Physical Treatments For Parkinson's
How can exercise affect the symptoms of Parkinson's?
This is an interesting area in Parkinsons disease research currently. There is evidence, certainly from animal models, that physical activity enhances the certain good chemicals in the brain. These are so call neurotrophic factors - you could think of them as a brain fertilizer, something that encourages the health and protection of the brain. There is similar data that's being generated now by research that exercise is beneficial in maintaining mobility in Parkinsons disease and it may have an favorable effect on brain chemistry, but that's still under investigation currently. Weight training is good for maintaining muscle bulk and tone but the exercise that is seemingly of greatest benefit is aerobic exercise. It doesn't have to be anything hugely exertional - it can be something simple like walking, or for those people who have difficulty with balance they can use a stationary bike.
What physical therapy is used to treat Parkinson's?
Balance may be an issue in some people with Parkinsons disease, and that's a problem that may not respond to intervention with medications. In that setting, physical therapy can be very helpful for developing strategy to reduce the risk of falling. Also, physical therapists who are familiar with Parkinsons disease can help develop exercise strategies tailored to the individual, to keep them as mobile as possible.
What speech therapy is used to treat people with Parkinson's?
Speech therapy, which is provided by a speech pathologist, can be helpful in two areas. One, addressing speech itself; trying to encourage the patient to improve enunciation as best as possible, since it is affected in many people with Parkinsons disease. And there is this technique, the so-called Lee Silverman Technique, that is tailored to people with Parkinsons disease, which can be beneficial in maintaining speech volume and clarity. Speech pathologists also address swallowing disorders in Parkinsons disease, and they can be helpful in better defining what the swallowing problem might be, and methods to intervene. Sometimes just dietary changes, or the consistency of the food that people are eating may have an impact. Some things that could be regarded ultimately as common sense recommendations, but speech pathologists are specially trained to look into these things, to enable people to avoid coughing, or choking while eating or drinking. On some occasions, a formal swallow study is conducted by a speech pathologist. Here, usually in association with a radiologist, people will swallow a barium-containing compound; a liquid, or sometimes eat a barium-containing cookie to see how the swallowing mechanism is working in somebody with Parkinsons disease. It can help identify people who may be at risk for aspiration, where they're putting liquid or solids into their lung instead of into their stomach.
How are 'thalamotomy' and 'pallidotomy' operations used to treat Parkinson's?
Thalamotomy and pallidotomy are surgical procedures that are used to treat the symptoms of Parkinsons disease. They are not curative. Thalamotomy, in particular, is beneficial for tremor. Pallidotomy may be helpful for alleviating tremor, stiffness and slowness and also those involuntary movements that are medication induced, so called dyskinesia. These are both what are referred to as ablative procedures, because they cause, intentionally so, a little bit of injury to the brain, and they cause the equivalent of a scar in this area. An electrode is placed into the brain and the tip is either heated or cooled to actually injure the brain tissue around the tip. Both of these procedures have been done quite a bit in the past, but not so much currently. They have fallen from favor in terms of causing this injury permanently into the brain.
What are the side effects of thalamotomies and pallidotomies?
Thatamontomies are only done on one side, it's usually not done on both sides of the brain because it can have a serious negative impact on speech. There's also concern about cognitive issues of doing both of these procedures, thatamontomy and pallidotomy, on both sides of the brain. Pallidotomy has been done mostly on one side or in a unilateral fashion.
How is 'DBS' surgery used to treat Parkinson's?
Deep brain stimulation surgery, or DBS for short, is used to treat the symptoms of Parkinsons disease. This is accomplished by a neurosurgeon implanting, permanently, electrodes into the brain, usually on both sides, occasionally just on one side. The electrodes are implanted into usually a target called the subthalamic nucleus, or STN for short. This is a structure deep within the brain that is involved in Parkinsons disease. When the brain cells that produce dopamine are defective or deficient, and not producing dopamine adequately, the STN structure becomes overly active. By inserting a thin wire electrode into that location and stimulating there, that overactivity can be reduced and thereby the symptoms are alleviated. When people had this procedure done, they had improvement, typically, of tremor, stiffness and slowness, and usually you can also reduce their medications by roughly about one half. Also, for people who are troubled by these involuntary movements, so-called dyskinesias that are medication-induced, those symptoms are also usually improved upon. The people who are candidates for DBS are people who still have medication improvement, but it just doesn't last long enough, it's just not having an extended duration as anticipated, and also people who are having refractory tremor - tremor that doesn't improve with medication - it's very troubling to the patient, and could have treatment by DBS. Or, people who are having a lot of difficulty with these involuntary movements, the so-called dyskinesias; those people also are considered to be candidates for DBS, when manipulation of their medications is not adequate to improve their symptoms.
What are the side effects of DBS?
The side effects of DBS may include, especially when it's done on both sides, difficulty with speech. There's some concern that it can cause cognitive difficulties, so people who have a large amount of difficulty with cognition or dementia are usually not considered being appropriate candidates for DBS.
How is 'nerve cell transplantation' used to treat people with Parkinson's?
Transplantation of tissue, which sounds like science fiction but has been accomplished in some studies so far, involves taking brain tissue from some other source. In the studies that have been accomplished, it was usually from a fetus source, taking brain tissue from that source and then implanting it into the part of the brain that's infected by Parkinsons Disease. These studies so far have not been markedly effective, and that technique has fallen from favor. It's not being done very much at all these days. The studies that were accomplished and were published did show some benefit that was very modest, especially in younger people with Parkinsons Disease. In that same group, some people developed these involuntary movements that were very persistent, and despite medication reduction, would not go away. This concept of fetal tissue transplantation into the brains of people with Parkinsons Disease is not being avidly pursued in terms of research currently.
How is 'GDNF' surgery used to treat people with Parkinson's?
GDNF, or glial-derived neurotrophic factor, is a naturally-occuring brain substance, and it was thought that by increasing this in the brain that it might help protect the brain from further injury in Parkinsons disease. The preliminary trials suggested that was being achieved, but these were trials that were done in what's called an open-label fashion, meaning that there wasn't a placebo group or a sham operation. People knew they were getting it, the investigators knew they were getting them. When it was done in a placebo-controlled fashion, the results were not clearly beneficial, and for that reason, the trial has not proceded further at this point. GDNF remains of interest in terms of a method of treating Parkinsons disease, and hopefully to forestall or slow the progression of Parkinsons disease. There are studies being looked at in terms of using stem cells implanted into the brains of people with Parkinsons disease, and the stem cells being taught or coded to increase GDNF production. It's not being done to my knowledge in people at this time, but there has been some work in animal models of Parkinsons disease, and it looks encouraging.
What role do stem cells have in treating Parkinson's?
Stem cells hold out great hope for the treatment of Parkinsons disease, and other disorders as well, as a method to undo or correct the changes that have been brought on the central nervous system by whatever disease process, whether it's Parkinsons disease or perhaps spinal cord injury, for example. Stem cells are precursors of the tissues of all of our body. Stem cells can be encouraged to become a brain cell, or a kidney, or a liver, or almost anything that one could imagine. If we have the tricks, if we have the techniques to encourage stem cells to develop along those lines. That really remains a challenge. How can we devise strategies for developing stem cells into other body parts - into brain tissues, or kidney tissues, or lung tissues - that's what we don't quite know how to do yet. Also, stem cells could be used to create substances that we know that are good for us, these neurotrophic factor, GDNF, or something similar. Stem cells could be little factories producing these good things that we all need to help our bodies and our brains remain as healthy as possible.
What role does gene therapy play in treating Parkinson's?
One method of altering how the brain functions is to alter the genes. The genes of all our tissues tell our cells, tell our tissues what to do; what proteins to synthesize and how much. One way to alter how the brain is behaving in Parkinsons disease is to insert genes directly into the brain that tell the brain to behave in a more favorable way, to try to address some of the problems that have been created by Parkinsons disease. There have been a number of efforts, certainly in the United States, in trying to accomplish that. These are still early in their course, but they are being tested in people. One effort involves a gene for another neurotrophic factor called Nurr 1 to try to undo or forestall the changes that are being created by Parkinsons disease. The data so far that I've seen presented at meetings looks encouraging, but it's not yet at a level where it's going to be offered widely as a therapy for Parkinsons disease. The clinical trials are still underway examining this kind of technique.