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Parkinson’s

Parkinson’s

04 May 10:00 by Julie McEwan

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Parkinson’s UK estimates that 1 in every 350 people in the UK is affected by Parkinson’s disease, which is roughly 145,000 people, with millions being affected worldwide. This is a horrible disease without any current cure and without one definitive test. So, due to common misdiagnoses the figures are conservative and may actually be up to 40% higher, also when it is diagnosed there are currently no measures to detect the stage of the disease.

Parkinson’s is a neurodegenerative disorder that is caused by a reduction of the chemical Dopamine in the brain, which is responsible for transmitting messages regarding movement of the body. The symptoms include tremors, rigidity of the body and impairments to coordination and balance, that can become progressively worse after onset. It is also a condition that I sadly witness first hand, following a diagnosis for my Mum back in 2015 and as such I am always interested in reading about the latest research in this area. Currently there are many ways to manage the disease, through dopamine substitute pharmaceuticals and devices to aid with mobility and daily activities that are so much harder for suffers, such as eating and dressing. New, innovative research is producing increasingly sophisticated aids but is also working towards both a definitive test and a treatment. Here are some of the research studies that I have read recently and the avenues being explored for the future.

Detection

One article that caught my eye, if you will pardon the pun, is one that investigated changes in the visual system amongst Parkinson’s sufferers who were newly diagnosed. It was found that alongside the more anticipated symptoms, it was commonly found that visual deteriorations were also evident. These included a reduction in blinking, the inability to distinguish colours correctly and a reduction in the clarity of their vision, which were not connected by the patients as a symptom of Parkinson’s. This study used neuroimaging techniques and ophthalmic examinations to come to these results and the imaging also showed a reduction of white matter concentration and other abnormalities in the parts of the brain associated with the visual system. It is hoped that these biomarkers, with further research and understanding, may be used as an early detection tool for the disease.

Genetic risk factors are also being investigated. One study has suggested that a genetic predisposition causes an abnormal autoimmune response to a protein called alpha synuclein. It is suggested that this autoimmune response ultimately leads to the destruction of dopamine producing cells, as the immune system is ‘tricked’ into attacking healthy cells.

Another study in Australia found a common correlation between writing speed and applied pen pressure in patients with Parkinson’s. The test involved drawing a spiral on a piece of paper and using a real-time software to take these measurements, the results showed clearly distinguishable differences between the control group and those with the disease. The results were also able to give indications of varying degrees of severity. It was the trial’s aim to produce an automated and cost-effective test that could be used by front line healthcare professionals for early diagnosis.

And finally – detection dogs. I wrote about the use of detection dogs in another blog, largely in the detection of cancer, and having read about the amazing steps that are being made it is good to hear that trials are underway with Parkinson’s detection (funded by Parkinson’s UK and the Michael J Fox Foundation). Strangely enough it was a human who is accredited with initially detecting the accompanying smell for Parkinson’s. A woman named Joy Milne detected a change in the smell of her husband, before he was diagnosed with Parkinson’s. After his diagnosis, Joy attended support groups with her husband and realised this smell was not unique to her husband but evident with other patients and this lead to this avenue of research.

Treatment

One potential treatment focuses on reprogramming other brain cells to replace the dopamine producing ones that have been lost. It has been found that these cells can be reprogrammed by a virus which turns astrocyte cells into dopamine producing cells and they act exactly like the original cells. These initial studies have shown positive results in this regard; however, the location of the cells is not ideal for transference of dopamine to the brain. Studies are ongoing to make this a more viable option, which if successful could ultimately lead to a treatment to reverse the symptoms of Parkinson’s.

Clinical trials using deep brain stimulation have also been used to reduce the symptoms associated with the disease. Initially this was an invasive surgery carried out by a neurosurgeon, who would implant a battery operated neurostimulator that would deliver electrical stimulation to parts of the brain, in a similar way that a pacemaker works in the heart. These impulses block the abnormal signals that are sent by the brain to produce the abnormal movements. More recently studies have looked at whether this benefit can be replicated via a less invasive method and a team at MIT have developed a method that blocks the abnormal signals by placing electrodes directly onto the scalp of the patient. It is hoped that now this option will be open to more patients and although this treatment will not result in a cure or stop the condition from progressing, it allows some alleviation from the debilitating symptoms that they experience.

Management

Advances in technology have bought to market more and more innovative products to help people living with Parkinson’s. Here are just a few examples of the great ideas I have seen.

Walk With Path have created the Path Finder – this is a device that is attached to the shoe of the patient and helps with rigidity and a regularly reported problem, freezing of gait. It has been described as “not being able to get your legs going” or “like my feet are stuck to the floor” and is connected to a feeling of loss of balance. This device emits a bright laser line in front of the user. Walking towards or stepping over this visible line has been found to assist people with Parkinson’s retain their sense of balance and alleviates frozen gait. This device has received excellent reviews amongst patients and the media.

Liftlabs - have created a small device that tracks and compensates for small vibrations and tremors and this has been utilised in a new “smart” spoon for Parkinson’s patients. This computer runs an algorithm that senses the motion of the user and detects whether it was intentional or unintentional. If it detects that movement was unintentional it will move in the opposite way to the motion – stabilising the utensil. Many videos are available if this device being used online and are commonly preceded by the same patient trying to perform the same task with a standard utensil. The results are amazing.

Studies have also shown the benefits of biofeedback technology. The research team, from the University of Houston, have developed the Smarter Balance System (SBS) which is a biofeedback rehabilitation system that takes the patient through a set of balance exercises and reports measurements from a custom-made belt. Inside the belt are vibrating actuators that press against the wearers body as they move. In conjunction with a smart phone programme the user is able to see their own range of motion and the vibrating motion acts in a similar way to a hands-on guidance that would be provided by a physical therapist. The aim with this technology, is to strengthen the user’s postural stability which will reduce their risks of falls and subsequent injury but also increase their confidence in completing daily tasks at home.

Research continues and one day hopefully an early diagnostic test will be found. Currently diagnosis is based around the presence of motor symptoms and by the time these appear up to 50% of the dopamine producing cells have already been destroyed. If reversal therapies are to be utilised in the future the sooner they can began the better for the patient. If this diagnostic test can also measure severity on an agreed scale all the better as this allows patients to access support and management options as soon as possible. The ultimate goal, as with any disease, has to be a cure. 

More Blogs from Julie McEwan

Julie has written numerous interesting and well researched blogs on a wide range of topics related to Medical Devices and Human Factors.  Please click here to read more of Julie's blogs and here to find out more about Julie.