Skip links

SydneyDBS

Header Right

Carmen Moller

By

Can asthma drugs alter the risk of developing Parkinson’s Disease?

Pathologic studies performed post mortem in patients with Parkinson’s Disease demonstrate abnormal aggregates of a protein called alpha-synuclein and much research is currently underway to try and understand why this abnormal protein accumulation occurs.

We know that a mutation in the alpha-synuclein gene causing overexpression of alpha-synuclein can cause a rare genetic form of Parkinson’s disease. This has peaked interest in whether there might be environmental factors that modulate expression of the alpha-synuclein gene and whether these factors might have an impact on the risk of developing PD.

An important recent finding has been that elements of the body’s sympathetic nervous system appear to modulate alpha-synuclein expression, specifically the B2 receptor (Mittal et al. Science 2017).

This is important because there are many existing medications, utilised for conditions such as asthma and hypertension that exert their effects by either stimulating or blocking B2 receptors. This raises the possibility that these medications might be important in reducing or indeed increasing the risk of developing PD in genetically susceptible individuals.

This hypothesis was first tested by examining a database of 4 million Norwegian patients (Mittal et al. Science 2017), to determine whether the asthma medication, salbutamol, which acts through stimulation of B2 receptors or the hypertension medication, propranolol, which acts by blocking (B1 and) B2 receptors, affected the risk of individuals in the study group developing Parkinson’s Disease over an 11 year follow-up period.  Notably, patients taking salbutamol were 1/3 less likely to develop PD than patients on neither medication.  By contrast, patients who took propranolol were 2.2 times as likely to develop Parkinson’s Disease than patients on neither treatment.

Recently, a further study has been published in support of these findings in the journal Movement Disorders (Gronich et al September 2018). In this instance, a database search analysis was performed on over 1.7 million Israelis, examining the likelihood of developing Parkinson’s Disease over a 13 year period.  Here again, the risk of patients who took the B2 blocking medication propranolol was more than double the risk of control subjects for developing Parkinson’s Disease. Patients who took asthma medications that act by stimulating B2 receptors (B2 agonists) conversely, had a reduced chance of developing PD, with the relative risk as much as halved in patients taking long acting B2 agonist medications.

These findings suggest that currently available B2 agonist medications utilised for the treatment of Asthma may reduce the risk of developing Parkinson’s Disease. More work needs to be done in this area, however the results do raise intriguing possibilities.  These include the possible use of B2 agonists to reduce the risk of developing Parkinson’s Disease in particularly susceptible populations (such as those who have a strong family history); or whether B2 agonists might modulate progression of Parkinson’s Disease in those already diagnosed.  These questions will need to be answered in future studies.

References

Mittal et al Science 2017: https://onlinelibrary.wiley.com/doi/10.1002/mds.108

Gronich et al Movement Disorders 2017 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5761666/

The information provided in this article is of a general nature only and is not treatment advice. Recommendations regarding therapy can only be made on a case by case basis, discussed between a patient and their treating doctor(s).

The information in this article was current at December 2018.

By

Impulse Control Disorders in Parkinson’s Disease

Impulse Control Disorders (ICDs) are a well-recognised side effect of medical treatment of Parkinson’s disease, and include a variety of hedonistic or pleasure-seeking behavioural disorders including pathologic gambling, compulsive shopping and eating, hypersexuality and hobbyism.

ICD severity can vary substantially. At the mild end of the spectrum, patients may experience an exacerbation of a pre-existing behaviour or personality trait, for example someone who has a tendency to hoard, might find it a bit more difficult to throw things out.  At the severe end, ICDs can cause financial and relationship havoc. Fortunately, we are starting to better understand ICDs, how to avoid them and how to help with de-escalation when they do occur.

Risk factors for ICDs

Studies have found that ICDs are more common in patients of younger age, those who live on their own, and patients who have a high caffeine intake. ICDs tend to progress faster in men.

ICDs can be a side effect of any of the medications that supplement or stimulate dopamine in the brain. The biggest risk factor for ICD development is treatment with a class of medications known as dopamine agonists. Formulations available in Australia include rotigotine (Neupro), pramipexole (Sifrol) and ropinirole (Repreve).  These medications can be used alone in the treatment of Parkinson’s disease or in combination with other anti-Parkinsonian medications.

How common are ICDs?

A study published in the journal Neurology this year by Corvol and others (link abstract) followed a relatively large group of French patients with early stage Parkinson’s disease over 5 years.  The key finding was that dopamine agonist use was associated with a cumulative increase in the development of ICDs.  45% of patients in the study who were treated with dopamine agonist therapy developed an ICD over 5 years.  The higher the dose, and the longer the duration of treatment, the higher the risk of ICD development.

Dopamine agonist treatment is not of course, all bad. Indeed dopamine agonists can be an important part of a treatment regime for PD. They can be particularly effective for symptoms such as restless legs, dream enactment behaviour and can improve mood.  Further, they can be helpful in reducing symptom variability through the day in those patients that have developed motor fluctuations or dyskinesias.

Can ICDs improve or resolve?

The good news is that ICDs can improve and do resolve completely in some patients. Corvol et al found that 50% of the ICDs that developed on dopamine agonist therapy had resolved one year after stopping the inciting medication.

 Prevention and management of ICDs

Keeping medication dose low and maintaining open and frank discussions about changes in behaviour are key in the prevention and management of ICDs.

Dopamine agonists may take weeks to become effective. Waiting for benefit can be difficult, but patience can be very important in optimising dopamine agonist treatment – keeping the dose low helps to reduce the risk of ICD development.

Talking about ICDs can be very challenging! Some patients feel embarrassed or ashamed of their ICD, others may be in denial or lack insight.  Partners & carers can be important in bringing ICDs to light.  Fortunately ICDs are treatable and do get better with alterations in therapy in the majority of patients.  Talking about them is the first step in achieving improvement.

Contact us
Sydney DBS Facebook Twitter

Integrated Neurology www.integratedneurology.com.au

Sydney North Neurosurgery www.snns.com.au

References:

Corvol et al. Longitudinal analysis of impulse control disorders in Parkinson’s disease. Neurology 2018.

Boylan & Kostic. Don’t ask, don’t tell. Impulse control disorders in PD. Neurology 2018.

The information provided in this article is of a general nature only and is not treatment advice. Recommendations regarding therapy can only be made on a case by case basis, discussed between a patient and their treating doctor(s).

The information in this article was current at October 2018.

By

Deep Brain Stimulation Support Group at North Shore Private Hospital

North Shore Private Hospital are hosting a Deep Brain Stimulation Support Group on Friday 15 February 2019 at 10.30am. Those that have had DBS surgery as well as those considering DBS or require more information are very welcome.


The main speaker will be The Hon. John Watkins AM. John had DBS surgery in early 2018. Movement Disorder Neurologist Dr Paul Silberstein and Neurosurgeon Dr Raymond Cook will also be in attendance to answer questions.

Morning tea will be provided and the meeting will run for approximately 2 hours.

Enjoy a morning listening to John Watkins speak about his Parkinson’s disease journey and after, have the opportunity to share personal experiences, ask questions, learn more about DBS and meet others who have had DBS surgery for their PD.

We look forward to seeing you there.

Register to attend at: seminars.nsp@ramsayhealth.com.au

FAQs
What are my public transport/parking options for getting to and from North Shore Private Hospital?
North Shore Private Hospital is located adjacent to Royal North Shore Hospital and a 10 minute walk from St Leonards train station. Paid parking is available at both hospitals or visitors can be dropped off at the hospital’s main entrance. More information at www.northshoreprivate.com.au/About-Us/Location

By

What about Laser Shoes?

Freezing of Gait (FOG) is a common longer-term manifestation of Parkinson’s Disease (PD).

Freezing is characterised by a sense of one’s feet sticking to the floor, making it difficult to initiate walking.  Freezing can affect one or both feet and tends to occur initially as an ‘off’ medication phenomenon i.e. when medication effects are low.  After many years of PD, freezing can also occur as an ‘on’ medication phenomenon.

Freezing is frustrating, debilitating, anxiety provoking and a significant cause of falls in people living with Parkinson’s Disease.

Clinicians have long recognised the benefits of using external cues to reduce freezing.  Cues include lines marked on the ground or using an object to step over (such as an upside down walking stick) to assist in gait initiation. In more recent times, projection of a laser light on the ground using a handheld, belt mounted or walker mounted device, has been used by some patients living with PD to reduce or overcome FOG.

Recently, this concept has been taken a step further with a Dutch group publishing on the benefits of laser shoes on gait freezing.   Effects were determined by a FOG questionnaire in a group of 21 patients with Parkinson’s disease who suffered gait freezing. Laser shoes reduced FOG severity by 18-20% and were also associated with a reduction in falls and near-falls.

This study was open label which raises the possibility that placebo effects might partially explain the results.  The study only ran for three weeks, making it impossible to comment on longer term effects.  Nevertheless, the results are encouraging and worthy of further investigation with larger studies and longer follow up.

Reference link to the study is here 

The following link relates to an article about another study by the same group, as well as video footage of a PD patient using the laser shoes https://technicollit.com/laser-shoes-prevent-freezing-in-parkinson-patients/

By

Sydney DBS Visit Patients in Noumea

Sydney DBS doctors, Neurosurgeon Dr Raymond Cook, Neurologist Dr Paul Silberstein and Neuropsychiatrist Dr Linton Meagher recently returned from their annual trip to Noumea, New Caledonia. During this visit, they assess patients for Deep Brain Stimulation as well as follow up with local patients who travelled to Sydney to undergo DBS at North Shore Private Hospital.

These DBS patients are at different stages in their follow up and by continuing to see these patients with the local team of professionals, ensures strong efficacy and a low complication rate for these patients. DBS helps many patients to achieve substantial improvements in neurologic symptoms including tremor, stiffness, slowness of movement and walking difficulty.

Dr Cook, Dr Silberstein and Dr Meagher also run a Parkinson’s Disease and Movement Disorder clinic where they work with local Neurologists to review patients. Dr Cook, Dr Silberstein and Dr Meagher have been making this trip annually since 2013. The doctors are pictured at the newly opened Medipole Hospital.

 

By

Sydney DBS Blog: Dealing with a Parkinson’s Disease Diagnosis


Dealing with a diagnosis of Parkinson’s Disease
A new diagnosis of Parkinson’s Disease can lead to a range of emotions such as shock, confusion, anxiety, worry or even a strange sense of calm. 

There are many ways of coping with a Parkinson’s disease diagnosis and there is no correct way to respond. Some suggestions to aid the process include:

Seek information from a trusted source when it is most suitable
Knowledge and understanding of Parkinson’s disease and its progression may help to clarify concerns. While some aspects of Parkinson’s disease are predictable, many are not and it is impossible to learn or understand everything immediately. Seeking out information is something to be explored at a pace suitable to each individual. 

When gathering information, PD NSW www.parkinsonsnsw.org.au and the Shake It Up Australia Foundation www.shakeitup.org.au are useful Australia based starting points. The Michael J Fox Foundation for Parkinson’s Research www.michaeljfox.org is a well-recognised international resource. Many countries have established patient support organisations with local information available through web and social media-based internet resources.

Consider support:
Support services and resources are available to provide assistance and strategies for dealing with a diagnosis of Parkinson’s disease and to learn and prepare for what may occur at different stages of the condition. 

Here are some patient support organisations in Australia. Many countries have their own support resources which can be accessed locally or online.

There is no “right” or “best” time to discuss a diagnosis with family and friends. Some people choose to discuss a new diagnosis immediately, whereas others delay discussion in order to allow time to process the diagnosis. Taking time to think through emotions and reactions can ultimately help to manage communication about PD in the optimum way for each individual.

Aim to maintain a healthy active lifestyle
Managing and maintaining a healthy lifestyle is helpful for both physical and emotional well-being

Aim to:
Eat a healthy diet

Exercise regularly – see our blog on PD and exercise here

Ensure sufficient rest

Reduce consumption of unhealthy foods 

Reduce alcohol consumption

Quit smoking

Aim to maintain a healthy mindset
Mindfulness based meditation techniques can be useful to help focus on the present rather than on concerns for the future. Many mindfulness-based apps are available for smartphone download. These can be used in isolation or accompany support and treatment from a counsellor, psychologist, GP or Psychiatrist.  

Planning for the future:
It can be helpful to consider planning for the future. For some people, this can provide a sense of control and lead to greater positivity. A health professional can provide assistance with developing a short-term plan and/or a longer-term plan. 

It’s important to bear in mind that most patients with Parkinson’s disease are able to achieve good quality of life over many years from the time of diagnosis.  There is a wide range of existing medical and non-medical therapies that provide significant benefit to people living with PD, and the research pipeline is looking promising for even better therapies in the future.

Contact us
Sydney DBS Facebook Twitter

Integrated Neurology www.integratedneurology.com.au

Sydney North Neurosurgery www.snns.com.au

References

The information provided in this article is of a general nature only and is not treatment advice. Recommendations regarding therapy can only be made on a case by case basis, discussed between a patient and their treating doctor(s).

The information in this article was current at 16 October 2018.