Physiotherapy beneficial for people with Parkinson's disease in the short term

23 sept 2012—Results from a systematic review and meta-analysis led by the University of Birmingham in the UK suggest that physiotherapy benefits people with Parkinson's disease in the short term (< 3 months).

The management of Parkinson's disease has traditionally centred on drug treatment, however, there has been increasing support for the inclusion of rehabilitation therapies, such as physiotherapy, to supplement pharmacological and neurosurgical treatment.

Dr Claire Tomlinson, from the University of Birmingham Clinical Trials Unit, and colleagues selected 39 randomised controlled trials including 1827 participants for review.  The review included trials assessing a variety of different physiotherapy methods used to treat participants including general physiotherapy, exercise, treadmill training and dance. 

Of the 18 potential physiotherapy outcomes assessed, physiotherapy resulted in improvements in nine areas.  For three outcomes (gait speed, the Berg balance scale and a clinician-rated disability scale) there is existing evidence to suggest that these improvements may be clinically meaningful to people with Parkinson's disease.  For example, participants demonstrated that with physiotherapy intervention they were able to walk faster or maintain their balance better compared to no intervention.

Dr Tomlinson, said: "This study indicates that physiotherapy could provide clinically meaningful benefits in the short term for people with Parkinson's disease. Further improved studies are needed; these will shed more light on how beneficial physiotherapy can be for patients in the longer term.  Once a larger and better quality of evidence is achieved, there might be scope for a recommendation for change in practice to be made."

More information: Physiotherapy intervention in Parkinson's disease: systematic review and meta-analysis, published by the British Medical Journal (BMJ) 2012;345(7872).

Provided by University of Birmingham

Parkinson's Treatment Drugs Even Out Over Long Term

11 mar 2009-- Two drugs -- levodopa and pramipexole -- used to treat early stage Parkinson's disease each have advantages and disadvantages, but their overall impact appears to even out over a long period of treatment.

That's the conclusion of a new study that included hundreds of patients in Canada and the United States.

"Clinicians and patients often struggle with what is the right initial approach to treating Parkinson's disease. This study tells us that, over the long haul, patients on the different drugs end up at roughly the same place in terms of their level of disability and quality of life," lead author Dr. Kevin Biglan, a neurologist at the University of Rochester Medical Center in New York, said in a school news release.

The two drugs use different mechanisms to counteract the decline in the production of dopamine in the brain that causes Parkinson's symptoms. Levodopa is an amino acid that the body metabolizes into dopamine. Pramipexole binds with dopamine receptors on cells in the brain and mimics dopamine's molecular function.

Levodopa is considered better at treating motor control problems in Parkinson's patients but is also associated with side effects such as dyskinesia (involuntary movements), and the effectiveness of the drug can wear off over time. Pramipexole is less commonly associated with dyskinesea and wearing off, but is less effective in treating motor control problems and more often causes sleepiness, according to background information in the news release.

Doctors often prescribe pramipexole first, because it extends the length of time a patient can benefit from levodopa before its effect wears off.

The initial study included 301 patients at 22 sites who were followed for two years. A subset of 222 of those patients was followed for an additional four years. At the start of the study, half the patients were randomly selected to receive levodopa and half to receive pramipexole. After six years of follow-up, 90 percent of patients were taking levodopa.

Patients initially treated with levodopa were more likely to develop motor control complications such as dyskinesia and wearing off, but these complications didn't have a significant impact on patients' quality of life or disability, the researchers found.

The study, published online March 9 in the journal Archives of Neurology, was funded by Pharmacia Corp. and Boehringer Ingelheim.

Jefferson researchers define ideal time for stem cell collection for Parkinson's disease therapy

(WASHINGTON, D.C.), 21nov 2008--Researchers have identified a stage during dopamine neuron differentiation that may be an ideal time to collect human embryonic stem cells for transplantation to treat Parkinson's disease, according to data presented at Neuroscience 2008, the 38th annual meeting of the Society for Neuroscience.

Lorraine Iacovitti, Ph.D., professor and interim director of the Farber Institute for Neurosciences of Thomas Jefferson University, and her research team found that neural progenitor cells that express the gene Lmx1a are committed to the midbrain dopamine neuron lineage, but still retain proliferative capacity. Because of these characteristics, the stage at which Lmx1a is expressed may be ideal for transplantation.

"Identifying the subset of developing dopamine neurons and selecting those cells at the stage appropriate for their transplantation has been challenging," said Dr. Iacovitti. "Our research demonstrates that we are now able to grow neurons and select the ones that may work as a therapy, without the use of synthetic genes. This advance represents an important leap forward in the quest to devise a viable cell replacement therapy for Parkinson's disease."

The Lmx1a-positive cells cannot be identified solely by this transcription factor. However, Dr. Iacovitti and her team also found that a large percentage of the Lmx1a-positive cells express a cell surface protein called TrkB. This protein was not expressed on any of the other cell types identified in the cell culture. With TrkB as a cell surface marker, dopamine neuron progenitor cells derived from human embryonic stem cells can be selected from a heterogenous population using magnetic-activated cell sorting (MACS) or fluorescence-activated cell sorting (FACS). Neither process alters the stem cell's genome. Dr. Iacovitti and her team are now testing the ability of these cells to counteract Parkinson's disease in animal models. They will also be adapting these procedures developed in human embryonic stem cells to adult-derived human induced-pluripotent stem cells.

New treatment promising for Parkinson's

By MALCOLM RITTER, AP Science WriterFri Jun 22, 8:35 PM ET
An experimental treatment for Parkinson's disease seemed to improve symptoms — dramatically so, for one 59-year-old man — without causing side effects in an early study of a dozen patients. The gene therapy treatment involved slipping billions of copies of a gene into the brain to calm overactive brain circuitry.
The small study focused on testing the safety of the procedure rather than its effectiveness, and experts cautioned it's too soon to draw conclusions about how well it works. But they called the results promising and said the approach merits further studies.
"We still have quite a bit more testing to do," said Dr. Michael Kaplitt of Weill Cornell Medical College in New York, an author of the study. Still, "the initial results are extremely encouraging."
Kaplitt and collaborators report their results in this week's issue of the British medical journal, The Lancet.
They're not alone in trying gene therapy for Parkinson's. In April, another team told a medical meeting that its experiments, which delivered a different kind of gene to a different part of the brain, also appeared safe and gave a preliminary hint of benefit.
More than half a million Americans have Parkinson's. They endure symptoms that include tremors, rigidity in their limbs, slowness of movement and impaired balance and coordination. Eventually they can become severely disabled.
Nathan Klein, a 59-year-old freelance television producer in Port Washington, N.Y., said the disease left him "pretty messed up." It weakened his voice, impaired his walking and made his hand tremble so badly he couldn't hold a glass of wine without spilling it all.
Klein was the first patient to be treated with Kaplitt's gene therapy procedure in 2003, and he said his symptoms gradually subsided afterward. Nowadays, he said, apart from freezing now and then when he wants to walk, the symptoms are basically gone.
"I'm elated," said Klein, who continues to take his regular pills for the disease. "It's unbelievable."
Kaplitt, who has a financial interest in Neurologix Inc., which paid for the research, noted that the 12 patients in the study still have Parkinson's symptoms. The amount of medication they were already taking for their symptoms didn't change significantly in the year after the surgery.
Current medicines can control symptoms, but can't stop the disease from getting worse over time, and they can produce troublesome side effects like uncontrollable movement.
Some patients gain relief from a surgical treatment called deep brain stimulation, in which electrodes are placed in the brain and connected to a programmable stimulator.
Kaplitt's procedure was aimed at achieving the same goal as that surgery, calming overactive circuitry in the brain. It gets overactive because it loses the normal supply of a chemical called GABA. The gene therapy was designed to make the brain produce more GABA.
For the gene therapy surgery, a tube about the width of a hair was threaded through a hole about the size of a quarter at the top of the skull. The tube delivered a dose of a virus engineered to ferry copies of a gene into cells of a brain region called the subthalamic nucleus. The gene copies enable the cells to pump out more GABA.
The Lancet paper reports that over a year, patients showed no side effects from the procedure. What's more, they showed improvements in an overall assessment of symptoms like tremors, stiffness and walking problems.
The improvements were evident at a checkup three months after the procedure and persisted to the end of the study, one year after the surgery, researchers reported. By that time, the overall amount of improvement from before surgery was about 24 percent when measured at times that patients were off their normal medication, and 27 percent at times when they were on medication.
Most of the effect appeared on just one side of the body. Because of concerns about safety with the untested procedure, the researchers treated only the brain circuitry controlling one side of the body.
Dr. Karl Kieburtz of the University of Rochester Medical Center, who didn't participate in Kaplitt's work, said the lack of any apparent side effects is itself significant.
But he urged caution in interpreting the evidence of benefits in symptoms. Other experimental therapies that looked good at such a preliminary stage have failed to pan out in more rigorous studies, he said, so more research is needed.
Future studies could include a head-to-head test against deep brain stimulation to see which relieves symptoms better, said neurosurgeon Dr. Guy M. McKhann of the Columbia University Medical Center in New York.
Dr. J. Timothy Greenamyre of the University of Pittsburgh, who was also familiar with the results, said the new study and prior research in animals leave him "very optimistic" about Kaplitt's approach.
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On the Net:
Lancet: http://www.thelancet.com
Information on Parkinson's disease:
http://www.ninds.nih.gov/disorders/parkinsons_disease/parkinsons_disease.htm

Clinical Trial to Examine Creatine as Parkinson's Treatment

THURSDAY, March 22 (HealthDay News) -- A large-scale clinical trial to determine whether the nutritional supplement creatine can slow the progression of Parkinson's disease is expected to be launched Thursday by the U.S. National Institute of Neurological Disorders and Stroke, part of the National Institutes of Health .The double-blind, placebo-controlled study will be conducted at 51 medical centers in the United States and in Canada, and will include 1,720 people with early-stage Parkinson's disease.
The study will enroll people who've been diagnosed with Parkinson's disease within the past five years and who have been treated for two years or less with drugs that increase levels of dopamine in the brain. Many symptoms of Parkinson's disease are due to a loss of dopamine, a neurotransmitter that helps control movement.
Creatine is not approved for treatment of Parkinson's disease or any other condition, but it's widely believed that it improves exercise performance. Studies have suggested that creatine can improve the function of mitochondria, which produce energy inside cells. There's also some indication that creatine may act as an antioxidant that prevents damage from compounds that are harmful to brain cells.
"This study is an important step toward developing a therapy that could change the course of this devastating disease," NIH Director Dr. Elias A. Zerhouni said in a prepared statement. "The goal is to improve the quality of life for people with Parkinson's for a longer period of time than is possible with existing therapies."
http://news.yahoo.com/s/hsn/20070322/hl_hsn/clinicaltrialtoexaminecreatineasparkinsonstreatment