How Does Dopamine Affect Parkinson’s Disease?

This educational video from Parkinson’s UK explains more about Parkinson’s disease. The film shares that the disease develops in the substantia nigra part of the brain when the cells that produce dopamine begin to die. The loss of dopamine in the brain leads to issues with movement.

MORE: The five stages of Parkinson’s disease

As the disease progresses and the brain has less and less dopamine, the symptoms of the disease become more apparent and the patient develops tremors, difficulty walking, and other issues with movement. Researchers are working on ways to stop or slow down the loss of these dopamine-producing cells so that Parkinson’s disease may be treated and ultimately cured.

MORE: 12 types of exercise suitable for people with Parkinson’s disease

Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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FDA Approves Osmolex, by Osmotica, to Treat Movement Problems in Parkinson’s and Other Adults

FDA approval

The U.S. Food and Drug Administration (FDA) has approved Osmolex ER (amantadine, extended release) to treat both Parkinson’s disease and therapy-induced extrapyramidal reactions in adults, or the movement and muscle-control problems that typify this disease and can be side effects of common medications.

Osmodex ER, developed and marketed by Osmotica Pharmaceutical, is a once-daily tablet that contains a combination of immediate release and extended release amantadine (its active agent). Osmotica uses its patented Osmodex technology that combines laser-drilled tablet technology with a variety of single-active and multiple-active drug delivery devices,  the company states in a press release.

The Osmodex technology is a potential solution for soluble low-bioavailability medicines or for those that require a targeted delivery, as it simplifies dosing and may aid in patient compliance.

The Osmolex ER tablet is taken in the morning, and provides a controlled release of amantadine throughout the day, the company states. The therapy is available as three dosage options – 129 mg, 193 mg and 258 mg tablets – with the intent that physicians can decide the best dose for each patient, up to a maximum daily dose of 322 mg.

“The FDA’s approval of OSMOLEX ER provides a new treatment option for those patients suffering from Parkinson’s disease and adults who have extrapyramidal reactions, or movement disorders, that are caused by certain medicines. We are eager to make OSMOLEX ER available to physicians and patients in the U.S.,” Brian Markison, chief executive officer of Osmotica, said in the release.

Plans are to begin marketing the treatment “as soon as possible,” Markison added.

Amantadine as a Parkinson’s treatment was first developed and marketed by Adamas Pharmaceutical. An extended-release version of the company’s therapy, sold under the name of Gocovri, was approved by the U.S. Food and Drug Administration (FDA) to treat dyskinesia (involuntary and uncontrollable movements) in Parkinson’s disease patients who are receiving levodopa-based therapy, alone or combined with other medications, in August 2017.

Amantadine blocks glutamate’s access to certain receptors in the brain, reducing their signaling and therefore the level of dyskinesia.

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Synaptic Proteins Linked to Parkinson’s Could Aid in Early Intervention, Study Says

synaptic proteins

Key proteins involved in neuron communication are potential targets that could aid in early diagnosis and prediction of disease progression in patients with different types of dementias, including Parkinson’s disease, a study suggests.

The study, “Synaptic markers of cognitive decline in neurodegenerative diseases: a proteomic approach,” was published in the journal Brain.

Specific synaptic proteins, which are involved in neuron-to-neuron communication, were identified and linked to cognitive decline associated with Parkinson’s, Alzheimer’s, and dementia with Lewy bodies.

Loss of synaptic contact is a a common finding in the brains of individuals with Alzheimer’s disease. Synaptic dysfunction also occurs in Parkinson’s and dementia with Lewy bodies, according to studies.

Though early cognitive deficits are related to memory, decline is seen in all cognitive areas as neurodegenerative diseases progress.

Researchers from the Karolinska Institutet in Sweden analyzed the protein content of the prefrontal cortex of 32 post-mortem human brains of patients with Alzheimer’s disease, Parkinson’s disease with dementia, dementia with Lewy bodies, and older adults without dementia.

They looked specifically at proteins in the prefrontal cortex because of its role in cognition and executive functions (reasoning and decision-making) in all three diseases.

This was the first detailed quantitative protein analysis that focused on synaptic protein characterization of Alzheimer’s, Parkinson’s and dementia with Lewy bodies brains.

A total of 10,325 proteins were identified, 851 of which were synaptic proteins.

Researchers detected a pattern of protein loss in the area where electric nerve impulses are transmitted between two nerve cells across all three neurological disorders. Significant changes in the levels of 25 synaptic proteins were observed in all dementia groups.

Cognitive impairment before death and the rate of cognitive decline also closely correlated with the loss of five key synaptic proteins (SNAP47, SYBU, LRFN2, SV2C and GRIA3).

The team was able to successfully differentiate not only the distinct types of dementia in the demented samples, but also dementia samples from healthy controls.

“Besides differentiating Parkinson’s disease dementia, dementia with Lewy bodies, and Alzheimer’s disease from controls with high sensitivity and specificity, synaptic proteins also reliably discriminated Parkinson’s disease dementia from Alzheimer’s disease patients,” the researchers wrote.

“Our findings suggest that particular pre- and postsynaptic proteins have an important predictive and discriminative molecular fingerprint in neurodegenerative diseases and represent potential targets for early disease intervention, such as synaptic regeneration,” Erika Bereczki, PhD, lead author of the publication, said in a press release. Bereczki is a researcher at the Department of Neurobiology, Care Sciences and Society, Karolinska Institutet.

“Our results suggest shared mechanisms, with major implications for prognostic and diagnostic marker development as well as advancing future therapeutic interventions for improving the disease course. This places synaptic dysfunction and repair approaches in the spotlight of attention, especially since the therapeutic intervention window for synaptic repair and regeneration is longer than the recent toxin-clearance approaches,” she said.

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Neurocrine to Ask FDA to Begin Reviewing Parkinson’s Therapy Ongentys in 2019

Parkinson's therapy Ongentyx

Neurocrine Biosciences will ask the U.S. Food and Drug Administration in early 2019 to begin the  regulatory review process that could lead to the approval of its Parkinson’s therapy Ongentys (opicapone).

It confirmed the timetable after meeting with FDA officials on its plan to file a New Drug Application for Ongentys, which European regulators approved in 2016. The application is a formal request that the FDA start reviewing a treatment for possible approval.

FDA officials’ decision not to ask for additional Phase 3 trials of Ongentys prompted Neurocrine to stick with its original timetable of submitting the application in the first half of 2019.

Neurocrine developed Ongentys as a once-a-day add-on therapy to levodopa for adults with Parkinson’s or movement problems. It inhibits an enzyme called catechol-o-methyltransferase, or COMT, that breaks down levodopa.

Ongentys prolongs levodopa’s effect by reducing the time when it wears off before the next dose. During these off-time periods, patients’ symptoms can flare up.

Scientists at BIAL in northern Portugal developed the compound. BIAL licensed the North American rights to Neurocrine in February 2017.

Ongentys does not generate the side effects associated with other COMT inhibitors, its developers say.

In addition to Ongentys, two other COMT inhibitors are available to Parkinson’s patients: Tasmar (tolcapone), which has been linked to liver toxicity, and Comtan (entacapone). While Comtan has not been linked to toxicity, meta-analyses have shown it to be only moderately effective.

The results of two Phase 3 trials of opicapone led to the European Union approving it in July 2016. BIPARK-I (NCT01568073) and BIPARK-II (NCT01227655) showed that a daily dose decreased Parkinson’s patients’ off-times.

The 600-patient BIPARK-I trial compared opicapone with entacapone. The two generated comparable results, the research team said.

Researchers randomized the 427 patients in the BIPARK-II trial to receive either 25 mg or 50 mg a day of Ongentys or a placebo. Patients who took the higher dose of Ongentys saw their off-time drop by 119 minutes — almost twice the 65 minutes seen in the placebo group.

Ongentys improved levodopa-treated patients’ movement fluctuations regardless of whether they were also taking a dopamine agonist or a monoamine oxidase type B inhibitor, researchers said.

Patients tolerated opicapone well in both trials, the team said.

One-year extension studies of the trials showed that opicapone maintained the reduced off-times and increased on-times long term, researchers said.

“We have a tremendous amount of work ahead of us as we compile the FDA-required datasets to prepare for the NDA [New Drug Application] filing,” Dr. Eiry W. Roberts, Neurocrine’s chief medical officer, said in a press release. “As part of our commitment to helping patients with movement disorders, we are eager to continue advancing this important medicine for the nearly one million patients suffering from Parkinson’s disease in the United States.”

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Reducing Your Risk of Falling With Parkinson’s Disease

In this 2015 video from the Davis Phinney Foundation for Parkinson’s, Heather Knight, a physical therapist, talks about managing the risk of falling.

MORE: Seven ways to help you self-manage Parkinson’s disease

Knight starts by detailing some of the risks people with Parkinson’s face, including tripping hazards, different underfoot surfaces, poor lighting, gait, and fatigue. She also talks about some practical tips to help prevent some of the potential hazards such as grab bars in the bathroom, stair railings, improved lighting, and decluttering.

Yoga, Tai chi, dancing and even boxing are all recommended exercises to help Parkinson’s patients with their balance, which in will turn help prevent falls. Knight also demonstrates some exercises which can aid mobility and improve balance.

MORE: Innovative boxing therapy helps patients with young-onset Parkinson’s disease

Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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Herantis’s Parkinson’s Therapy Passes Preliminary Trial Safety Evaluation

Parkinson's therapy trial

An independent review board has found Herantis Pharma’s Parkinson’s therapy safe, paving the way for a Phase 1/2 clinical trial in Sweden to continue.

The board based its decision on the safety results seen in the first few patients treated with cerebral dopamine neurotrophic factor, or CDNF, at Karolinska University Hospital in Stockholm.

Its findings mean Herantis can recruit patients at two other study sites — Helsinki University Hospital in Finland and the Skåne University Hospital in Lund, Sweden. Karolinska University Hospital will continue recruiting patients.

The trial is evaluating the drug’s effectiveness as well as safety.

“Patient safety is always our first priority,” Sigrid Booms, Herantis’ director of clinical development, said in a press release. “Clinical [trial] dosing of CDNF for the first time in the world is a major milestone for our company. We are very pleased with the progress, and the collaboration with the top-level neurological and neurosurgical teams of these three hospitals.”

The company hopes to “have all patients recruited in the study by the end of 2018,” Booms added.

Herantis is developing CDNF as a treatment for neurodegenerative diseases such as Parkinson’s and ALS.

Preclinical-trial studies showed that natural CDNF, a protein found in blood and cerebrospinal fluid, can protect against and restore nerve cell damage.

The findings prompted Herantis to start the Phase 1/2 trial of its formulation of CDNF as a treatment for Parkinson’s (NCT03295786).

The trial’s goals include seeing if CDNF is safe and effective, and if Parkinson’s patients can tolerate it.

Herantis is administering the treatment directly to patients’ brains with a delivery system implanted there. It is taking this approach, it said, because oral or TV-delivered administration would not be effective.

In addition to testing the safety of the treatment itself, Herantis is evaluating the implanted delivery system’s safety and effectiveness. The company will have some previous results to go on. Researchers in another clinical trial reviewed the implant system’s safety in 40 patients.

Two-thirds of the patients in the Phase 1/2 trial are receiving monthly infusions of one of two doses of CDNF for six months. The other third are receiving monthly infusions of a placebo.

After the trial is completed, some patients may be able to receive CDNF in an extension study.

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My Spouse Has Parkinson’s Disease, So I’m Going Out

marriage

Sherri Journeying Through

The Press Democrat published the following question and reply from the “Dear Abby” column just this past week:

“I’m a 72-year-old married woman. My husband has atypical Parkinson’s and can no longer talk or walk … I need someone to talk to, to share life with. I tell my husband what I do each day, but of course, there is no feedback. …

“Can I date? If I explained to him how I need companionship, he might agree. But am I being selfish? … I feel like my life is over. … I feel like I’m dying.”

Dear Abby replied:

“I think it would be not only selfish but cruel to tell your husband you need companionship and want to seek another relationship. How would you feel if you were in his position, unable to walk or talk, and he said that to you?”

I think about the coming years and think about how that could be my husband writing Dear Abby. It might go something like:

Dear Abby,

I am a 58-year-old man. My wife has regular (that’s relative) Parkinson’s disease. I have to put on her socks and shoes, let her use the grocery cart to stabilize her mobility issues, fix her meals without making them too spicy, make sure she takes her meds on time so she doesn’t get crabby and start shaking like the washing machine on the spin cycle, and well, you can fill in the blanks.

Can I see other women? I mean, she’s just not as attractive as she was when I first saw her and told myself, “I’m gonna marry that girl.” Well, “that” girl is gone. The girl of 40 years ago now shuffles like a penguin, and I have to walk slower than I’d like to “keep up” with her. You know what I mean? The sparks just aren’t there, even though we got married on the Fourth of July. What do I do? I want a real relationship.

My husband is a caring, good man and would never write that, and I am sure he doesn’t feel that way. This is a hypothetical situation, stemming from the real letter penned to Ms. Abby. But I am sure there are plenty of spouses, caregivers, partners, and the like who feel that way. And there are just as many, if not more, people with Parkinson’s disease who wish they could go back in time and make the choice not to marry if they could have seen the future. If they could have seen the burden they were going to become to the one they pledged their life to.

But we can’t go back in time, and we don’t get a do-over. We have to make the best of the moments given now. Today.

We’ve got to talk about the hard things now, while still able. Make some decisions now while we still have use of our brains. Decide together whether our spouse can go dancing with their new girlfriend (or boyfriend) while we stay home alone staring at the ceiling.

Can you imagine?

I believe, no matter the faraway look in our loved one’s eyes, that there is still someone inside who feels. Yes, they want their spouse to enjoy their life, keep in touch with friends, go to a movie with one of the kids. But date?

I am sure there are some who give their consent and even perhaps their blessing. But that’s not what the majority go into marriage with — a clause to retreat should the going get tough. They choose “till death do us part.”

Some people retreat completely when they hear the diagnosis of PD. They choose to go back on their promise and get out. And then there are some who dive into their new role of caregiver and look like angels, or at least, heroes.

If you are a caregiver, may I suggest the same that Ms. Abby did? Find yourself a support group to get involved in. And if you don’t have a friend that you feel you can talk to about your struggles, find yourself a new friend. If your grown children don’t live near you so they can offer some help, a move on someone’s part might be worth the consideration.

But dating? No. My personal opinion, but no.

Pick up the phone and dial the American Parkinson Disease Association at 800-223-2732. They can assist in finding a support group near you.

***

Note: Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Parkinson’s News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to Parkinson’s disease.

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7 Ways to Make Your Home Safer for Those Living With Parkinson’s

Being diagnosed with a complex and serious disease like Parkinson’s is never easy. Patients and caregivers immediately start considering what changes will be necessary in order to make day-to-day life easier and safer for the recently diagnosed.

There are several things you can do to improve your daily routine while living with Parkinson’s. Many of these changes  include small adjustments and renovations to your home, which should be your safe place.

To help you with all these overwhelming changes, we’ve put together a list of tips based on suggestions from the Michael J. Fox Foundation. These tips will help you improve your life and safety while living and coping with Parkinson’s symptoms.

1. Don’t change all at once: It’s important that you don’t change the whole scene all at the same time; do it at a slow pace and start by making small changes.

Remove potential obstacles that could be dangerous for someone who has a hard time walking and balancing on their own. If you have big, fluffy rugs that could become a tripping hazard, consider moving them out of main rooms or walkways. Don’t forget to always leave space in between pieces of furniture, so that your loved one can walk freely and safely around the perimeter.

MORE: Boxing therapy can help young-onset Parkinson’s disease

2. Improve the lighting in your household: Some people may not like having a lot of light around them, but having a well-lit house can be very beneficial for people living with Parkinson’s disease.

It makes navigating each room easier and helps avoid undesired bumps and stumbles. If you can, install touch lights and lights that are sensitive to movement and sound.

3. Give your bathroom a makeover: Make sure you have a non-slip mat in the shower or bath tub.

If you can afford to upgrade your toilet, an elevated toilet seat is something several patients’ agree makes their lives a little bit easier. The extra elevation can make it easier to stand back up. Also install safety rails to help patients get up.

4. Switch your chairs to some that might be easier to get out of: Adjustable recliners or chairs with straight backs, firm seats and arm rests are the perfect choice.

Firm cushions can add height and help with standing up, as well.

MORE: See how Gregory Chandler hasn’t let Parkinson’s stop him from enjoying life 

5. Install railings along walls and hallways: Those living with Parkinson’s disease may have trouble walking or even just keeping their balance. To help with the mobility of patients, install railings and supports along the walls and hallways of the house.

If you can afford these home improvements, invest in them. They can be extremely helpful with improving balance and preventing falls.

6. Try to make more significant renovations: Even though it might be expensive, if you can afford to, try and adapt your house as much as possible.

Building ramps, stair lifts and wider doorways can make an enormous difference to someone living with Parkinson’s.

7. Don’t forget to invest in comfort: Rest is very important and one can only rest well if they feel comfortable. Make sure your bedroom is the most comfortable room in the house; invest in your mattress, bedding, window treatments.

MORE: Willie Geist and Ryan Reynolds team up with Michael J. Fox to beat Parkinson’s

Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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Medical Cannabis Helps Older People with Parkinson’s, Other Diseases, Study Finds

Cannabis and Parkinson's

Medical cannabis is a safe and effective way for older people to alleviate symptoms of Parkinson’s, cancer and other diseases, particularly pain, a study shows.

The study in the European Journal of Internal Medicine also reported that after six months more than 18 percent of patients surveyed had either reduced or discontinued their use of opioid pain medications.

The use of medical cannabis has grown significantly in recent years. Because of an aging population, the use has increased in older people in particular.

“While older patients represent a large and growing population of medical cannabis users, few studies have addressed how it affects this particular group, which also suffers from dementia, frequent falls, mobility problems, and hearing and visual impairments,” Dr. Victor Novack, a professor in the Ben Gurion University Faculty of Health Sciences in Israel, said in a press release.

This prompted a Ben Gurion team to look at who among the elderly use medical cannabis and whether it is safe and effective for them. Novack is also head of the Soroka Cannabis Clinical Research Institute.

The study, “Epidemiological characteristics, safety and efficacy of medical cannabis in the elderly,” involved 2,736 patients 65  years or older. They had received medical cannabis through Tikun Olam, Israel’s largest medical cannabis supplier, between January 2015 and October 2017.

Researchers asked patients whether the cannabis had reduced their pain and improved their quality of life. They also asked if it had led to any adverse events at six months.

The mean age of those who answered the questionnaire was 74.5  years. Sixty-seven percent said they used cannabis to relieve pain. Sixty-one percent said their treatment was related to cancer.

Amazingly, after six months of treatment, 94 percent of the respondents reported an improvement in their condition. A key finding was that their pain level had dropped in half, according to a scale used to measure it.

After six months, 18 percent had either reduced or discontinued their use of opioids for pain. Because opioids can have long-term consequences, including addiction, this was a good sign, researchers said.

In terms of safety, patients’ most common adverse events were dizziness, which occurred in 10 percent, and dry mouth, in 7 percent.

“After monitoring patients 65 and older for six months, we found medical cannabis treatment significantly relieves pain and improves quality of life for seniors with minimal side effects reported,” Novack said.

This prompted the researchers to write that “our study finds that the therapeutic use of cannabis is safe and efficacious in the elderly population.”

In addition, “cannabis use may decrease the use of other prescription medicines, including opioids,” they wrote.

They called for research based on clinical trials rather than just questionnaires.

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Emerald Health Pharmaceuticals’ Cannabinoid-Derived Compound Beneficial in Parkinson’s, Mouse Study Finds

EHP-102

Emerald Health Pharmaceuticals investigational EHP-102 (previously known as VCE-003.2), a patented compound derived from the non-psychotrophic cannabinoid called cannabigerol, has shown anti-inflammatory and neuroprotective properties in a mouse model of Parkinson’s disease.

The study “Benefits of VCE-003.2, a cannabigerol quinone derivative, against inflammation-driven neuronal deterioration in experimental Parkinson’s disease: possible involvement of different binding sites at the PPARγ receptor” was published in the Journal of Neuroinflammation.

Cannabinoids are the active chemicals that give the cannabis plant its medical and recreational properties. Researchers evaluated the anti-inflammatory and neuroprotective properties of EHP-102 in cellular models of neuroinflammation and in mice that, after injection of a specific molecule (LPS) directly into a brain region called corpus striatum, developed the inflammatory symptoms characteristic of Parkinson’s disease.

LPS induces the reactivation of microglia cells and increases the expression of proinflammatory markers in the brain striatum, including iNOS, which has been found to contribute to the loss of neurons observed in Parkinson’s disease.

Mice treated with the cannabinoid EHP-102 showed a reduction in the reactivation of microglia cells in the brain, accompanied by a marked reduction in the levels of pro-inflammatory markers, attenuating the loss of neurons.

Importantly, EHP-102 also was efficient in attenuating inflammation in mouse and rat microglia cell lines treated with LPS.

Researchers confirmed that the therapeutic activity of EHP-102 is not mediated by its effects on the cannabinoid receptors, but rather via activation of a different type of receptor that belongs to the peroxisome proliferator-activated receptor (PPAR) family.

“More than 10 million people worldwide are living with Parkinson’s disease and many do not have access to effective therapies to treat symptoms of the disease,” Eduardo Muñoz, PhD, said in a press release. Muñoz is EHP’s chief scientific officer and professor of immunology at the University of Córdoba,

“We believe these findings will help advance preclinical studies and clinical trials of cannabinoid-derived medicines and add to the experimental evidence that shows this pharmaceutical agent may preserve neuronal integrity in Parkinson’s disease,” he added.

“We congratulate Drs. Muñoz and Bellido [Mari-Luz Bellido, PhD, EHP’s vice president of European Operations] for their publication in a prominent scientific journal,” said Jim DeMesa, MD, CEO of Emerald Health Pharmaceuticals. “These outstanding scientists have been pioneers in cannabinoid science for over fifteen years and we are proud to be working closely with them as we develop our two novel cannabinoid drugs targeting life-threatening neurodegenerative and auto-immune diseases.”

This team has shown previously that many of its patented cannabidiol and cannabigerol derivatives also affect other disease-modifying targets, and is currently developing two drug candidates from its portfolio of cannabinoid analogs, one derived from cannabidiol for multiple sclerosis and scleroderma.

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