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MRgFUS for Parkinson’s Disease: A Game-Changing Non-Invasive Treatment or Just Another Lesioning Surgery?

January 20, 2025By 0 comment

Parkinson’s disease (PD) is a progressive neurological disorder that affects movement, causing symptoms like tremor, rigidity, and bradykinesia. While medications help manage symptoms, they often become less effective over time, leading many patients to explore advanced treatment options. Magnetic Resonance-guided Focused Ultrasound (MRgFUS) has emerged as an exciting, non-invasive alternative to surgery for certain Parkinson’s symptoms, offering precise brain lesioning without incisions or implants.

This article provides a comprehensive Q&A format, breaking down MRgFUS from its basic principles to its latest clinical evidence. We explore its advantages, limitations, comparisons with DBS, patient eligibility, long-term effectiveness, costs, and future prospects. Additionally, we take a critical look at whether MRgFUS is truly a breakthrough or just another lesioning procedure with the same pitfalls as past surgical techniques.

By the end of this guide, readers will have a well-rounded, evidence-backed understanding of MRgFUS for Parkinson’s disease, helping them make informed decisions about this emerging technology.

1. What is MRgFUS?

Magnetic Resonance-guided Focused Ultrasound (MRgFUS) is a revolutionary technology that allows doctors to perform non-invasive brain treatments. It combines focused ultrasound waves with real-time Magnetic Resonance Imaging (MRI). The ultrasound waves are concentrated on a small, precise spot in the brain, creating heat to either ablate or modify tissue. This enables doctors to target and treat specific areas responsible for symptoms without the need for surgery.

The MRI serves a dual purpose: it guides the ultrasound to the target location and monitors the temperature during the procedure, ensuring safety and accuracy. This integration of imaging and sound-wave technology allows for incisionless treatments, reducing the risks of infection, bleeding, and long recovery times seen in traditional brain surgeries.

MRgFUS is used in treating conditions like essential tremor and Parkinson’s disease, offering a safer alternative to more invasive procedures like deep brain stimulation (DBS). Its precision means that only the problem-causing brain tissue is affected, leaving surrounding healthy tissue unharmed​​​.

2. How did MRgFUS evolve?

The concept of targeting specific brain regions for treatment has been around since the 1940s, starting with early lesioning techniques. These procedures involved creating controlled injuries in brain regions to treat movement disorders but often resulted in side effects due to the lack of precision.

In the 1990s, deep brain stimulation (DBS) replaced lesioning for many patients. DBS allowed for adjustable and reversible treatments, but its invasive nature and the need for implanted hardware posed challenges, such as infection risks and device maintenance​​.

The development of MRI revolutionized imaging, enabling real-time visualization of the brain with high accuracy. Simultaneously, advancements in ultrasound technology led to the ability to focus sound waves with pinpoint accuracy. By combining these technologies, MRgFUS was developed as a safer, more precise alternative.

The FDA approved MRgFUS for essential tremor in 2016, followed by tremor-dominant Parkinson’s disease in 2018. It has since gained recognition for its minimal invasiveness and growing potential to treat a variety of neurological conditions​​.

3. How does MRgFUS work?

MRgFUS operates on a simple principle: focusing ultrasound waves to generate heat at a specific target in the brain, similar to using a magnifying glass to concentrate sunlight on a single point. Thousands of ultrasound beams pass harmlessly through the skin and skull before converging on the target. The heat generated at this focus disrupts abnormal brain circuits causing disease symptoms.

MRI plays a critical role by guiding the ultrasound to the precise location and monitoring temperature changes in real-time. This ensures that the correct target is treated while protecting surrounding healthy tissue. The patient remains awake during the procedure, allowing doctors to confirm immediate symptom relief, such as reduced tremors​​.

This process does not involve any incisions or hardware implants. Instead, it relies on precise imaging and temperature control, offering a less invasive option for treating brain conditions​​.

4. What are the current applications of MRgFUS?

MRgFUS is FDA-approved for two main conditions: essential tremor and tremor-dominant Parkinson’s disease. It is particularly effective for patients who have not responded to medications or are unsuitable for invasive surgeries like DBS​​.

In addition to these, MRgFUS is being explored for:

  • Neuropathic Pain: Targeting brain regions responsible for chronic pain​​.
  • Obsessive-Compulsive Disorder (OCD): Altering abnormal circuits in the brain​.
  • Drug Delivery: Temporarily opening the blood-brain barrier to deliver medications directly to the brain​​.

MRgFUS’s precision, safety, and minimal recovery time make it a promising tool in treating neurological and other disorders​​.

5. Why is MRgFUS promising for neurological disorders?

Neurological disorders often involve dysfunction in specific brain circuits, and MRgFUS excels in targeting these precisely. For example, in essential tremor or Parkinson’s disease, MRgFUS can disrupt overactive circuits, leading to symptom relief. Unlike traditional surgeries, it requires no incisions, reducing risks of complications like infections and bleeding​​​.

Another groundbreaking aspect of MRgFUS is its ability to open the blood-brain barrier temporarily. This natural protective barrier prevents most medications from reaching the brain. By opening it selectively, MRgFUS allows therapies for conditions like Alzheimer’s and brain tumors to reach their targets effectively​​.

Its non-invasiveness, coupled with precise real-time monitoring, makes MRgFUS a transformative option in neurology, providing symptom relief with fewer side effects and quicker recovery​.

6. How is MRgFUS used in Parkinson’s Disease?

MRgFUS is increasingly recognized as a game-changer in the treatment of Parkinson’s disease (PD), particularly for motor symptoms such as tremor, rigidity, and bradykinesia. It is most commonly used to create precise lesions in brain areas involved in motor control, such as the subthalamic nucleus (STN) or the globus pallidus internus (GPi). These regions are overactive in PD, and disrupting their function can significantly reduce symptoms​​.

The process starts with identifying patients whose symptoms are not fully controlled by medications or those who are unsuitable for deep brain stimulation (DBS). MRgFUS is especially useful for individuals with asymmetric symptoms (where one side of the body is more affected) and those who prefer a non-invasive alternative. During the procedure, patients are awake, allowing doctors to monitor improvements in real-time, such as tremor reduction or smoother movements​​.

Clinical trials and studies have shown significant symptom improvement with MRgFUS. For example, one study reported a 52% reduction in motor symptom severity on the treated side, sustained over three years. The technique is primarily unilateral, meaning it treats only one side of the brain at a time, to minimize risks such as speech or gait disturbances​​.

7. What studies support MRgFUS in Parkinson’s Disease?

Numerous studies have demonstrated the efficacy of MRgFUS in managing Parkinson’s disease. A landmark randomized controlled trial published in the New England Journal of Medicine showed that patients who underwent MRgFUS subthalamotomy had a significant reduction in motor symptoms compared to a control group. This study highlighted an 8-point improvement on the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS III) for the treated side after four months, compared to a 1-point change in the control group​.

Another long-term study followed patients for three years after unilateral MRgFUS treatment (long term follow up of intial RCT published). Results showed a sustained 52% improvement in motor symptoms on the treated side, with no major delayed adverse events reported. The same study noted that patients experienced a marked improvement in rigidity, bradykinesia, and tremor, while their quality of life improved significantly​.

Other studies have focused on the anatomical and physiological effects of MRgFUS. Research published in Science Advances used lesion-symptom mapping to show that targeting specific subregions of the STN can selectively improve tremor, rigidity, or bradykinesia. These findings help refine the treatment and improve outcomes​.

8. Who are the best candidates for MRgFUS?

The ideal candidates for MRgFUS are individuals with Parkinson’s disease who meet specific criteria:

  1. Asymmetric Motor Symptoms: MRgFUS is most effective for patients with symptoms predominantly affecting one side of the body​.
  2. Medication-resistant Symptoms: Patients whose symptoms persist despite optimal medical management are good candidates​​.
  3. Ineligibility for DBS: Patients who cannot undergo invasive surgeries due to medical risks (e.g., bleeding disorders, advanced age) or those who prefer a non-invasive approach​​.

Patients with low skull density ratios (which can affect ultrasound wave penetration) or severe axial symptoms like balance and gait disturbances may not benefit as much. Additionally, individuals with cognitive impairment, significant bilateral symptoms, or claustrophobia that prevents them from undergoing MRI are usually excluded​​.

9. What are the limitations and risks of MRgFUS?

While MRgFUS offers many advantages, it is not without limitations. One of the main challenges is that it is currently approved for unilateral treatment, meaning it addresses symptoms on only one side of the body. This limitation exists to reduce the risk of complications such as speech disturbances, weakness, or gait instability​​.

Risks of MRgFUS include:

  • Transient Symptoms: Temporary weakness, numbness, or speech difficulties are common but usually resolve within a few weeks​​.
  • Targeting Challenges: Accurate targeting is essential, and factors like a low skull density ratio can make it difficult to achieve optimal results​.
  • Limited Accessibility: MRgFUS requires specialized equipment and expertise, which may not be widely available​.

Despite these challenges, studies consistently report high patient satisfaction, with minimal serious adverse effects​.

10. What is the future of MRgFUS in Parkinson’s Disease?

The future of MRgFUS in Parkinson’s disease looks promising, with ongoing research aimed at expanding its applications. One exciting area is the development of bilateral treatments, which could address symptoms on both sides of the body. Current studies are exploring staged approaches, where the second hemisphere is treated after a safe interval to minimize risks​​.

Another major frontier is the combination of MRgFUS with drug delivery systems. By temporarily opening the blood-brain barrier, MRgFUS could enable the direct delivery of medications, such as gene therapies or neuroprotective agents, to slow or halt disease progression​​.

Advances in imaging and targeting techniques are also expected to improve precision, allowing for smaller lesions and fewer side effects. Research into other neurological and psychiatric conditions, such as depression and epilepsy, further highlights the potential of MRgFUS to revolutionize treatment across multiple disciplines

MRgFUS vs Deep Brain Stimulation (DBS) for Parkinson's Disease

Here are 10 thoughtful  questions to compare MRgFUS and Deep Brain Stimulation (DBS) for Parkinson’s disease, along with simplified answers based on the detailed discussion earlier:

1. What are MRgFUS and DBS, and how are they used to treat Parkinson’s disease?

  • Answer: Both are advanced brain treatments for Parkinson’s disease but work differently:
    • MRgFUS: Uses focused ultrasound beams guided by MRI to create a small lesion in the brain area responsible for symptoms like tremor or rigidity, without any surgery.
    • DBS: Involves implanting electrodes in the brain connected to a pacemaker-like device in the chest. It sends electrical signals to regulate abnormal brain activity causing symptoms.

2. How do MRgFUS and DBS differ in their approach to treatment?

  • Answer: MRgFUS is non-invasive and uses ultrasound to permanently destroy a small part of the brain tissue, while DBS is invasive, requires surgery to implant hardware, and works by modulating brain signals without destroying tissue.

3. Which treatment is reversible, MRgFUS or DBS?

  • Answer: Only DBS is reversible. Doctors can adjust or turn off the stimulation if needed. MRgFUS creates permanent lesions, so its effects cannot be reversed.

4. Who is a better candidate for MRgFUS or DBS?

  • Answer:
    • MRgFUS: Suitable for patients with tremor or asymmetric motor symptoms who are not eligible for surgery or do not want implanted devices.
    • DBS: Recommended for younger patients or those with bilateral symptoms who need adjustable, long-term solutions.

5. Is MRgFUS safer than DBS?

  • Answer: MRgFUS avoids surgical risks like infections or hardware issues, but it is limited to treating one side of the body (unilateral) and carries a small risk of side effects like speech or gait problems. DBS, while invasive, is well-studied, and its side effects can often be managed or reversed.

6. How long do the benefits of MRgFUS and DBS last?

  • Answer: DBS benefits can be adjusted over time to match disease progression, making it effective for many years. MRgFUS shows promising results lasting 1–3 years, but long-term data is still limited.

7. What are the costs of MRgFUS compared to DBS?

  • Answer: Both are expensive, but MRgFUS often has higher upfront costs due to specialized equipment. DBS requires ongoing costs for battery replacements and programming but can be more cost-effective over time.

8. Can either treatment completely cure Parkinson’s disease?

  • Answer: No, neither MRgFUS nor DBS cures Parkinson’s disease. They are designed to manage symptoms like tremor, rigidity, and bradykinesia, improving the patient’s quality of life.

9. Why do some experts prefer DBS over MRgFUS?

  • Answer: DBS is more versatile, as it can treat both sides of the body, adjust to disease progression, and be tailored to individual needs. MRgFUS is less flexible and currently limited to unilateral treatments, making it less suitable for advanced cases.

10. What is the future of MRgFUS and DBS in Parkinson’s disease?

  • Answer: Both have promising futures:
    • MRgFUS: Research is exploring bilateral treatments, temporary lesioning, and combining it with drug delivery.
    • DBS: Continues to improve with new technologies, including adaptive DBS systems that respond to real-time brain activity.

Conclusion: Weighing the Role of MRgFUS in Parkinson’s Disease Treatment

Parkinson’s disease is a complex, progressive disorder that requires a personalized treatment approach based on symptom severity, disease progression, and patient preferences. In this article, we explored Magnetic Resonance-guided Focused Ultrasound (MRgFUS) in depth—its working mechanism, current indications, and evolving role in Parkinson’s disease. We then compared it with Deep Brain Stimulation (DBS), the gold standard surgical treatment, highlighting their differences in effectiveness, safety, adjustability, and long-term outcomes.

MRgFUS stands out as a non-invasive, incision-free option that offers relief for patients with tremor and asymmetric motor symptoms, particularly those who are not candidates for invasive surgery. However, it remains a permanent lesioning procedure with limitations in bilateral treatment, long-term efficacy, and adjustability compared to DBS. While early research is promising, MRgFUS is not yet a full replacement for DBS but rather a complementary option for select patients.

For patients and caregivers, understanding these treatment options is crucial for making informed decisions. MRgFUS represents a significant advancement in functional neurosurgery, but its long-term role in Parkinson’s treatment will depend on ongoing research, improved targeting techniques, and accessibility. As science advances, the future may bring even more refined, safer, and personalized approaches to managing Parkinson’s disease.

This guide serves as a comprehensive resource to help patients and caregivers navigate the evolving landscape of Parkinson’s treatments, ensuring they are equipped with the knowledge to discuss options with their healthcare providers.

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Commemorating the Inaugural Dr. Uday Muthane Oration

January 14, 2025By 0 comment

On a remarkable day- 10th January 2025, more than 150 delegates—comprising senior neurologists, neurosurgeons, psychiatrists, colleagues, neurology residents, and cherished friends—gathered to celebrate the First Dr. Uday Muthane Oration. Organized by the Karnataka Movement Disorders Forum, this event was more than just an academic conference; it was a tribute to a visionary leader in the field of Movement Disorders. The gathering bore witness to the enduring impact of Dr. Uday Muthane’s contributions while setting the stage for future advancements in patient care, research, and mentorship within the neurology community.

Setting the Stage for a Momentous Occasion

The day began with a sense of anticipation and pride, as delegates arrived at the venue, greeting old friends, mentors, and colleagues. Many of Dr. Muthane’s classmates, family members, and long-standing associates traveled from various parts of the country—and even abroad—to be a part of this historic event.

The Karnataka Movement Disorders Forum, in conjunction with the local organizing team, ensured that every detail reflected the spirit of Dr. Muthane’s legacy: dedication to pioneering research, compassionate patient care, and the nurturing of budding neurologists. A warm welcome note was extended to all delegates, culminating in an enthusiastic applause that set the tone for the day’s proceedings.

Why an Oration for Dr. Uday Muthane?

Dr. Uday Muthane has long been recognized as a pioneer in Movement Disorders, with over 30 years of expertise. By creating an annual oration in his name, the community aimed to:

  1. Honor His Contributions: Dr. Muthane’s extensive research on juvenile Parkinson’s disease, Huntington’s disease genetics, and other cutting-edge topics has played a pivotal role in shaping modern Movement Disorder treatments in India.
  2. Inspire Future Generations: Through this oration, aspiring neurologists and researchers are reminded that groundbreaking work can originate from passion, hard work, and a steadfast commitment to improving patient outcomes.
  3. Foster Collaboration: Bringing together experts in neurology, neurosurgery, psychiatry, and allied fields under one roof encourages the exchange of ideas and collaboration on innovative treatments.

It was fitting, then, that this inaugural ceremony resonated with Dr. Muthane’s core values—education, mentorship, and a relentless quest for knowledge.

(L-R): Prof. P. Satish Chandra, Prof. R. Srinivasa, Prof. Yasha Muthane, Prof. Pramod Kumar Pal

A Distinguished Panel of Dignitaries

Presiding over this special occasion were several notable figures who have intersected with Dr. Muthane’s journey in myriad ways:

  • Dr. P. Satishchandra, Ex-Director of the National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, whose leadership has shaped countless careers in neurology.
  • Prof. R. Srinivasa, the mentor who guided a young Dr. Uday Muthane to pursue neurology, symbolizing the importance of mentorship in medical education.
  • Dr. Pramod Pal, President of the Movement Disorders Society of India and a leading Movement Disorders Specialist at NIMHANS, an eminent researcher recognized nationally and internationally.
  • Prof. Yasha Muthane, Dean, NIMHANS, and an unwavering pillar of support in Dr. Muthane’s personal and professional life.

Their presence underscored the collaborative and close-knit nature of India’s neurology community, where personal connections often intertwine with academic and clinical accomplishments.

Starting the Day: Invocation and the Rationale Behind the Oration

The program officially commenced with a heartfelt invocation by Dr. Sneha, a Movement Disorders specialist at Fortis Hospital. Immediately afterward, Dr. Uday Murgod—a Senior Neurologist from Manipal Hospital, Bangalore—took the stage to explain why this oration was created and how it pays homage to the vast contributions of Dr. Uday Muthane.

Dr. Murgod has the unique distinction of having been Dr. Muthane’s student, working on the Genetics of Huntington’s Disease during his residency. His anecdotes about Dr. Muthane’s early career not only offered a window into the professor’s passion and academic rigor but also emphasized the personal mentorship that shaped so many of his students into today’s leading neurologists.

The Star of the Afternoon: Prof. Dirk Dressler

Following this moving tribute, Prof. Ravi Yadav, Secretary of the Movement Disorders Society of India and a respected Movement Disorders Specialist at NIMHANS, introduced the day’s orator, Prof. Dirk Dressler. Hailing from Hannover, Germany, and known for his extensive research on Botulinum toxins, Prof. Dressler commands global respect, having published over 400 scientific articles.

His oration, entitled “Botulinum Neurotoxins – A Pandora’s Box of Novel Properties and Novel Indications”, took attendees on an enlightening journey through nearly four decades of Botulinum toxin research and clinical application. Prof. Dressler recounted how early skepticism about the toxin’s safety and efficacy eventually gave way to broad acceptance and innovative treatments that now benefit countless patients worldwide.

In a lively 45-minute session, he highlighted the evolution of Botulinum toxin’s clinical indications—from reducing spasticity in stroke patients to alleviating cervical dystonia and beyond—and offered a glimpse into promising, cutting-edge applications yet to emerge. His talk was peppered with personal stories and multi-center research experiences, making it both instructive and deeply engaging.

Felicitation of Prof. Dirk Dressler after delivering the Inaugural Dr. Uday Muthane Oration

A Fitting Tribute: Felicitation and Warm Applause

No Indian celebration is complete without a formal gesture of gratitude. After his captivating oration, Prof. Dirk Dressler was invited onto the stage for a heartfelt felicitation. He was presented with a shawl, the traditional Mysore Peta (a regal turban symbolic of Karnataka’s cultural heritage), and a beautifully engraved plaque commemorating his role as the inaugural speaker. The audience erupted in applause, acknowledging not only his lecture but also the lifelong dedication he has shown toward clinical excellence and research in Movement Disorders.

(L-R) Standing : Dr. Manjunath, Dr Prashanth LK, Dr. Hrishikesh Kumar, Dr. Vinay Goyal, Dr. P. Satishchandra, Dr. Srinivasa R, Dr. Yasha Muthane, Dr. Ravi Yadav. Seating - Dr. Pramod Kumar Pal

Additional Honors: Felicitating Dr. Pramod Pal

In the spirit of celebrating achievements, the event also recognized Dr. Pramod Pal, who had recently received an honorary membership from the International Parkinson and Movement Disorder Society (IPMDS). Dr. Manjunath, one of Dr. Pal’s former students, introduced him to the gathering, recalling anecdotes that highlighted Dr. Pal’s steadfast commitment to the Movement Disorders community. The recognition served as a reminder that leadership within this specialty continually flourishes, fueled by mentorship, collaboration, and global engagement.

Dr. Prashanth LK delivering Vote of thanks at the Inaugural Dr Muthane Oration

Vote of Thanks and Personal Touches

Wrapping up the successful oration, Dr. Prashanth LK delivered a heartfelt vote of thanks, acknowledging:

  • The esteemed teachers and mentors of Dr. Uday Muthane
  • Eminent colleagues, both past and present
  • Classmates and family members who joined in celebrating this momentous occasion
  • Younger neurologists and Movement Disorders specialists who hold the future of the field in their hands

There was a shared appreciation that while awards and speeches are significant, it is the personal connections, friendships, and shared histories that truly shape a fulfilling, lasting legacy. The presence of so many of Dr. Muthane’s peers and relatives made the evening feel less like a formal scientific event and more like a family reunion under the banner of academic celebration.

Team involved in conceptualization and initiation of the Prof. Uday Muthane Oration

Behind the Scenes: The Teamwork and Coordination

The oration was organized under the auspices of the Karnataka Movement Disorders Forum, with anchoring support from Dr. Somadutta, a Movement Disorders specialist. A core group of specialists from across Karnataka, including Dr. Kuldeep Shetty, Dr. Nitish Kamble, Dr. Anish Mehta, Dr. Vikram Holla, Dr. Abbas, Dr. Srinivas, Dr. Sneha Kamath and many others, ensured that every detail—from the venue arrangements to the audiovisual setup—was meticulously planned and executed. Their collective passion, synergy, and behind-the-scenes coordination were essential to orchestrating an event of such quality and warmth.

Reflecting on the Highlights

  1. Attendance and Reach: Over 150 delegates testified to the magnetic pull Dr. Muthane’s name holds within the broader medical community.
  2. Interdisciplinary Approach: Neurologists, neurosurgeons, psychiatrists, and residents gathered under one roof, reflecting the modern, team-based approach necessary for tackling complex Movement Disorders.
  3. Passing the Torch: Younger attendees found mentorship and inspiration in the presence of leading experts, potentially igniting new research projects and collaborative efforts.
  4. Personal Narratives: The speeches peppered with personal stories and decades-long camaraderie underscored how successful academic careers are built on mentorship, friendship, and shared passion.

A Glimpse into the Future

The Inaugural Dr. Uday Muthane Oration is not merely an event now consigned to history—it serves as a cornerstone for future conferences, workshops, and ongoing research. By honoring individuals who have dedicated their lives to unraveling the intricacies of Parkinson’s disease, dystonias, Huntington’s disease, ataxias, and numerous other Movement Disorders, the annual oration aims to:

  • Encourage new talent to pursue advanced research and clinical practice.
  • Strengthen global collaborations, bringing international experts like Prof. Dressler to share expertise and foster partnerships.
  • Maintain the sense of family among the neurology fraternity, ensuring that knowledge is passed down with care, respect, and genuine warmth.

Closing Thoughts: A Night to Remember

As the curtains fell on this unforgettable day, smiles and conversations spilled into the corridors. Attendees lingered to congratulate Dr. Muthane, exchange contact information, and snap photos to preserve these cherished moments. The synergy of personal warmth and professional excellence was palpable, reminding everyone why communities like the Karnataka Movement Disorders Forum thrive—they are built on respect, unity, and a shared vision of improving patients’ lives.

For Dr. Uday Muthane himself, seeing the seeds he sowed decades ago bear fruit in the form of enthusiastic students, groundbreaking research, and now an oration in his name must have been profoundly fulfilling. And for the delegates, the event offered a rare blend of inspiration, camaraderie, and scientific enlightenment—leaving them with renewed motivation to push the boundaries of what is known in Movement Disorders.

This commemorative oration was not just about celebrating milestones; it was a testament to how dedication, mentorship, and collaboration can create lasting ripples in the realm of neurological care. As we look ahead, the First Dr. Uday Muthane Oration stands as a beacon, guiding and encouraging future leaders in their journey to transform patient care and research in Movement Disorders for generations to come.

Note for Visitors: Photos and videos from this landmark event, including highlights of Prof. Dirk Dressler’s talk and the felicitation ceremony, are available below. We hope they capture the warmth, excitement, and collaborative energy of the day. Feel free to share your memories, insights, and tributes in the comments section. Let us continue to honor Dr. Uday Muthane’s contributions by nurturing innovation, compassion, and the spirit of exploration in the field of Movement Disorders.

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2024 Breakthrough Therapy for Parkinson’s Disease: Introducing The Produodopa – A New Social Media Sensation and Hope

August 20, 2024By 0 comment

1. What’s the video about a Parkinson’s patient getting better with new medicine on social media? (Circulated in 2024)

A recent video showing the remarkable effects of a new Parkinson’s medication, Produodopa, has gone viral. Damien Gath, a 52-year-old man who has lived with Parkinson’s for 12 years, experienced a dramatic improvement in his symptoms just days after starting the treatment. Before the treatment, Mr. Gath struggled with severe, uncontrollable shaking that made daily tasks like making a cup of coffee nearly impossible. However, just two days after receiving Produodopa, his involuntary movements almost completely stopped, allowing him to perform everyday activities with ease. Mr. Gath described the effects as “extraordinary and life-changing,” marking a significant breakthrough in managing his condition and restoring a sense of normalcy to his life. This promising outcome has sparked hope for many living with Parkinson’s, showcasing Produodopa as a potential game-changer in the treatment of this challenging disease.

2. What is PRODUODOPA?

Produodopa is a new medication designed to help manage the symptoms of Parkinson’s disease. It is a combination of two drugs: foslevodopa and foscarbidopa. These drugs work together to increase the levels of dopamine in the brain, a chemical that helps control movement. In Parkinson’s disease, dopamine levels are low, leading to symptoms like tremors, stiffness, and difficulty with movement.

PRODUODOPA (foslevodopa/foscarbidopa) was developed by AbbVie as an innovative solution for advanced Parkinson’s disease, particularly for patients who suffer from severe motor fluctuations and for whom traditional treatments were no longer effective. AbbVie sought to address the need for a more consistent delivery method of levodopa, the gold standard in Parkinson’s treatment, which led to the creation of the first 24-hour continuous subcutaneous infusion therapy.

The medication received marketing authorization in the European Union through the Decentralized Procedure in the third quarter of 2022. Following this, the VYAFUSER™ pump, designed to administer the PRODUODOPA infusion, received the Conformité Européenne (CE) Mark in November 2023, allowing its use across Europe.

PRODUODOPA was launched in the European Union in January 2024, backed by extensive clinical research, including three significant studies that demonstrated its efficacy, safety, and tolerability. This medication marks a significant advancement in Parkinson’s treatment, offering new hope to those with advanced stages of the disease.

3. How does PRODUODOPA help with Parkinson’s disease?

Produodopa is administered through an infusion that delivers the medication continuously into the bloodstream, using a small pump. This steady delivery helps maintain consistent dopamine levels, reducing the fluctuations in symptoms that patients often experience with other treatments. The goal of Produodopa is to provide better control over Parkinson’s symptoms, helping patients lead a more normal, active life.

4. Are there other medicines like PRODUODOPA for Parkinson’s?

Yes, there are medications similar to Produodopa used to treat Parkinson’s disease. It belongs to similar group of medications which are being used for management of Parkinson’s disease These include:

  1. Levodopa and Carbidopa combination medications which are available in the market in the brand names of LCD, Syndopa, Sinemet, Tidomet
  2. Dopamine agonist molecules like – Pramipexole, Ropinirole – available with brand names of Pramirol/pramipex and Ropark
  3. Apomorphine injections and Pumps
  4. Levodopa inteinfusions pumps – known by brand name Duodopa

5. How is PRODUODOPA different from other Levodopa type medicines?

Produodopa differs from other Levodopa medicines in India primarily in how it is delivered and its formulation. While traditional Levodopa medications are typically taken as oral tablets or capsules, Produodopa is administered through a continuous infusion directly into the bloodstream using a small pump. This method ensures a steady and consistent release of medication, helping to maintain stable dopamine levels in the brain throughout the day.

This continuous delivery can reduce the “off” periods and fluctuations in symptoms that patients often experience with oral Levodopa, where the medication’s effect can wear off between doses. Additionally, Produodopa combines two drugs, foslevodopa and foscarbidopa, which work together more effectively to manage symptoms, potentially offering better control over Parkinson’s disease compared to standard oral Levodopa formulations available in India.

6. What is the Difference between PRODUODOPA pumps and APOMORPHINE Pumps?

PRODUODOPA pumps and apomorphine pumps are both used in the treatment of advanced Parkinson’s disease, but they differ significantly in terms of their active ingredients, mechanisms of action, and how they are used. (If all can remember there was significant social media wave about Nanavathi apomorphine therapy for Parkinson’s disease in 2019-20, when it was launched in India)

  1. Active Ingredients
  • PRODUODOPA: The active ingredients in PRODUODOPA are foslevodopa and foscarbidopa, which are prodrugs of levodopa and carbidopa, respectively. Levodopa is a precursor to dopamine, the neurotransmitter that is deficient in Parkinson’s disease. Carbidopa prevents the breakdown of levodopa before it reaches the brain, increasing its availability.
  • Apomorphine: Apomorphine is a dopamine agonist, meaning it directly stimulates dopamine receptors in the brain. Unlike levodopa, it does not require conversion into dopamine but directly mimics the effects of dopamine.
  1. Mechanism of Action
  • PRODUODOPA: PRODUODOPA delivers a continuous subcutaneous infusion of levodopa and carbidopa, providing 24-hour coverage. This helps to maintain stable dopamine levels, reducing motor fluctuations (“on” and “off” periods) and dyskinesia (involuntary movements).
  • Apomorphine: Apomorphine acts as a dopamine receptor agonist, directly stimulating the dopamine receptors in the brain. It is usually administered via a subcutaneous pump or injection and provides rapid relief of “off” periods when symptoms return due to the wearing off of other medications. It can also be used to reduce motor fluctuations and dyskinesia over a 24 hour coverage.
  1. Usage and Indications
  • PRODUODOPA: This pump is typically used in patients with advanced Parkinson’s disease who experience severe motor fluctuations and whose symptoms are not adequately controlled by oral medications. The continuous delivery is designed for long-term management of symptoms.
  • Apomorphine: Apomorphine pumps are used for patients with advanced Parkinson’s disease who experience frequent and unpredictable “off” periods. It can be used as a rescue therapy for sudden “off” episodes or as a continuous infusion for more stable symptom control.
  1. Administration
  • PRODUODOPA: The medication is delivered via a subcutaneous pump over 24 hours, requiring careful management of the infusion site and device.
  • Apomorphine: Apomorphine can be administered either as a continuous subcutaneous infusion (Day time) via a pump or as intermittent injections. The continuous infusion is more commonly used for patients with frequent “off” periods, while the injections are used for rapid relief.
  1. Side Effects
  • PRODUODOPA: Common side effects include infusion site reactions (e.g., erythema, pain, infection), hallucinations, falls, and anxiety. There are also general levodopa-related side effects like dyskinesia and orthostatic hypotension.
  • Apomorphine: Side effects can include nausea, vomiting, injection site reactions, orthostatic hypotension, somnolence, and hallucinations. Patients often require antiemetic treatment (to prevent nausea) when starting apomorphine.
  1. Patient Suitability
  • PRODUODOPA: This treatment is suitable for patients who need continuous dopamine replacement therapy due to advanced disease with motor complications. It is generally considered when oral treatments are no longer sufficient.
  • Apomorphine: This is more suitable for patients who require rapid, on-demand relief from “off” periods or need a continuous dopamine agonist treatment when other treatments are insufficient.

In summary, while both pumps are used in managing advanced Parkinson’s disease, PRODUODOPA provides continuous levodopa-based therapy, while apomorphine offers a direct dopamine receptor stimulation either as a rescue or continuous therapy. The choice between the two depends on the patient’s specific symptoms, treatment history, and overall management strategy.

7. Is PRODUODOPA available in India?

Produodopa is currently approved only in the EUROPE / European Union as of August 2024.  Produodopa is not available in India or even in United States of America (USA) as of today (August 2024) .  This availability will be based upon the application for approval from respective medical authorities (e.g FDA in USA and Drug Controller body in India) by ABBVIE.   This would be dependent on multiple factors including resources and legal requirements.

8. Can PRODUODOPA cure Parkinson’s disease?

PRODUODOPA is used for symptomatic therapy and to improve the quality of life in patients with advanced Parkinson’s disease.  It works in similar line of expectations of Levodopa.  It’s not a cure for Parkinson’s Disease.

9. Will all Parkinson’s patients start using PRODUODOPA?

Not all Parkinson’s disease patients will start using PRODUODOPA. The decision to use PRODUODOPA depends on several factors, including the stage of the disease, the severity of symptoms, and the patient’s response to other treatments. Here’s why:

  1. Stage of the Disease
  • PRODUODOPA is typically prescribed for patients with advanced Parkinson’s disease who experience significant motor fluctuations and are not adequately controlled by oral medications. For patients in the earlier stages of the disease, other treatments like oral levodopa, dopamine agonists, or MAO-B inhibitors may be sufficient.
  1. Symptom Management
  • Patients with Parkinson’s disease who have “off” periods or severe motor complications that are not well managed with standard treatments may benefit from PRODUODOPA. However, those whose symptoms are well-controlled with other medications may not need this therapy.
  1. Patient Suitability
  • Some patients may not be suitable candidates for PRODUODOPA due to the need for continuous subcutaneous infusion, potential side effects, or other health conditions that could complicate treatment. Each patient requires a personalized approach to determine if PRODUODOPA is the best option.
  1. Treatment Goals
  • The choice of treatment, including whether to use PRODUODOPA, is based on the patient’s overall treatment goals, which may focus on maintaining quality of life, reducing motor fluctuations, or managing specific symptoms.
  1. Availability and Access
  • The availability of PRODUODOPA and the patient’s access to this treatment may also play a role. In some regions, access to this advanced therapy might be limited.

In summary, while PRODUODOPA represents a significant advancement in the treatment of Parkinson’s disease, it is not suitable or necessary for all patients. It is generally reserved for those with more advanced disease and specific treatment needs.   Being an new product, there would be initial over hype followed by understanding its outcomes and possible realistic expectations with time.

10. Who should take PRODUODOPA?

PRODUODOPA is typically recommended for patients with advanced Parkinson’s disease who are experiencing significant motor fluctuations, “off” periods, or dyskinesias that are not well managed with standard oral medications. Here’s a more detailed outline of who might be considered for this treatment:

  1. Advanced Parkinson’s Disease Patients
  • PRODUODOPA is generally prescribed to patients in the later stages of Parkinson’s disease, where oral treatments are no longer effective at controlling symptoms throughout the day.
  1. Patients with Motor Fluctuations
  • Patients who experience “on-off” phenomena, where they have periods of good symptom control (“on” time) followed by periods of poor control (“off” time), might benefit from the continuous dopaminergic stimulation that PRODUODOPA provides.
  1. Patients with Severe Dyskinesias
  • Individuals suffering from involuntary movements (dyskinesias) that are difficult to manage with conventional therapies might be candidates for PRODUODOPA, as it helps in providing more stable dopamine levels in the brain.
  1. Patients Not Responding to Oral Medications
  • If a patient’s symptoms are not adequately controlled by oral levodopa or other dopaminergic medications, and they experience significant motor complications, they might be considered for PRODUODOPA therapy.
  1. Patients Who Are Candidates for Advanced Therapies
  • Patients who have been evaluated and deemed suitable for advanced Parkinson’s disease treatments, including infusion therapies like PRODUODOPA, by a specialist may be recommended this treatment.
  1. Patients with Acceptable Health Status for Infusion Therapy
  • Candidates should be physically capable of managing the infusion pump and tolerate continuous infusion therapy. Patients must also be monitored for potential side effects and complications related to the therapy.

In summary, PRODUODOPA is aimed at those with advanced disease, particularly when other treatments fail to provide adequate symptom control. It requires a thorough evaluation by a neurologist or movement disorder specialist to determine if it is appropriate for the individual patient.

11. What is the evidence for benefit of PRODUODOPA in current medical literature?

Based upon available current medical literature and information’s published on the ABBVIE website on PRODUODOPA following are the critical studies and outcomes which have been utilized for getting approval for regular utilization in patients.

  1. 12-Week Study: Efficacy and Safety Overview

A 12-week, Phase 3, randomized, double-blind, double-dummy study evaluated the efficacy, safety, and tolerability of continuous 24-hour subcutaneous infusion of PRODUODOPA versus oral immediate-release (IR) levodopa/carbidopa (LD/CD) in patients with advanced Parkinson’s disease (PD) and severe motor fluctuations.

  • Participants: 141 patients (74 on PRODUODOPA, 67 on oral IR LD/CD)
  • Completion Rates:
    • PRODUODOPA: 48 out of 74 completed the study; 26 discontinued, primarily due to adverse events, consent withdrawal, or difficulty with the drug delivery system.
    • Oral IR LD/CD: 62 out of 67 completed the study; 5 discontinued.
  • Efficacy:
    • Primary Endpoint: Change in average daily normalized ‘On’ time without troublesome dyskinesia at 12 weeks.
      • PRODUODOPA significantly increased ‘On’ time without troublesome dyskinesia and reduced ‘Off’ time compared to oral IR LD/CD.
    • Secondary Endpoints: Included changes in MDS-UPDRS Part II scores and morning akinesia. Hierarchical testing was terminated early as the MDS-UPDRS Part II did not reach statistical significance, limiting conclusions on subsequent secondary endpoints.
  • Adverse Events (AEs):
    • PRODUODOPA: 85% of patients reported AEs, 22% discontinued due to AEs, 8% experienced severe AEs, and 70% had AEs related to the study drug.
    • Oral IR LD/CD: 63% of patients reported AEs, 1% discontinued due to AEs, 1% experienced severe AEs, and 22% had AEs related to the study drug.
    • Most Common AEs: Infusion site events (e.g., erythema, pain, cellulitis) were significantly more frequent in the PRODUODOPA group, with some patients experiencing hallucinations, dyskinesia, and falls.
  1. 52-Week Study: Long-Term Safety and Tolerability

A Phase 3, single-arm, open-label study assessed the long-term safety, tolerability, and efficacy of 24-hour continuous subcutaneous infusion of PRODUODOPA over 52 weeks in 244 patients with advanced PD.

  • Participants: 244 patients, with 137 completing the study and 107 discontinuing.
  • Endpoints:
    • Primary: Safety and tolerability, assessed through adverse events, laboratory parameters, and infusion site evaluations.
    • Secondary: Changes from baseline in normalized ‘Off’ and ‘On’ times, MDS-UPDRS scores, PDSS-2, PDQ-39, EQ-5D-5L, and the presence of morning akinesia.
  • Safety Analysis:
    • AEs: 94.3% of patients experienced AEs, with 91.8% reporting AEs associated with the study drug. Severe AEs occurred in 25.8% of patients, and 26.2% discontinued due to AEs.
    • Serious AEs: 25.8% of patients reported serious AEs. There were 3 deaths during the study, with 1.2% of patients affected.

Conclusion

Both studies highlight the potential benefits of PRODUODOPA in managing motor fluctuations in advanced PD, with significant improvements in ‘On’ time without troublesome dyskinesia. However, the increased incidence of infusion site reactions and other adverse events underscores the importance of careful patient monitoring and management during treatment, particularly over longer periods.

12. What are the side effects of PRODUODOPA?

The safety profile of PRODUODOPA (a levodopa/carbidopa intestinal gel used in advanced Parkinson’s disease) is characterized by the following adverse events and considerations as provided in the Abbvie information website(The current company which is marketing this product):

 

Most Frequent Adverse Reactions (≥10%)

  • Infusion Site Events: The most common adverse reactions in clinical trials include infusion site reactions such as erythema, cellulitis, nodule formation, pain, edema, and infections.
  • Hallucinations
  • Falls
  • Anxiety

Infusion Site Events

  • Prevalence: In Phase 3 studies, 77.6% of patients reported infusion site reactions, and 41.4% experienced infusion site infections.
  • Severity: The majority of these events were mild to moderate in severity and typically resolved with treatment or spontaneously.
  • Complications: A few cases of sepsis resulting from infusion site infections required hospitalization.
  • Management: Monitoring for skin changes at the infusion site is crucial, with an emphasis on using aseptic techniques and rotating the infusion site frequently.

Detailed Adverse Reactions Across Studies

In clinical trials with 379 patients and a total exposure of 414.3 person-years:

Infections and Infestations

  • Very Common (≥1/10):
    • Infusion site cellulitis, infusion site infection, urinary tract infection
  • Common (≥1/100 to <1/10):
    • Infusion site abscess

Psychiatric Disorders

  • Very Common (≥1/10):
    • Anxiety, depression, hallucinations
  • Common (≥1/100 to <1/10):
    • Abnormal dreams, agitation, confusion, delusions, impulse control disorder, insomnia, paranoia, psychosis, suicidal ideation
  • Uncommon (≥1/1,000 to <1/100):
    • Completed suicide, dementia, disorientation, dopamine dysregulation syndrome

Nervous System Disorders

  • Common (≥1/100 to <1/10):
    • Cognitive disorders, dizziness, dyskinesia, dystonia, headache, hypoaesthesia, “on and off” phenomena, polyneuropathy, somnolence, tremor

Gastrointestinal Disorders

  • Common (≥1/100 to <1/10):
    • Abdominal distension, abdominal pain, constipation, nausea, vomiting, dry mouth, dysgeusia, dyspepsia

General Disorders and Administration Site Conditions

  • Very Common (≥1/10):
    • Infusion site erythema, reaction, nodule, pain, edema
  • Common (≥1/100 to <1/10):
    • Asthenia, fatigue, infusion site bruising, exfoliation, haematoma, irritation, rash, swelling, malaise, peripheral edema

Summary

PRODUODOPA is associated with various adverse events, particularly those related to the infusion site. Most of these events are manageable and mild to moderate in severity, but they require close monitoring, especially for signs of infection. The psychiatric and nervous system adverse effects are also notable, underscoring the importance of careful patient selection and monitoring.

The above information highlights the importance of reading the full prescribing information and product characteristics before prescribing PRODUODOPA.

References and Resources for information in this webpage

  1. https://www.bbc.com/news/articles/cd1xwr2qy3do
  2. https://www.abbviepro.com/gb/en/neuroscience/parkinsons/products/produodopa-home/clinical-data.html
  3. https://news.abbvie.com/2024-01-09-AbbVie-Launches-PRODUODOPA-R-foslevodopa-foscarbidopa-for-People-Living-with-Advanced-Parkinsons-Disease-in-the-European-Union
  4. Soileau MJ, et al. Lancet Neurol. 2022;21:1099–1109.
  5. Aldred J, et al. Neurol Ther. 2023 Dec;12(6):1937-1958. doi: 10.1007/5. s40120-023-00533-1.
  6. https://players.brightcove.net/1029485116001/default_default/index.html?videoId=6356573915112
  7. https://www.parkinsons.org.uk/news/new-treatment-parkinsons-made-available-nhs-england
  8. https://www.thesun.co.uk/health/29754761/man-parkinsons-nhs-treatment-before-after-video-produodopa/
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Awareness

World Parkinson’s Disease Awareness Day 2024

March 22, 2024By 3 Comments

World Parkinson’s Disease Awareness Day Program 2024

Date: April 6th, 2024
Time: 8am to 1 pm (Patient awareness program starts at 10am)
Venue: Centre for Brain Research, Indian Institute of Science, Bangalore

Join Us for a Day of Awareness and Understanding

We are thrilled to invite you to the World Parkinson’s Disease Awareness Program (Official World Parkinson’s Disease Day is on April 11th Annually), an enlightening event dedicated to shedding light on Parkinson’s Disease and its impact on individuals and communities. Hosted at the prestigious Centre for Brain Research, Indian Institute of Science, Bangalore, this program promises to be an enriching experience for all.

What to Expect:

– Informative Talks: Delve into the world of Parkinson’s Disease with insightful talks by medical experts. Learn about the latest advancements in research and treatment options.

– Patient Perspectives: Hear firsthand accounts from individuals living with Parkinson’s Disease. Gain valuable insights into their experiences, challenges, and triumphs.

– Panel Discussions: Engage in thought-provoking discussions on various aspects of Parkinson’s Disease. Explore topics ranging from symptom management to caregiver support.

– Networking Opportunities: Connect with fellow attendees, including scientists, researchers, healthcare providers, patients, caregivers, and members of the general public. Share knowledge, experiences, and resources.

Registration:

Participation in the World Parkinson’s Disease Awareness Program is free and open to all. However, registration is required to ensure a seamless experience for everyone. Reserve your spot today by completing the registration form  – https://forms.gle/9JWdeytHFABH1SP6A

Date and Venue:

Mark your calendars for April 6th and join us at the Centre for Brain Research, Indian Institute of Science, Bangalore. Together, let’s raise awareness, foster understanding, and support those affected by Parkinson’s Disease.

Spread the Word:

Help us reach more people by sharing this event with your friends, family, colleagues, and networks. Together, we can make a difference in the lives of individuals living with Parkinson’s Disease.

Contact Us:

For inquiries or further information, please contact – 7026603300 and ask about the program information

We look forward to welcoming you to this impactful event! – World Parkinson’s Disease Awareness Day 2024

www.movementdisordersclinic.com

Register Here

Program Details

Academic session

Time Topic Speaker
07:45 AM – 08:00 AM Registration
08:00 AM – 08: 20 AM Animal Models in Parkinson’s Disease Dr. Latha Diwakar, Centre for Brain Research, Bangalore
08:20 AM – 08:40 AM Biomarkers in Parkinson’s Disease Dr Albert Stezin, Centre for Brain Research, Bangalore
08:40 AM – 09:00 AM Parkinson’s Genetics in India Dr. Shweta Ramdas, Centre for Brain Research Bangalore
09:00 AM – 09:20 AM Autophagy and Movement Disorders Dr. Ravi Manjithaya, Jawaharlal Nehru centre for Advanced Scientific Research, Bangalore
09:20 AM – 09:40 AM Parkinson’s Disease Current Research in India Dr Phalguni Alladi, NIMHANS, Bangalore
09:40 AM – 10:00 AM What can we do in India on Parkinson’s / Neurodegeneration research in near future Dr. Ramprasad VL, Medgenome Labs, Bangalore
10:00 AM – 10:15 AM Coffee Break

Academic Session Video Recording

Patients and Caregiver Session

Time Topic Speaker
10:15 AM – 12:00 PM Patients and Caregivers Session
Current Advances in Therapies for Parkinson’s Dr Anish Mehta Associate ProfessorConsultant NeurologistPDF in Movement Disorders Ramaiah Medical College and Hospitals
What can be the future of PD treatment Dr. Srinivas Raju, Consultant Neurologist, Manipal Hospital Hebbal, Bangalore
Speech and Swallowing Therapy – Role in Parkinson Disease management Dr N Shivashankar Sr. Consultant, Speech Pathology and Audiology, Apollo Specialty Hospital, Jayanagar, Bangalore Adjunct Professor, Nitte Institute of speech and hearing, Mangalore. Retd. Professor and Associate Dean, NIMHANS, Bangalore
Brain Donations and Role in research and therapy Dr. Anita Mahadevan, Prof. & HOD, Neuropathology Department, NIMHANS
CBR and it’s Vision Dr. K V S Hari, Director, Centre for Brain Research, IISc, Bangalore
Panel Discussion – Interactions for research and Patient collaborations Dr. Ravi Muddashetty, Dr. Ravi Manjithya, Dr. Ramprasad VL
12:00 PM – 1:30 PM Patient Experiences
How to cope with Parkinson’s Disease Prof. Mahadevan, IIsc Faculty & PwP
Young onset Parkinson’ disease – How i came over the hurdles Harish Kulkarni, Senior Manager, Capegemini, India & PWP
How to plan yourself when you have Parkinson’s disease Geetha R, Health CoordinatorPeople’s Health Movement National Trainer for Adolescent Health Consultant Women’s and Children’s Health & PwP
Women and Young Onset Parkinson’s Disease Dr Prathima Kadiyala, MRCP(UK) ,Diploma in Dermatology, (UK) General physician and skin care Tirupati & PwP
1:00 PM – 1:30PM Question and Answers
13:30 – 14:00 Lunch and Validection

Patients and General Public Session Video Recording

Speakers

For Scientific Session and Public Awareness Session

Dr Shivashankar

Dr Shivashankar

Dr N Shivashankar
Sr. Consultant, Speech Pathology and Audiology, Apollo Specialty Hospital, Jayanagar, Bangalore
Adjunct Professor, Nitte Institute of speech and hearing, Mangalore.
Retd. Professor and Associate Dean, NIMHANS, Bangalore

Geetha R, PwP & Health Co-ordinator

Geetha R

Geetha R

Health Coordinator

People’s Health Movement

National Trainer for Adolescent Health

ConsultantWomen’s and Children’s Health

Harish Kulkarni, IT professional & PwP

Harish Kulkarni

Harish Kulkarni,

Senior Manager, Capegemini, India

PWP

Dr. Anish Mehta

Dr. Anish Mehta

Dr Anish Mehta
Associate Professor
Consultant Neurologist
PDF in Movement Disorders
Ramaiah Medical College and Hospitals

Dr Latha Diwakar

Dr. Latha Diwakar

Dr Latha Diwakar

Senior Scientific Officer

Centre for Brain Research, IISc, Bangalore.

Dr. Albert Stezin

Dr. Albert Stezin

Dr. Albert Stezin

Scientific officer,

Centre for Brain Research, IISc, Bangalore

Dr. Ramprasad VL

Dr Ramprasad VL

Dr. Ramprasad VL

CEO and Principal Scientist

Medgenome Labs Pvt Ltd, Bangalore, India

Dr Srinivas Raju

Dr Srinivas Raju

Dr Srinivas Raju

Consultant Neurologist,

Manipal Hospital, Hebbal, Bangalore

Dr. Ravi Muddashetty

Dr Ravi Muddashetty

Dr. Ravi Muddashetty

Centre for Brain Research, IISc, Bangalore

Dr Ravi Manjithaya

Dr Ravi Manjithaya

Dr. Ravi Manjithaya

Neurosciences Chair

Jawaharlal Nehru Centre for Advanced Scientific Research (JNCASR)

Bangalore, India

Dr Anita Mahadevan

Dr Anita Mahadevan

Dr Anita Mahadevan

Prof. & Head – Department of Neuropathology,

In-charge – Human Brain Bank, NIMHANS

NIMHANS, Bangalore, India

Dr Prathima Kadiyala, PwP

Dr Prathima Kadiyala

Dr Prathima Kadiyala, PwP

MRCP(UK), Dipoloma in Dermatology,(UK) General physician and skin care

Tirupati & P

Dr Phalguni Alladi

Dr Phalguni Alladi

Dr. Phalguni Alladi

Department of Clinical Psychoparmacology and Neurophysiology

NIMHANS, Bangalore, India

Dr Mahadevan, Pwp

Dr Mahadevan

Dr Mahadevan, Pwp

IISc, Bangalore

Prof. KVS Hari

Prof. KVS Hari

Prof. KVS Hari

Director, Centre for Brain Research, IISc, Bangalore

Event Co-ordinators

Patient / Care Giver / Public co-ordinators: Mr. Rajiv Gupta, Dr. Prathima Kadiyala, Mr. Gokul Casheekar, Dr. Rosy Neupane, Mr. Punit, Mrs. Anjali

Scientific Co-ordinators:  Dr. Ravi Muddashetty, Dr. Ravi Manjithaya, Dr. Prashanth LK, Dr. Guruprasad, Dr. Kuldeep Shetty, Dr. Srinivas Raju

Supported By

PD Avengers

Centre for Brain Research, IISc

Keep Moving Foundation

Program Recordings

Women and YOPD

YOPD : How to Manage the Hurdles

Women and YOPD : Personal Thoughts

Address by Prof. Hari, Director, Centre for Brain Research

Animal Models in Parkinson's Disease

Women and YOPD

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news

Parkinson’s and Driving: Fitness Evaluations and Safe Driving Practices

March 18, 2024By 0 comment

Are you or a loved one navigating the challenges of Parkinson’s Disease while trying to stay safe behind the wheel? Driving represents freedom and independence, but when Parkinson’s enters the equation, it brings a host of questions and concerns. How does Parkinson’s affect driving ability? What assessments can ensure safety on the road? Dive into our comprehensive guide, where we unravel the mysteries of driving with Parkinson’s, from essential evaluations to adapting for safety. Stay tuned as we steer through the turns and traffic lights of Parkinson’s and driving, ensuring you’re equipped to navigate this journey with confidence and care.  These are primarily created based upon a recent systematic review in Movement Disorders journal (2024 March).

  1. How Common Are Driving-Related Issues Among Individuals with Parkinson’s Disease?

Driving-related issues are relatively common among individuals with Parkinson’s Disease (PD), significantly affecting their independence and quality of life. The article highlights that a meta-analysis found PD patients, especially those with an average disease duration of 6.7 years, are more likely to fail an on-road driving test and have over a two-fold increase in crash risk in driving simulator tests compared to healthy counterparts. Additionally, it notes that PD patients exhibit a gradual deterioration in their driving abilities and tend to cease driving earlier than those without the condition.

The combination of PD’s motor symptoms (like bradykinesia, rigidity, and tremors), cognitive impairments (such as issues with executive functioning and spatial awareness), and the effects of medication (including drowsiness or sudden sleep onset) all contribute to the challenges faced by individuals with PD when driving. These factors underscore the importance of regular and comprehensive evaluations of driving fitness for people with PD to ensure safety on the road.

  1. Why Do People with Parkinson’s Disease Face Difficulties in Driving?

Individuals with Parkinson’s Disease (PD) encounter driving difficulties due to a combination of motor and non-motor symptoms, as well as the side effects of medications used to manage the condition. The motor symptoms include bradykinesia (slowness of movement), rigidity, rest tremor, and postural instability. These symptoms can impair physical abilities necessary for driving, such as steering, braking, and accelerating.

Non-motor symptoms that affect driving include cognitive impairments, which might involve challenges with attention, decision-making, and spatial awareness. Neuropsychiatric symptoms, such as depression and anxiety, can also impact driving abilities. Furthermore, sleep disorders associated with PD, like excessive daytime sleepiness, can make it dangerous to drive.

The medications prescribed for PD, while essential for managing symptoms, can have side effects like sudden onset of sleep, which poses a significant risk for driving. The complex interplay of these factors contributes to the driving difficulties experienced by people with PD, making it crucial to assess their driving fitness regularly.

  1. What are the potential risks for driving with Parkinson’s Disease?

Driving with Parkinson’s Disease (PD) comes with potential risks due to the symptoms of the condition and the side effects of medications used in its management. Here’s a simplified overview of these risks:

  1. Motor Skills Impairment: PD can cause tremors, stiffness, and slowness of movement, making it hard to steer, accelerate, or brake quickly when needed.
  2. Cognitive Changes: PD can affect memory, attention, and problem-solving skills, which are crucial for navigating, responding to unexpected events, and making split-second decisions on the road.
  3. Visual Disturbances: Some people with PD experience vision problems, such as difficulty with depth perception and contrast sensitivity, making it harder to see road signs, signals, and obstacles.
  4. Sudden Onset of Sleep: Medications for PD, especially dopamine agonists, can lead to sudden sleepiness or even sleep attacks, which can occur without any warning, posing a significant risk while driving.
  5. Fluctuating Symptoms: PD symptoms can fluctuate throughout the day, with periods of better or worse motor function. This unpredictability can affect driving abilities at different times.
  6. Impaired Reaction Time: PD can slow physical and mental reactions, delaying responses to traffic lights, other vehicles, pedestrians, or unexpected hazards.

Understanding these risks is essential for individuals with PD, their families, and healthcare providers to make informed decisions about driving. Regular evaluations and adjustments to driving habits or the decision to stop driving may be necessary to ensure safety.

  1. Do Countries Have Official Driving Guidelines for People with Parkinson’s Disease?

Yes, several countries have officially established guidelines for evaluating and managing the driving abilities of individuals with Parkinson’s Disease (PD). According to the systematic review covered in the article, nine national guidelines were identified from seven different countries. These countries are Australia, Canada (which has two separate sets of guidelines from different organizations), Ireland, New Zealand, Singapore, the United Kingdom, and the United States (also with two distinct guidelines from different entities). These guidelines aim to assess the fitness to drive of individuals with PD, considering the unique challenges posed by the condition.

  1. What Specific Tests Are Used in the Assessment of Driving Fitness for Parkinson’s Disease Patients?

In evaluating the driving fitness of individuals with Parkinson’s Disease (PD), several specific tests are recommended to comprehensively assess motor, cognitive, and visual abilities. These tests aim to determine a person’s capability to drive safely. Here’s a breakdown of these tests in layman’s terms:

  1. Motor Assessment Tests:
    • Rapid Paced Walk Test (RPWT): This test checks how quickly and safely a person can walk a short distance. It helps understand the person’s mobility and balance, which are crucial for operating pedals and getting in and out of a car. (https://icsw.nhtsa.gov/people/injury/olddrive/safe/01c02.htm ) The RPWT is valuable because it is quick, easy to administer, requires minimal equipment, and can be performed in various settings. While it directly assesses walking ability, the insights gained can indirectly inform evaluations of driving fitness by indicating the level of physical function and mobility.
    • Manual Tests of Motor Strength and Range of Motion: These involve simple exercises to assess the strength of arms and legs, and how well a person can move their joints. Such movements are vital for steering, turning, and using car controls.
  2. Cognitive and Neuropsychological Tests:
    • Trail Making Test-B (TMT-B): This paper-and-pencil test involves connecting numbered and lettered dots in a specific order as quickly as possible. It evaluates a person’s ability to switch attention between tasks, a skill needed for keeping track of road conditions, navigation, and responding to unexpected events.
    • Clock Drawing Test: In this test, the person is asked to draw a clock showing a specific time. It checks spatial awareness and the ability to plan and execute a task—key for understanding road signs and making turns.
    • Mini-Mental State Examination (MMSE): This brief 30-point questionnaire assesses various cognitive functions, including arithmetic, memory, and orientation, indicating the overall cognitive ability that impacts decision-making while driving.
  3. Visual Assessment Tests:
    • Visual Acuity Test: This test, often done using an eye chart, checks how clearly a person can see at distances, critical for reading road signs and seeing obstacles.
    • Visual Fields Test: This evaluates the full horizontal and vertical range of what a person can see without moving their eyes, important for detecting vehicles, pedestrians, and other objects in peripheral vision.
    • Contrast Sensitivity Test: This measures how well a person can distinguish between objects and their background, especially in poor light, fog, or glare, which affects night driving and driving under challenging weather conditions.

These evaluations are typically conducted in a clinical setting by healthcare professionals, including neurologists, occupational therapists, and sometimes driving specialists. The aim is to ensure that individuals with PD can meet the demands of safe driving or identify areas where adaptations might help. Regular reassessment is recommended to account for the progressive nature of PD and its impact on driving skills.

 

  1. What Are the Red Flags Indicating That a Person With Parkinson’s Disease May Not Be Fit to Drive?

For individuals with Parkinson’s Disease (PD), certain “red flags” signal that driving may no longer be safe. These indicators are critical for evaluating when it might be time to reassess driving abilities or consider stopping driving altogether. Here’s a simplified explanation of these warning signs:

  1. Motor Function Impairment: Difficulty with movements, such as stiffness or tremors, that could affect the ability to steer, brake, or accelerate smoothly.
  2. Cognitive Decline: Issues with memory, attention, problem-solving, or multitasking that impair the ability to navigate, respond to road signs, or make quick decisions in traffic.
  3. Visual Impairments: Problems with seeing clearly, judging distances, or having a limited field of vision, making it hard to spot vehicles, pedestrians, or obstacles.
  4. Increased Reaction Times: Slower responses to unexpected events, such as needing to brake suddenly or react to a traffic signal change.
  5. Medication Side Effects: Experiencing sudden sleepiness, dizziness, or other effects from PD medications that could impair driving at any moment.
  6. History of Close Calls or Minor Accidents: An increase in “near misses,” fender benders, or trouble with parking could indicate declining driving skills.
  7. Feedback from Others: Concerns expressed by family members, friends, or others about the individual’s driving performance or safety.
  8. Feeling Anxious or Overwhelmed While Driving: Increased stress or discomfort when driving, especially in complex situations like heavy traffic or unfamiliar areas.
  9. Difficulty with Driving Tasks: Problems with tasks that used to be easy, such as making turns, merging onto highways, or maintaining lane position.
  10. Navigational Challenges: Getting lost, even in familiar areas, or difficulty following directions due to cognitive decline.

Recognizing these red flags is crucial for ensuring the safety of the driver with PD, their passengers, and others on the road. Regular assessments by healthcare professionals can help monitor these factors and make informed decisions about driving fitness.

  1. How should a person with Parkinson’s Disease evaluate for his driving fitness?

Here’s a simplified explanation of how someone with Parkinson’s Disease (PD) should go about testing for driving fitness, :

  1. Start with Your Doctor: The first step is to talk to the doctor treating your PD, usually a neurologist. They know your health history and how PD affects you, making them a good starting point for evaluating your driving fitness.
  2. Check Your Physical Abilities: You might be asked to perform certain physical tasks to see how well you can move. This could include walking quickly or showing how strong and flexible your arms and legs are. These tests help determine if you can control a car safely.
  3. Assess Your Thinking Skills: Since driving requires quick thinking and problem-solving, your doctor might also check your cognitive abilities. This could involve tests where you connect dots, draw a clock, or remember lists of words. These tests check your ability to pay attention, make decisions, and remember important information while driving.
  4. Evaluate Your Eyesight: Good vision is crucial for driving, so your eyesight will be checked. This can include reading letters from a distance (like a standard eye chart test), checking your peripheral vision, and perhaps assessing how well you see contrasts, which is important for driving at night or in poor weather.
  5. Consider PD Symptoms and Medication Side Effects: Your doctor will think about how your PD symptoms and the side effects of your medication might affect your driving. For example, if your medication makes you drowsy, this is important to consider.
  6. Undergo Specialized Driving Tests if Needed: Based on these evaluations, your doctor might suggest a specialized driving test. This can be a practical test in a car to see how well you handle actual driving situations.
  7. Follow-Up Tests: Since PD can change over time, you might need to go back for regular check-ups to make sure you can still drive safely.
  8. Make Adjustments as Needed: If the tests show that driving could be risky for you or others, your doctor might suggest ways to adjust. This could mean driving only during the day, using special equipment to make driving easier, or exploring alternatives to driving.

In simple terms, testing for driving fitness in PD involves a combination of medical evaluations, physical and cognitive tests, and practical driving assessments, all aimed at ensuring you can drive safely without putting yourself or others at risk.

  1. Where can someone read about ‘Fitness for Driving’ in Parkinson’s Disease?

Here’s a suggested list of resources and types of documents where you can learn more about driving guidelines for people with Parkinson’s Disease:

  1. National Guidelines: Look for guidelines issued by national health or transportation authorities in various countries, such as Australia, Canada, Ireland, New Zealand, Singapore, the United Kingdom, and the United States. These guidelines provide country-specific recommendations for evaluating driving fitness in individuals with PD.
  2. Recommendation Papers from Professional Associations: Papers published by associations like the American Academy of Neurology (AAN) often provide evidence-based recommendations for clinicians assessing the driving capabilities of their patients with PD.
  3. Consensus Statements: Documents like consensus statements from expert panels offer agreed-upon guidance based on the latest research and expert opinion. These can help in understanding the collective stance on driving assessment procedures and criteria for people with PD.
  4. Research Studies on Driving and PD: Academic journals and medical research platforms often publish studies on the effects of PD on driving, evaluation methods, and intervention outcomes. These studies can provide data-driven insights into the challenges and solutions related to driving with PD.
  5. Resources from Parkinson’s Disease Foundations and Associations: Organizations dedicated to PD support and research, such as the Parkinson’s Foundation, Michael J. Fox Foundation for Parkinson’s Research, and Parkinson’s UK, may offer resources, guides, and articles on driving with PD.
  6. Government and Transportation Department Websites: Many countries’ transportation or road safety departments provide guidelines and resources for drivers with medical conditions, including PD. These resources can offer practical advice and legal considerations for driving with a health condition.
  7. Occupational Therapy and Driving Rehabilitation Resources: Organizations specializing in occupational therapy and driving rehabilitation may offer resources on adaptations, evaluations, and training programs to support safe driving among individuals with PD.
  8. Online Forums and Community Support Groups: Online platforms and social media groups for individuals with PD and their families can be a source of shared experiences, tips, and advice on managing driving and PD.

 

  1. How often should a person with Parkinson’s disease undergo a driving assessment?

For individuals with Parkinson’s Disease (PD), the frequency of driving assessments is not one-size-fits-all; it should be personalized based on the progression of their condition, the impact of symptoms on driving abilities, and any changes in treatment. The article suggests that regular follow-up assessments are recommended due to the progressive nature of PD. While a specific timeline isn’t universally mandated, the guidelines suggest a range that could be as frequent as every 6 months to as long as 5 years, depending on individual circumstances.

In practice, the treating physician, often a neurologist familiar with the patient’s condition, plays a crucial role in determining the assessment frequency. They will consider factors such as:

  • The severity and progression rate of PD symptoms.
  • The presence of any cognitive decline or visual impairment.
  • The effects of PD medications on alertness and motor control.
  • Feedback from the patient and family members about driving capabilities.
  • Any recent incidents or near-misses while driving.

Given these variables, the decision on how often to undergo driving assessment should be made collaboratively between the individual with PD, their family, and their healthcare team. This ensures a balance between maintaining independence and ensuring safety on the road for all.

In navigating the journey of driving with Parkinson’s Disease, the road might seem uncertain, filled with caution signs and speed bumps. However, armed with the right knowledge, assessments, and adaptations, it’s possible to maintain independence and safety behind the wheel. Remember, each journey is unique, and staying in tune with your body, seeking regular evaluations, and making informed decisions are key to driving safely with Parkinson’s. As we conclude this guide, let’s embrace the journey ahead with caution, courage, and the confidence that comes from being well-informed. Safe travels!

 

Reading reference:  Stamatelos, P., Economou, A., Yannis, G., Stefanis, L. and Papageorgiou, S.G. (2024), Parkinson’s Disease and Driving Fitness: A Systematic Review of the Existing Guidelines. Mov Disord Clin Pract, 11: 198-208. https://doi.org/10.1002/mdc3.13942

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Diet for Parkinson’s: Unveiling the Current Science Behind Your Food Choices

February 6, 2024By 0 comment

Parkinson’s disease (PD) is a common brain condition that affects many people worldwide and What is a right diet for Parkinson Disease is an enigma.  Some studies have looked at how different diets might affect Parkinson’s Disease and found some interesting connections, but there’s still a lot we don’t know. We do know that many people with PD aren’t getting the right nutrients they need, which can make their health and how they feel worse. So, researchers are trying to figure out if changing what people eat or taking certain vitamins could help them feel better and slow down how fast PD gets worse (What’s the Best Diet for Parkinson Disease? ). This article will talk about what we know so far about how food and supplements might help people with Parkinson’s disease, and what we need to learn more about based upon a recent scientific publication in the Journal of Parkinson’s Disease by Kira Tosfesky.

Dietary Patterns

Mediterranean Diets

Mediterranean diets are all about eating lots of plant-based foods like veggies, fruits, whole grains, beans, and nuts. They also include fish and seafood, a bit of chicken, and some wine. But you eat less red meat, sweets, and sugary drinks. Studies from 2020 to 2023 found that following this diet could lower the risk of getting Parkinson’s disease (PD). One study even showed that men who followed this diet had Parkinson’s symptoms show up later, up to 8.4 years later. These diets are thought to help because they have lots of antioxidants and good fats that protect the brain. However, there haven’t been many big studies testing if this diet can really help people with Parkinson feel better.

MIND Diet

The MIND diet is a mix of the Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets, made to keep the brain healthy. It says to eat a lot of leafy greens, beans, and berries, but not so much cheese, butter, or margarine. One study found that following the MIND diet was linked to a lower risk of getting parkinsonism, a condition like Parkinson’s disease, and slower symptoms than following the Mediterranean diet. Another study showed that women who followed the MIND diet had Parkinson’s symptoms show up later, up to 17.4 years later. But we still need more research to know for sure if this diet can really help people with Parkinson’s feel better.

Vegetarian and Vegan Diets

Some studies suggest that societies where people mostly eat vegetarian or vegan diets have lower rates of Parkinson’s disease (PD). A study in the UK found that people who ate healthy plant-based diets had a lower risk of getting PD, while those who ate unhealthy plant-based diets had a higher risk. Another study tested a vegetarian diet on 16 patients with PD for 14 days and found that it helped improve their symptoms. But we still need more research to know if these diets can really help people with PD feel better.

Ketogenic diet

The ketogenic diet (KD) is a special diet that is high in fat and low in carbohydrates. This diet might help people with Parkinson’s disease (PD) because it provides a different type of fuel for the brain called ketones. Ketones can help the brain work better when the usual fuel, glucose, doesn’t work as well in PD. Some studies tested this diet on people with PD and found that it might help improve symptoms like movement problems and anxiety. However, some people had more tremors or stiffness when they started the diet, so we need more research to understand if the ketogenic diet is really helpful for everyone with PD.

Protein redistribution diets:

Changing when you eat protein might help people with Parkinson’s disease (PD) get more benefit from their medication. Protein-redistribution diets involve eating most of your protein at dinner and less during the day. Studies on these diets showed that they could reduce movement problems by 32–79% and help with other symptoms too. But some people worry that these diets might make you lose weight or muscle. So, more research is needed to understand if they’re safe and helpful for everyone with PD.

Food Groups

Dairy:

Eating a lot of dairy, like milk, cheese, and yogurt, might have different effects on Parkinson’s disease (PD). Some studies suggest that high dairy consumption could raise the risk of getting PD. However, the type of dairy matters too. Low-fat dairy seems to be linked more strongly to PD risk than full-fat dairy. Ice cream, yogurt, and cheese have been connected to faster PD progression. The reasons behind these connections are not fully understood, but it could be because of certain chemicals in dairy products or pesticides used in farming.

Alcohol:

The relationship between alcohol and PD is mixed. Some studies suggest that moderate alcohol intake might increase the risk of PD in men. But other research shows a U-shaped association, meaning both heavy drinkers and those who don’t drink at all might have higher risks. However, these findings might be influenced by other factors like smoking or personality traits. Some think that the antioxidants in alcohol could protect against PD, but more research is needed to understand how alcohol affects PD risk.

Caffeine:

Drinking coffee and tea with caffeine might help lower the risk of PD and slow down its progression. Caffeine seems to affect certain chemicals in the brain that are involved in PD. However, studies testing caffeine pills alone haven’t shown the same benefits. This suggests that other parts of coffee and tea might also play a role in protecting against PD.

PD-Specific Foods:

Some foods seem to affect how fast Parkinson’s disease progresses. Eating more fresh vegetables, fruits, nuts, fish, olive oil, and spices could slow down the disease. On the other hand, canned fruits and vegetables, fried foods, beef, and dairy products like ice cream and yogurt might make PD symptoms worse. These findings are based on what people with PD have reported, but more research is needed to understand how different foods affect the disease.

Nutritional Supplements

Vitamin D:

Many studies have found that people with Parkinson’s disease (PD) often have low levels of vitamin D. This can affect how severe their symptoms are and even increase the risk of falls. Vitamin D plays an important role in the brain, especially in the area affected by PD. Some studies have tested giving extra vitamin D to people with PD, but so far, it doesn’t seem to have a big effect on symptoms. However, it’s still important for people with PD to make sure they get enough vitamin D to keep their bones healthy.

Vitamin E and Omega-3 Fatty Acids:

Vitamin E and omega-3 fatty acids are thought to help with PD because they have antioxidant and anti-inflammatory properties. Some studies have found that taking these supplements can improve PD symptoms and reduce inflammation in the body. Fish oil, which contains omega-3 fatty acids, seems to slow down PD progression according to some studies. But more research is needed to confirm these benefits.

Vitamins B6, B9, and B12:

People with PD often have high levels of a substance called homocysteine in their blood, which can be harmful. Vitamins B6, B9 (folate), and B12 can help lower homocysteine levels. Some studies suggest that taking these vitamins might help prevent or slow down PD, but more research is needed to be sure.

Other Vitamins:

Vitamins B1 (thiamine) and C don’t seem to have a big effect on PD risk, but they might help with symptoms. Thiamine deficiency has been linked to memory problems in PD, while vitamin C might help the body absorb PD medications better.

Fiber, Prebiotics, and Probiotics:

Gut problems are common in PD, so some researchers are looking at how fiber, prebiotics, and probiotics might help. Probiotics, in particular, seem to improve PD symptoms and mood in some studies, but more research is needed to understand their effects fully.

Mucuna Pruriens:

Mucuna pruriens is a plant that contains levodopa, the main medication used to treat PD. Some studies suggest that it might work as well as synthetic levodopa in controlling PD symptoms.

Conclusions

Conclusions:

Diet for Parkinson disease is a common daily enigma for both people with PD and health care professionals. Understanding the role of nutrition in Parkinson’s disease (PD) is crucial for patients, researchers, and doctors. While many studies show a link between diet and PD, there’s a lack of high-quality research, making it hard to give clear recommendations. Challenges in studying nutrition in PD include differences in people’s diets, difficulty in measuring food intake accurately, and the need for long-term studies to see if diets can change the course of the disease. Despite these challenges, some diets like the Mediterranean and MIND diets seem promising for PD. However, more research is needed to confirm their benefits. Certain supplements, like vitamin E and omega-3 fatty acids, may also help with PD symptoms, but more studies are necessary. Other dietary factors, such as alcohol and dairy, have mixed evidence regarding their impact on PD risk and progression. While probiotics show promise in managing PD symptoms, more research is needed to understand their effectiveness fully. Overall, nutrition plays a crucial role in PD management, but more research is needed to provide clear guidelines and overcome barriers to dietary changes for patients.

Reference Publication : 

Tosefsky, Kira N. et al. ‘The Role of Diet in Parkinson’s Disease’. 1 Jan. 2024 : 1 – 14.

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Unveiling the Silence: Bridging the Gap in Disclosing Aging-Related Disorders

January 30, 2024By 0 comment

In the realm of health narratives, there exists a stark contrast between Western societies and the Indian subcontinent ( Parkinson’s disease awareness India celebrity endorsement )when it comes to the openness surrounding aging-related disorders. While the Western world has seen public figures bravely and transparently sharing their battles with conditions like Parkinson’s disease and dementia, a notable silence shrouds a similar dialogue in India. Despite a population of comparable magnitude, individuals who have reached pinnacles in their respective fields often navigate their journeys with aging-related disorders discreetly. This prompts a crucial exploration into the factors contributing to this disparity and begs the question: Why does a culture that thrives on collective strength find it challenging to put a face on aging-related health struggles?

Untangling the Threads: Unraveling the Silence in India

While Western societies have witnessed a surge of notable figures championing the cause of aging-related disorders, one cannot help but notice the conspicuous void in the Indian narrative. Michael J. Fox, the iconic actor, and advocate, boldly embraced his journey with Parkinson’s disease, establishing himself as a global symbol of resilience. His foundation, dedicated to Parkinson’s research, stands as a testament to the transformative power of public disclosure. Similarly, personalities like Glenn Campbell and Terry Jones, facing Alzheimer’s and dementia, have not only shared their personal battles but also actively contributed to awareness and research.

On the flip side, the Indian landscape seems relatively muted in these discussions. The absence of comparable figures taking the lead in initiating conversations around aging-related disorders prompts a crucial question: Is the void a reflection of an actual dearth, or does it point toward the need for a cultural shift, where open dialogue becomes the norm rather than the exception?.

Bridging the Divide: Western Advocacy vs. the Indian Void

In the heart of this disparity lies a complex interplay of cultural nuances, societal expectations, and deeply ingrained norms surrounding privacy. The cultural fabric in India often weaves a narrative of strength, resilience, and reverence for age. Individuals who have attained eminence in their fields may find themselves caught in the dichotomy of upholding these cultural values while confronting the vulnerability that accompanies aging-related disorders. This cultural reticence, coupled with the fear of perceived weakness or an expectation to exude unwavering strength, may contribute to the reluctance in openly sharing health struggles. As we navigate these intricacies, it becomes evident that addressing the silence surrounding aging-related disorders requires not just individual courage but a broader societal shift in perceptions.

Exploring the Silence: Factors Influencing Concealment

The disparity becomes evident when one scans the global landscape, finding Western luminaries openly discussing their encounters with aging-related disorders. Meanwhile, in India, where accomplished individuals wield significant influence, a shroud of secrecy surrounds similar health battles. One might wonder about the underlying factors steering this reluctance. Is it cultural reticence, the fear of perceived vulnerability, or perhaps a deeply ingrained societal expectation of invincibility, especially for those who have reached the zenith of their professions? As we unravel these threads, it becomes essential to examine how cultural norms, societal expectations, and personal privacy intertwine to create an environment where aging-related health struggles often remain hidden.

Empowering Voices: The Ripple Effect of Openness

When individuals with aging-related disorders step into the light and share their narratives, a profound ripple effect occurs. Beyond personal catharsis, these stories have the potential to transform societal perceptions, erode stigma, and ignite a dialogue that resonates with millions facing similar challenges. The power of personal narratives extends beyond individual experiences; it becomes a catalyst for widespread awareness, fostering empathy, and inspiring collective action. Moreover, the impact goes beyond awareness as it lays the foundation for advocacy, research initiatives, and a collaborative effort to reshape how society views and addresses aging-related disorders.

  1. How Can Individuals Open Up?

Individuals with aging-related disorders possess the agency to break the silence. By sharing their stories, they not only embark on a personal journey of empowerment but also contribute to a collective narrative that challenges stereotypes and sparks essential conversations.

  1. What Could Openness Achieve?

The potential benefits of openness are vast. Beyond personal empowerment, openness can reshape societal attitudes, drive awareness, and fuel advocacy efforts. It has the power to inspire research initiatives, facilitate early detection, and ultimately contribute to the global endeavor of finding effective therapies and cures.

Empowering the Future: Merging Ancient Wisdom with Modern Advocacy

As we reflect on the journey toward destigmatizing aging-related disorders in India, it’s essential to draw inspiration from the rich tapestry of the nation’s history. Ancient Indian science, with luminaries like Charaka, Sushruta, and Aryabhata, laid the foundation for significant advancements in medicine and mathematics. The profound knowledge embedded in the Vedas continues to garner acknowledgment and validation.

In the current landscape, where India is making strides in various fields, from technology to healthcare, the potential for transformative impact is immense. The acknowledgement of aging-related disorders by the current generation is not merely a personal disclosure; it is a beacon that can illuminate the path toward collective understanding, awareness, and research.

By aligning with the spirit of ancient Indian knowledge that valued holistic well-being, individuals who choose to openly discuss their aging-related struggles contribute to a legacy of progress. Their stories become integral to a modern narrative that combines the wisdom of the past with the urgency of the present. This isn’t just about personal empowerment; it’s about fostering a cultural shift that values openness and leverages collective strength to address the challenges of aging-related disorders.

In this moment of renaissance, where the importance of mental and physical well-being takes center stage, the current generation in India ( Parkinson’s disease awareness India celebrity endorsement )has the opportunity to be pioneers in fostering a new era of understanding. By creating awareness, supporting research, and sharing personal experiences, individuals can contribute to a global dialogue that transcends cultural boundaries, ultimately benefiting millions in India and beyond.

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Ten Questions Will Answer: Can My Genes (DNA) Predict My Parkinson’s Destiny?

January 24, 2024By 0 comment

Unlocking the Parkinson’s Code: Will I Inherit Parkinson? Is It In Your Genes? Discover the Secrets of Your Genetic Destiny – Your Inheritance, Your Risk, and the Probability of Parkinson’s Unveiled! Dive into the genetic puzzle of Parkinson’s with these 10 crucial questions –  Empower yourself with a clearer understanding of the genetic probabilities surrounding Parkinson’s disease.

1. Can I get Parkinson's disease if one of my parents has it? (Will I Inherit Parkinson?)

While having a parent with Parkinson’s disease may slightly increase your risk, most people with a parent with Parkinson’s do not develop the condition. Many factors contribute to Parkinson’s, and it’s not solely determined by genetics.

2. If one of my parents has Parkinson's disease, should I get genetic testing done to know whether I can get Parkinson's disease?

Genetic testing is not routinely recommended for Parkinson’s disease. While having a parent with Parkinson’s may slightly increase your risk, most cases are not solely determined by genetics. Genetic testing is not a crystal ball, and even if you have a genetic predisposition, it doesn’t guarantee you will develop the condition. If you have concerns, it’s best to discuss them with a healthcare professional who can provide guidance based on your individual situation. Regular check-ups and a healthy lifestyle are essential for overall well-being.

3. What is the probability that genetic testing will help me know whether I will develop Parkinson's disease?

The role of genetic testing in predicting Parkinson’s disease is complex. While certain genetic mutations are associated with an increased risk, having these mutations doesn’t guarantee you will develop the condition. Most cases of Parkinson’s are not caused by a single gene, and environmental factors also play a significant role

Genetic testing can identify specific mutations linked to Parkinson’s, but it cannot provide a definite answer about whether you will develop the disease. It can offer insight into potential risk factors, allowing for better-informed discussions with healthcare professionals. However, the decision to undergo genetic testing should be made in consultation with a healthcare provider, considering individual circumstances and the limitations of current genetic knowledge regarding Parkinson’s disease.

4. What type of mutations can predict that I might be more likely to develop Parkinson's disease?

Certain mutations in specific genes, such as SNCA, LRRK2, and PARK2, have been associated with an increased risk of Parkinson’s disease. However, it’s crucial to understand that having these mutations doesn’t guarantee the development of the condition. These genetic factors contribute to a small percentage of Parkinson’s cases.

In most instances, Parkinson’s disease is considered a complex disorder influenced by a combination of genetic and environmental factors. Genetic testing may identify these mutations, but the interpretation of the results is complex and requires the expertise of a healthcare professional. It’s essential to approach genetic testing with caution and discuss the implications thoroughly with your healthcare provider before making any decisions.

5. Why, despite advances in science, can we not definitively tell whether someone will develop Parkinson's disease or not?

Parkinson’s disease is a complex condition influenced by a combination of genetic and environmental factors. While scientific advancements have allowed us to identify certain genetic mutations associated with an increased risk, these factors are only part of the overall picture.

  1. Genetic Complexity: Most cases of Parkinson’s are not caused by a single gene, making it challenging to pinpoint definitive genetic markers. Multiple genes and their interactions contribute to the risk.
  2. Environmental Factors: Exposure to certain environmental factors, such as toxins or head injuries, also plays a role in Parkinson’s disease. Identifying and measuring these factors accurately is difficult.
  3. Individual Differences: Each person’s genetic makeup and life experiences are unique. Predicting disease development requires considering the interplay of various genetic and environmental factors, making it a highly individualized and intricate process.
  4. Ongoing Research: Parkinson’s disease is an active area of research, and scientists are continually discovering new aspects of its complexity. Our understanding of the disease evolves over time, and predicting individual outcomes remains a challenging task.

In summary, the multifaceted nature of Parkinson’s disease, combined with the intricate interplay of genetic and environmental factors, makes it difficult to definitively predict its development in any given individual. Research is ongoing, and as our understanding grows, we may gain more insights into the factors influencing Parkinson’s disease.

6. Can a genetic testing report confirm that I don't have Parkinson's disease?

No, a genetic testing report cannot definitively confirm that you don’t have Parkinson’s disease. While certain genetic mutations are associated with an increased risk, the absence of these mutations does not guarantee immunity from the condition.

Parkinson’s disease is complex, involving a combination of genetic and environmental factors. Genetic testing may provide information about specific mutations, but it cannot account for all the variables that contribute to the development of the disease. Furthermore, the majority of Parkinson’s cases do not result from known genetic mutations.

7. If I need to get genetic testing for Parkinson's disease, what type of test should be done, and what are the advantages/disadvantages of different types of genetic testing for Parkinson's disease?

There are different types of genetic tests for Parkinson’s disease, each with its advantages and disadvantages. The decision to undergo testing should be made in consultation with a healthcare professional, considering individual circumstances and preferences. Here are some common types:

  1. Single Gene Testing:

– Advantages: This test focuses on specific genes associated with Parkinson’s, such as SNCA, LRRK2, and PARK2. It provides targeted information.

– Disadvantages: It may not identify other less common or newly discovered genetic factors contributing to Parkinson’s. Results may not provide a comprehensive view.

  1. Panel Testing:

– Advantages: This broader test examines multiple genes simultaneously, increasing the likelihood of detecting relevant mutations.

– Disadvantages: It may still miss some rare or emerging genetic factors. Interpretation can be complex, requiring specialized knowledge.

  1. Whole Exome Sequencing (WES):

– Advantages: WES analyzes the coding regions of all genes, potentially identifying rare or novel mutations.

– Disadvantages: It may uncover variations of unknown significance, leading to uncertainty in interpretation. It is more expensive and may produce more data than needed for Parkinson’s assessment.

  1. Whole Genome Sequencing (WGS):

– Advantages: WGS analyzes the entire genome, providing a comprehensive overview of genetic variations.

– Disadvantages: Similar to WES, it may reveal variations with unclear significance. It is the most expensive option.

8. What is Polygenic Risk Score (PRS)? Does it help in diagnosing Parkinson’s Disease?

A Polygenic Risk Score (PRS) is a numerical representation of an individual’s genetic susceptibility to a particular condition, such as Parkinson’s disease, based on multiple genetic variants across the genome. In the context of Parkinson’s disease, a polygenic risk score combines information from various genetic markers to estimate an individual’s overall risk of developing the condition.

Here’s how a Polygenic Risk Score works and its role in diagnosing Parkinson’s disease:

  1. Multiple Genetic Variants: Parkinson’s disease is believed to have a complex genetic basis involving the interaction of multiple genetic factors. Researchers have identified various genetic markers (or variants) associated with an increased or decreased risk of Parkinson’s.
  2. Weighted Contributions: Each genetic variant is assigned a weight based on its observed association with Parkinson’s disease in large-scale genetic studies. Some variants may contribute more significantly to the risk, while others have a lesser impact.
  3. Cumulative Risk Assessment: The Polygenic Risk Score is calculated by summing up the weighted contributions of these genetic variants. The resulting score provides an estimate of an individual’s overall genetic susceptibility to Parkinson’s disease.
  4. Population Comparisons: The Polygenic Risk Score is often compared to scores from large population studies to determine where an individual falls in terms of their genetic risk compared to the general population.
  5. Risk Stratification: Individuals with higher Polygenic Risk Scores may be considered at a relatively higher risk of developing Parkinson’s disease, while those with lower scores may have a lower risk. However, it’s important to note that a Polygenic Risk Score is not a diagnostic tool but rather a probabilistic assessment.
  6. Clinical Application: While Polygenic Risk Scores show promise in understanding genetic risk, they are not currently used as standalone diagnostic tools for Parkinson’s disease. Instead, they may contribute to a comprehensive risk assessment when combined with clinical evaluation, family history, and other relevant factors.

In summary, a Polygenic Risk Score for Parkinson’s disease provides a personalized genetic risk estimate based on multiple genetic variants. While it adds valuable information to our understanding of genetic contributions to Parkinson’s risk, it is not a definitive diagnostic tool and should be interpreted in conjunction with other clinical and genetic information by healthcare professionals.

9. Are there specific factors that increase the chances of getting Parkinson's disease?

Yes, age is a significant factor. The likelihood of developing Parkinson’s disease increases with age. However, it’s important to note that not everyone who gets older will develop the condition.

10. Is Parkinson's disease contagious or can you catch it from someone else?

No, Parkinson’s disease is not contagious. It is not caused by a virus or bacteria and cannot be passed from person to person like a cold or the flu.

To Conclude

In moments of contemplation about the possibility of developing Parkinson’s disease, questions inevitably arise about the role of genetic testing in diagnosis. While our answers provide valuable insights, it’s crucial to understand that, at this juncture in medical science, clinical diagnosis of Parkinson’s disease relies more on a thorough assessment by a healthcare professional. Tests may serve to substantiate the diagnosis, but they are not the sole determinant. Early signs, such as tremors, stiffness, and balance issues, may raise concerns, yet these symptoms can stem from various conditions. If you observe persistent symptoms, seeking guidance from a healthcare professional becomes paramount for an accurate diagnosis.

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Unveiling the Groundbreaking Solution for Parkinson’s Freezing of Gait

January 18, 2024By 0 comment

Parkinson’s disease affects over 9 million people worldwide and causes “freezing of gait,” which is one of the most debilitating symptoms. Recent research from the Harvard John A. Paulson School of Engineering and Applied Sciences and the Boston University Sargent College of Health & Rehabilitation Sciences has developed a soft, wearable robot that gently assists the wearer’s hip movement, enabling longer strides and eliminating freezing episodes indoors. The wearable garment uses cable-driven actuators and sensors, generating assistive moments in concert with biological muscles. The device’s impact was immediate, and the participant was able to walk without freezing indoors, and even outdoors, he experienced only occasional episodes. The device has the potential to deepen our understanding of gait freezing, a phenomenon that remains poorly understood. This soft robotic device offers a ray of hope for Parkinson’s patients worldwide, paving the way for further research into soft robotics and their potential to improve the lives of individuals grappling with this debilitating disease.

The study titled “Soft robotic apparel to avert freezing of gait in Parkinson’s disease” has been published in Nature Medicine (January 2024). The key findings of the study include:

  1. The soft robotic garment gently assists the wearer’s hip movement, enabling longer strides and eliminating freezing episodes indoors.
  2. The device’s impact was immediate, and the participant was able to walk without freezing indoors, and even outdoors, he experienced only occasional episodes.
  3. The study involved a 73-year-old man with Parkinson’s disease, who, despite undergoing surgical and pharmacologic treatments, experienced frequent and debilitating freezing episodes, leading to frequent falls and reduced mobility.
  4. The device’s sensors collected motion data and generated assistive forces in sync with muscle movement, effectively reducing freezing episodes.
  5. The study’s results offer a ray of hope for Parkinson’s patients worldwide, paving the way for further research into soft robotics and their potential to improve the lives of individuals grappling with this debilitating disease.

These findings support the potential of soft robotic devices in addressing the challenges faced by Parkinson’s patients, particularly in mitigating the effects of freezing of gait.

What is Freezing of Gait?

Freezing of gait is a common, disabling symptom of Parkinson’s disease (PD), but the mechanisms and treatments of FOG remain great challenges for clinicians and researchers. Freezing of gait (FOG) is defined as a brief, episodic absence or marked reduction of forward progression of the feet despite the intention to walk. During a freezing episode, a person with PD may feel like their feet are stuck in place, or glue to the ground. Freezing may also affect other parts of the body or speech. Some people are more likely to have freezing episodes than others. Freezing may occur when the person with PD is due for the next dose of dopaminergic medications. This is called “off” freezing — usually, until compensation strategies such as cueing is provided.

FOG is one of the most disabling yet poorly understood symptoms of Parkinson’s disease (PD). FoG is an episodic gait pattern characterized by the inability to step that occurs on initiation or particularly with perception of tight surroundings. This phenomenon impairs balance, increases falls, and reduces the quality of life. The exact cause of FOG is not known, but it is thought to be related to the degeneration of the basal ganglia, which is responsible for controlling movement.

FOG is not unique to PD and can also occur in other neurological conditions, such as, Higher Gait Disorders (HGD), multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration.

There are several treatment options for FOG, including pharmacological, surgical, and behavioral therapies. Pharmacological treatments include levodopa, dopamine agonists, and monoamine oxidase inhibitors. Surgical treatments include deep brain stimulation (DBS) and lesioning of the subthalamic nucleus (STN) or globus pallidus internus (GPi) with variable / suboptimal benefits for exclusive FOG. Behavioral therapies include cueing, which involves providing visual or auditory cues to help the patient initiate movement, and physical therapy, which can help improve balance and gait.

In recent years, researchers have developed a soft, wearable robot designed to combat freezing of gait in Parkinson’s patients. Worn around the hips and thighs, this innovative robotic garment gently assists the wearer’s hip movement, enabling longer strides and eliminating freezing episodes indoors. The device’s sensors collected motion data and generated assistive forces in sync with muscle movement, effectively reducing freezing episodes. The device’s impact was immediate, and the participant was able to walk without freezing indoors, and even outdoors, he experienced only occasional episodes.

In conclusion, FOG is a common and debilitating symptom of Parkinson’s disease that can also occur in other neurological conditions. The exact cause of FOG is not known, but it is thought to be related to the degeneration of the basal ganglia. There are several treatment options for FOG, including pharmacological, surgical, and behavioral therapies. Recent research has also shown promising results with a soft, wearable robot designed to combat freezing of gait in Parkinson’s patients.

Reference:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8233405/
  2. https://translationalneurodegeneration.biomedcentral.com/articles/10.1186/s40035-020-00191-5
  3. https://www.nature.com/articles/s41591-023-02731-8
  4. https://www.thebrighterside.news/post/revolutionary-soft-robotic-exosuit-offers-hope-for-9-million-parkinson-s-patients-worldwide
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Awareness

Michael J Fox’s Fight Against Parkinson’s: Supporting Research and Awareness

January 16, 2024By 0 comment

The documentary “Still: A Michael J. Fox Movie” provides an affecting portrait of the beloved actor and advocate, exploring his personal and professional triumphs and travails, particularly his journey with Parkinson’s disease. The film delves into Fox’s life, from his early career and success in iconic 80s hits like “Back to the Future” and “Family Ties,” to his public revelation of his Parkinson’s diagnosis in 1998, a condition he had kept secret for seven years. The documentary includes dramatic reconstructions, interviews with Fox, and glimpses into his daily life with his family and personal trainer. It portrays Fox as a thoroughly likable man, without self-pity, and highlights his natural upbeat style as a survival mechanism. The film has been praised for its well-balanced and thought-provoking approach, offering a new storytelling format that effectively communicates the heart of Fox’s story, filling the audience with both sadness and hope. The documentary is available for streaming on Apple TV+ and has been nominated for seven Emmy Awards, including Outstanding Documentary

By watching “Still: A Michael J. Fox Movie,” you’ll gain a deeper understanding of the challenges faced by those living with Parkinson’s disease and learn about the ongoing efforts to find a cure. The documentary serves as a powerful reminder of the importance of awareness, research, and support in the fight against this debilitating condition.

“Still: A Michael J. Fox Movie” has received several accolades and awards, including the following:

  1. Critics’ Choice Documentary Awards: The film won five prizes at the Critics’ Choice Documentary Awards, including Best Feature and Best Director.
  2. Other Awards: The documentary also won Outstanding Sound Design and has been recognized for achievement in documentaries.

The film’s success at the Critics’ Choice Documentary Awards and its recognition for various aspects of its production highlight its exceptional quality and impact.

What is Michael J Fox Foundation

The Michael J. Fox Foundation for Parkinson’s Research, founded in 2000 by Michael J. Fox, is dedicated to finding a cure for Parkinson’s disease through an aggressively funded research agenda and ensuring the development of improved therapies for people living with the condition. The foundation has become the largest non-profit funder of Parkinson’s disease research in the world, with more than $1 billion of research projects to date.

Works of the Michael J. Fox Foundation:

  1. Research Funding: The foundation focuses on funding research to find a cure for Parkinson’s disease and develop improved therapies for those affected by the condition.
  2. Clinical Studies: In 2010, the foundation launched the first large-scale clinical study on evolution biomarkers of the disease, which has led to ground breaking research and a better understanding of the condition.
  3. Living with Parkinson’s: The foundation’s online source for information on Parkinson’s disease includes guides for the newly diagnosed and caregivers, stories from people living with the disease, and additional resources.
  4. Awareness and Advocacy: The foundation has raised awareness for Parkinson’s disease through various initiatives, such as the Nike raffle in 2016, which raised $6.75 million for the cause.
  5. Collaboration: The Michael J. Fox Foundation collaborates with other organizations and researchers to advance the understanding and treatment of Parkinson’s disease.

The foundation’s efforts have led to significant progress in Parkinson’s research, including the discovery of a biomarker for the disease, which has increased hope for a cure in the future[2]. Michael J. Fox’s personal journey with Parkinson’s disease and his advocacy work through the foundation have raised awareness and funds for research, making a significant impact on the lives of those affected by the condition.

Apple TV + Documentary source

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