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The Future of Medicine: A New Way for Parkinson’s Patients to Get Their Medicine
Alberto Espay, Neurologist, UC Health
In this country, about a million and a half people have Parkinson’s disease. It’s the second most common neurodegenerative disease—a condition where certain brain cells die sooner than they should. Parkinson’s is recognized by the tremors that occur, often at rest; [it’s] associated with slowness of movement, stiffness, and walking or postural difficulty. Dopamine [a neurotransmitter] is a lubricant for movement. If we lack enough dopamine concentration in our brains, our movements look stiff. In Parkinson’s, the manufacturing is faulty. You have fewer neurons churning out dopamine.
The study that’s providing patients with the most dramatic change in quality of life treats them with [a drug called] levodopa. It’s delivered in a gel through a pump that lets it get straight into the small bowel, [allowing us] to provide patients with continuous stimulation of dopamine receptors, basically bathing them in dopamine. [Gastroenterologist] Dr. Nathan Schmulewitz inserts the tube, which is connected to the pump, and through which the medication is given continuously during 16 hours of wakefulness.
With the pump, we [don’t get] the peaks and valleys that occur when someone uses oral medications. Although we’re still in the experimental phase, we’ve advanced enough to see results in our patients. They’ve regained independence. [One patient had] filed for disability and was being cared for by his wife at home. Now [he] is untethered from any medications, other than his levodopa pump, and is active as a chaplain at his local hospital.
We still don’t have an intervention we can call “neuroprotective.” Neuroprotective action implies that neurons at risk are kept from dying and the milestones of disease-related disability are delayed. It’s exciting that within a few years we will have interventions available that will offer not only control of symptoms today but less burden of disease in the future. This is the promise of the neuroprotective therapies currently under evaluation at UC.
I evaluated and treated a patient who developed Parkinson’s disease at a relatively early age, while employed as a nurse. Her symptoms were classic, yet she was tested extensively for unrelated conditions and given a drug regimen that would have been acceptable for the late ’80s. The treatment was not only failing to control her motor symptoms but was also causing a variety of problems, including difficulties with concentration and memory. These problems forced her supervisors to lay her off. I completely changed her regimen, and within a couple of months she felt like her old self again, with no tremors, no shuffling, and no difficulties with thinking or memory. She’s now feeling recharged and living life to the fullest possible. Stories like hers, the certainty of knowing that our center gets people on their feet, one person at a time, gets me out of bed every morning.
Originally published in the January 2011 issue.