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22/08/2019 By Dr Paul Silberstein

Drs Cook & Silberstein feature on the cover of the North Shore Times/Mosman Daily

Neurosurgeon Dr Raymond Cook and Neurologist Dr Paul Silberstein feature on the cover of the North Shore Times/Mosman Daily in the story ‘Brains trust: The north shore team taking the fight to Parkinson’s disease’.

The story talks about the work both doctors do for people that are living with Parkinson’s disease and features an interview with a Parkinson’s patient, Carole McFadden, whose life has profoundly changed after recently having deep brain stimulation surgery at North Shore Private Hospital.

Shake it Up Australia Foundation founder, Clyde Campbell, also discusses the journey that led him to launch the foundation, and the impressive work they do to fund medical treatments with the aim of finding a cure for Parkinson’s disease.

The full story can be accessed online at http://newslocal.smedia.com.au/north-shore-times. Click on ‘back issues’ to access archived editions of the weekly newspaper.

01/08/2019 By Dr Paul Silberstein

Device assisted therapies for treatment of patients with Parkinson’s disease

In a recent study, researchers investigated the clinical effectiveness of three different device-assisted therapies for people with Parkinson’s Disease experiencing motor fluctuations and dyskinesias. The team found beneficial effects of all three treatment options. Keen to find out more? Read our summary here.

Device assisted therapies for treatment of patients with Parkinson’s disease

In the early stages of PD, most patients experience substantial benefit with medical therapy and exercise, achieving a 60-80% improvement of physical symptoms with consistent control through the day.

Over years, however, symptom control can become inconsistent and is sometimes accompanied by periods of excessive movement called ‘dyskinesia’.

Medication adjustments can be effective in ironing out these motor fluctuations and dyskinesia, however in the longer term, some patients find that consistent symptom control cannot be achieved even after altering their medications.

At this stage, a second tier of therapies can be effective in regaining consistent control of Parkinson’s symptoms and reducing dyskinesia. These therapies are delivered by medical devices and are collectively referred to as ‘Device Assisted Therapies’.

Currently, there are three device assisted therapies with proven efficacy in patients with motor fluctuations and dyskinesias:

· Deep Brain Stimulation (DBS)

· Apomorphine infusion (Apo)

· Intrajejunal levodopa infusion (IJLI)

Whilst all three therapies have been examined using the gold standard study format for medical interventions (a blinded randomised placebo controlled trial), head to head comparisons of all three therapies have not been previously performed.

In a recent study, researchers investigated the clinical effectiveness of the three different device-assisted therapies for people with Parkinson’s Disease experiencing motor fluctuations and dyskinesias.

The researchers observed 173 people in total who were undergoing:

· Bilateral subthalamic stimulation (STN-DBS) – 101 people

· Apomorphine (APO) – 39 people

· Intrajejunal levodopa infusion (IJLI) – 33 people.

The research, which is the first real-life comparison in people with Parkinson’s Disease undergoing device assisted therapies was published in the journal Movement Disorders. Link to summary here https://www.ncbi.nlm.nih.gov/pubmed/30719763

Importantly, the study examined and compared the effects of the three therapies on a broad range of PD symptoms aswell as quality of life. Specifically, the study examined and compared the effect of each of the therapies on:

· Physical (motor) symptoms

· Non-motor symptoms (cognition, mood, bladder and bowel, sleep disturbance & pain)

· Quality of Life

As had been demonstrated in earlier studies, all three therapies were effective in reducing motor fluctuations and dyskinesias and improving quality of life. Each therapy was however associated with a different profile of improvement of non-motor symptoms

· STN-DBS improved urinary and sexual functions, mood/cognition, sleep/fatigue, and the miscellaneous domain (pain, sense of taste and smell, weight change, excessive sweating)

· IJLI improved the mood/cognition, sleep/fatigue, miscellaneous and gastrointestinal symptoms.

· APO improved mood/cognition, perceptual problems/hallucinations, attention/memory, and the miscellaneous domain.

“Our results highlight the importance of holistic assessments of motor as well as nonmotor aspects of Parkinson’s Disease that could provide a means to personalise treatment options to patients’ individual Parkinson’s Disease profiles,” the researchers wrote.

This work assists clinicians in providing optimal recommendations regarding device assisted therapies, taking into account the full profile of an individual patient’s symptoms.

10/07/2019 By Dr Paul Silberstein

The novel GDNF trial yields mixed results

The novel GDNF clinical trial offered hope for restoring brain cells in people with Parkinson’s Disease. Including 41 people with Parkinson’s Disease aged between 41 and 72, the clinical trial was designed to investigate whether GDNF could slow, stop or reverse Parkinson’s Disease. Results were recently published. Read our study summary here.

Neurotrophic factors are small proteins produced in the brain that support the growth, survival and differentiation of brain cells. These proteins are important for maintenance of brain health and consequently there has been considerable interest in whether these proteins might improve survival or indeed assist regeneration of brain cells that are affected by Parkinson’s disease.

From 2012 to 2017, UK researchers conducted a novel clinical trial looking at the effects of delivering one such Neurotrophic factor, Glial Derived Neurotrophic Factor (GDNF) directly to the brain, using a new type of surgically implanted device. Link to article here https://www.parkinsonsmovement.com/the-gdnf-trial/

Including 41 people with Parkinson’s Disease aged between 41 and 72, the clinical trial was designed to investigate whether GDNF could slow, stop or reverse Parkinson’s Disease.

The group, all of whom had been diagnosed around eight years ago, were split into two smaller groups who were allocated either a placebo or the GDNF treatment.

Using a device mounted on the skull, the researchers were able to directly infuse GDNF into the putamen – an important brain region that is affected by PD. Study participants received either placebo or GDNF treatment every four weeks for 40 weeks.

After the 40-week period, the researchers noted that there was “no overall difference between the GDNF and placebo group” in terms of their movement scores. However, nine people showed what researchers called a “clinically significant improvement”.

The researchers then conducted an extension study for an additional 40 weeks and again found no clear difference between patients who had received GDNF versus placebo.

Overall, neither the GDNF study nor the extension study helped to improve movement-related symptoms in people with Parkinson’s, ultimately leading to the conclusion that GDNF infusions at the dose and for the duration used did not improve Parkinson’s disease.

Despite these disappointing results, the study demonstrated that direct monthly brain infusions of substances that might treat Parkinson’s disease is feasible and tolerable, thus providing an important platform for future trials into possible therapies for Parkinsons’s disease.

A documentary regarding this trial has been produced by the BBC: https://www.bbc.com/news/av/stories-47483307/the-radical-drug-trial-hoping-for-a-miracle-parkinson-s-cure

19/06/2019 By Dr Paul Silberstein

Video documents NSPH’s 500th DBS surgery milestone

Neurosurgeon Dr Raymond Cook, Neurologist Dr Paul Silberstein and the Sydney DBS team recently completed their 500th Deep Brain Stimulation (DBS) surgery and this milestone has been documented in a video produced by North Shore Private Hospital.

The Sydney DBS team, who have worked together for 14 years at North Shore Private Hospital, have been a key group in the renaissance of Parkinson’s disease and Movement Disorder surgery in Australia, and continue as the most experienced DBS team in NSW.

DBS involves the placement of stimulating electrodes in specific deep brain targets by a neurosurgical team. These wires are routed under the skin to an implanted battery, placed in the chest or abdominal wall. The battery produces a continuous impulse to the brain and provides 24 hour therapy to alleviate symptoms.

In Parkinson’s disease, DBS improves consistency of symptom control when this cannot be achieved with medication, reduces excessive movement (dyskinesia), facilitates a reduction in drug therapy and improves quality of life. DBS is also effective in substantially reducing symptoms in a number of other medication refractory Movement Disorders including Tremor syndromes, Dystonia and Tic disorders.

Successful therapy requires high surgical accuracy. The Sydney DBS team uses state of the art surgical equipment, carefully selected and sourced from international suppliers, and takes pride in surgical precision, high efficacy and a low complication rate. Excellent post-operative care is provided in the North Shore Private Intensive Care Unit and Neurosurgery ward.

23/05/2019 By Dr Paul Silberstein

Apathy and Parkinson’s disease

Apathy, a lack of feeling, enthusiasm, or concern, can affect as many as 40% of people with Parkinson’s Disease. And, according to Shake it Up Australia Foundation (https://shakeitup.org.au/apathy-and-parkinsons-disease/), apathy can have a detrimental effect on a person’s treatment outcomes, progress and mental health.

While more prevalent in older people and those with severe symptoms, apathy can occur in anyone living with Parkinson’s disease at any time.

Friends and family may be the first to notice if someone with PD is feeling apathetic. Common signs to look for include a lack of interest or concern about life, people and the world, as well as a loss of ‘get up and go.’ Activities a person once enjoyed may now seem too difficult.

If your loved one is showing signs of apathy, visit your doctor. Apathy can be confused with other mental health conditions, such as anxiety or depression, and a correct diagnosis is important in obtaining optimal treatment.

The good news is that there are many strategies to help people with PD who are experiencing apathy. Your doctor can help create a dedicated treatment program incorporating healthy lifestyle changes such as sleep, diet and exercise. Cognitive exercises and social activities can also help reduce feelings of apathy. Establishing a routine, and setting clear goals, can help people suffering from apathy stay on track and motivated.

While there is limited evidence supporting medications to treat apathy in people with PD, research in this area is ongoing. Certain medications can help people on an individual level. If you’re concerned that a loved one with Parkinson’s Disease may be experiencing apathy, visit your doctor.

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 May 2019.

18/04/2019 By Dr Paul Silberstein

World Parkinson’s Day Fundraiser at NSPH

Thank you staff and visitors to North Shore Private Hospital for supporting Shake it Up Australia Foundation for Parkinson’s Research on World Parkinson’s Day. 100 beautifully decorated cupcakes on our cupcake stall sold out in no time!

All monies raised at the yearly April 11 World Parkinson’s Day fundraiser go to Shake it Up Australia Foundation to support the amazing work they do for Parkinson’s research.

For more information on Shake it Up, head to www.shakeitup.org or follow them on Facebook at https://www.facebook.com/shakeitupaust/https://www.facebook.com/shakeitupaust/

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