Selegiline)
• COMT Inhibitors
• Anticholinergics
 Conventional Treatments:
Surgery
• Thalamotomy
• Involves destruction of small amounts of tissue in
the thalamus—major center for relaying
messages/transmitting sensations
• Can cause slurred speech and lack of coordination
• Pallidotomy
• electric current used to destroy small amount of
tissue in the pallidum (globus pallidus)
• May improve tremors, rigidity by interrupting
pathway between globus pallidus and thalamus
 Conventional Treatments:
Surgery
• Deep Brain
Stimulation
• implant device,
pacemaker-like unit
transmits impulses to
electrodes placed in
subthalamic nucleus
• Produces same effects
of lesion surgeries, but
can be turned on and
off
 Experimental Treatment:
Surgery
• Fetal Cell Transplant Therapy
• stem cells obtained via aborted fetus, grown in culture,
transplanted into Parkinson’s patient at nigrostriatal pathway
• New cells establish connections and “replace” cells originally
lost, these cells function normally and even produce
dopamine
• Autologous “Self” Transplant
• analagous to fetal cell transplant, except that precursor
nerve cells are taken from patient and coaxed to produce
dopamine, then implanted back into original patient
• Reduces threat of autoimmune response and reduced
“controversial baggage” associated with FCT therapy
 Experimental Treatment:
Surgery
• Retinal Pigmented Epithelial Cell
Transplant
• Dopamine-producing cells taken from pigmented
retinal epithelium
• Mechanism of transplant analagous to fetal cell
transplant therapy
• If loss of contact from substrate, these cells die
• Consequently, lower risk of aberrant integration—
possible cause of dyskinesias seen in some FCT
patients
 Sources
• Aminoff, M. (2003). Parkinson Primer: Overview of Parkinson’s Disease. Retrieved
November 16, 2005, from
http://www.parkinson.org/site/pp.asp?c=9dJFJLPNB&b=71354.
– This source provided me with the most of the background information necessary in
explaining the foundation of the disease. This source was especially helpful in determining
the characteristic symptoms of the disorder as well as statistics.
• Freed, C.R., Green, P.E., Breeze, R.E., Tsai, W., DuMouchel, W., Kao, R., Dillon, S.,
et al. (1994). Transplantation of Embryonic Dopamine Neurons for Severe
Parkinson’s Disease. New England Journal of Medicine, 344, (7), 710-
719.
– This source played a large part in writing the actual paper. In this article was information on
the background of stem cells, implications in stem cell research, and most beneficial, the
actual experimental procedure itself.
• Lieberman, A. (2004). What is Parkinson’s Disease? Retrieved November 14, 2005,
from http://www.pdcaregiver.org/WhatIsParkinsons.html.
– This source didn’t help much background information on the disease, but did help in
providing an comprehendable version of the substantia nigra and its role in development of
Parkinson’s disease. Also beneficial were the figures associated with this source.