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MSU Researcher Gets NIH Grant for Parkinson's Disease Work
Saturday, July 24, 2010
ANN ARBOR, MI (MICHIGAN RADIO) - A Michigan State University researcher is working on new treatments for Parkinson's disease.
Dr. John Goudreau says a protein known as "parkin" can save certain neurons in the brain from injury caused by Parkinson's disease.
The associate professor of neurology, pharmacology and toxicology is using a $1.5 million grant from the National Institutes of Health to explore his theory.
Goudreau uses a boxing analogy.
"So you have a couple of prizefighters," Goudreau says. "One gets hit and goes down to the mat and can't get up. These other cells that seem to be resistant to the disease take the same kind of hit, they go down to the mat, but they can bounce back up again and again. So we wanted to figure out why they were able to do that."
About four million people worldwide have Parkinson's disease. Goudreau says that's expected to increase to more than 8 million by the year 2030.
Parkinson's Disease Patient Tells Personal Story to Benefit PD Research; Donates Book Proceeds to PD
Saturday, July 17, 2010
Elkridge, MD
After undergoing experimental brain surgery, a Maryland Parkinson’s disease patient believed his story would make an interesting and uplifting book for people suffering from the same condition. He just couldn't find a literary agent who agreed with him. Most publishers will only accept requested manuscripts from agents they have done business with in the past. Becoming a author at an established publishing house, he discovered, was like trying to join an exclusive country club by just walking in off the street and asking for an application. Frustrated after years of trying to get an agent to even answer a query letter, Bill Schmalfeldt decided to take matters into his own hands. Reaching into his own pocket, he has self-published his story and is donating 100 percent of the author’s proceeds from the book’s sale to help find a cure for this crippling, degenerative neurological disease. "No Doorway Wide Enough" is Schmalfeldt’s personal story about living with a neurological disease that afflicts over a million Americans. 100 percent of the author proceeds will be donated to the National Parkinson Foundation and the Charles DBS Research Fund at Vanderbilt University Medical Center. “The title comes from my days as a Navy hospital corpsman at the former U.S. Naval Home in Gulfport, Ms.,” the 55-year old writer said. “I used to wonder why it was that some of the older folks tended to stop and ‘size up’ a doorway before walking through. I did a spot-on impression of this effect for my friends at parties. Got lots of laughs. Now I know the reason for it.” The book began its life as a blog, "My Parkinson's Disease Diary". With his daily entries, Schmalfeldt weaves a fascinating tale that starts with being diagnosed at age 45, why he decided to participate in an experimental clinical trial that involved brain surgery, and his recovery and life afterwards. With a wry and sardonic sense of humor, Schmalfeldt tells of his personal struggle with the disease, pulling no punches over his frustration over the mixed results of his surgery. “It’s the story of my Parkinson’s decade — 2000 to 2010,” Schmalfeldt said. “This book is written not only for the Parkinson’s disease patient,” Schmalfeldt said, “but for anyone who knows, cares for, or loves someone who has this beast of a disease. It's also for the guy or gal who will see the neurologist tomorrow, next week or next year and get the diagnosis. The one thing I want people to take away from this book is that Parkinson’s disease is not a death sentence. It’s a life sentence.” Schmalfeldt said that the book was also meant to highlight the importance of clinical trials in medical research. In 2007, Schmalfeldt volunteered for a clinical trial at Vanderbilt University Medical Center in Nashville to test the safety and tolerabilty of deep brain stimulation in early PD. “Clinical trials are vital in the search for new treatments and cures in a variety of diseases,” said Schmalfeldt, who works from home as a writer-editor for the Clinical Center at the National Institutes of Health in Bethesda, Md.“Without people volunteering to take part in this kind of research, scientists would have a much harder time finding new drugs, treatments and outright cures for the diseases that have plagued mankind throughout the years.” A former news reporter, radio talk show host and one of the original program directors at XM Satellite Radio, Schmalfeldt learned about the clinical trial at Vanderbilt in the course of his duties at NIH. “I write and produce podcasts about the importance of clinical trials,” he said. “What kind of hypocrite would I be if I saw a trial that I was qualified for and didn’t participate?" But it's not all happy talk. His story can not have a happy ending, barring the discovery of a cure. He discusses with brutal frankness his increasing problems with walking, freezing-of-gait, loss of balance, speech difficulties (particularly difficult for the award-winning former broadcaster), and what seems to be the onset of the early stages of Parkinson's disease dementia. He recounts a recent hallucination that helps explain why he gave up driving in May 2000. "Gail and I were leaving the parking lot at the Mall of Columbia," Schmalfeldt said. "I was looking out my widow to the right, and I turned my head back towards the center and saw something that scared the hell out of me. It looked like Gail was just about to run over a small child! Except, of course, for the fact that she wasn’t. What I thought was a kid was actually the little group of charms she has hanging from the rear view mirror. But for a second there, it looked just like a little kid." These "illusions" (as his neurologist calls them) are happening more frequently and, according to Schmalfeldt, motivate him to tell his story now while he can still do so clearly. This is Schmalfeldt’s first try at non-fiction. His previous works, “…by the people…”, “Undercover Trucker: How I Saved America by Truckin’ Towels for the Taliban,” and “Hunky Dunk,” are available at his web site as well as at major online booksellers worldwide. The book is available as a hardcover, a deluxe paperback, a standard paperback, an Amazon "Kindle" book, and in practically every available downloadable eBook format. A native of Clinton, Iowa, Schmalfeldt lives with his wife, Gail, in Elkridge, Md. He continues to blog daily at http://parkinsondiary.com. 
Parkinson's Patients More Likely To Stick With Certain 'Add-On' Drugs
Saturday, July 10, 2010
Of the three main types of oral drugs commonly added to levodopa therapy for patients with advanced Parkinson's disease, one might be the most effective, according to a new review.
People with Parkinson's disease often initially experience tremors, stiffness, slowed movement or difficulty with balance and coordination. These symptoms result from the destruction of brain cells that produce dopamine an important chemical that transmits nerve impulses.
Many people with Parkinson's start treatment by taking levodopa, which the body converts to dopamine. After a time, however, levodopa alone is not always enough.
The three classes of drugs for add-on treatment are dopamine agonists, which stimulate dopamine receptors in the brain, drugs known as COMT inhibitors and MAOB inhibitors, which slow the breakdown of dopamine in the body.
Of these, dopamine agonists might be most effective, according to a new review.
The irony for patients and doctors alike is that while all of the add-on drugs help improve functional motor skills, they simultaneously might increase numerous other side effects such as dyskinesia, dizziness, sleep disturbances, nausea, constipationand even hallucinations.
Although the risk of side effects increased with all three types of add-on drugs, patients were most likely to continue treatment when they were taking dopamine agonists. This class includes medications such as pramipexole (Mirapex), ropinirole (Requip), cabergoline (Dostinex) and bromocriptine (Parlodel).
"There's a tendency to think that stronger drugs give more adverse effects, but we didn't find that with dopamine agonists," says review co-author Carl E. Clarke, M.D., a neurologist at the University of Birmingham in England. "They seem to be as well tolerated as the other classes, so the results are quite positive in terms of using the agonists ahead of the other two."
Parkinson's disease is a chronic, progressive disorder affecting more than 6 million people worldwide, making it the most common degenerative condition of the brain after Alzheimer's disease. Both illnesses are most common in the elderly, so with an aging U.S. population, their prevalence is likely to increase.
"No treatments have been proven to slow progression of the disease," said William J. Weiner, M.D., director of the Maryland Parkinson's Disease and Movement Disorders Center at the University of Maryland Medical Center. "Yet with treatment to alleviate motor symptoms, most patients can function extremely well for six to 10 years."
Levodopa typically controls symptoms very well for up to five years, but eventually a patient's symptoms start to reappear each day before the next dose is due or symptoms might reappear and disappear unpredictably. Patients might also develop dyskinesia, which results in uncontrollable jerking and writhing movements.
Doctors can then add another medication to the levodopa therapy.
"The greater efficacy and reduced likelihood of patient withdrawal with dopamine agonist therapy possibly outweighs the disadvantage of increased side effects," concludes the review.
This finding matches Weiner's clinical experience gained from decades of treating people with the disease.
"Most [Parkinson's] patients prefer to have these dyskinesias and other moderate side effects than to have more disabling motor complications like being unable to walk," he says. "Hallucinations may be troublesome and frightening initially, but they are typically benign a patient might think he sees a dog and people can get used to them."
The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.
This review assessed data from 44 randomized trials involving 8,436 participants. The authors caution, however, that the studies compared each class of drugs against placebo, rather than conducting "head-to-head" comparisons of each class against the others.
This leaves open the possibility that the findings arose not from actual differences in the treatments, but rather from other factors such as differences in the types of people included in the various trials. A large trial featuring direct comparisons of the three drug classes currently is underway in the United Kingdom, Clarke said.
Of the drugs in the COMT inhibitor class, the review suggests that tolcapone (Tasmar) is as effective as the dopamine agonists. However, tolcapone has been linked to a few cases of fatal liver toxicity and can now only be prescribed in the United States with intense monitoring.
"Tolcapone is worth using in patients where [the alternative] is not working well, and we mustn't discount it," Clarke said. "This evidence clearly states that."
The review disclosed that Clarke has received payments for consulting, lectures and travel from Boehringer-Ingelheim, GlaxoSmithKline, Lundbeck, Orion, Teva, UCB, and Valeant.
The Cochrane Library contains high quality health care information, including Systematic Reviews from The Cochrane Collaboration. These reviews bring together research on the effects of health care and are considered the gold standard for determining the relative effectiveness of different interventions. The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions.
Stowe R, et al. Evaluation of the efficacy and safety of adjuvant treatment to levodopa therapy in Parkinson s disease patients with motor complications (Review). Cochrane Database of Systematic Reviews 2010, Issue 7.
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