As part of National Parkinson’s Disease Awareness Month,
Demetrius Maraganore, MD, Chairman of Neurology at NorthShore, shared some of the findings of his ongoing research into the genetic factors that influence Parkinson’s disease progression and outcomes. He also tells us why research like this is so important
for Parkinson’s disease patients and their families:
Why is funding for and research into Parkinson’s disease so important?
It’s important because the treatments that we have available don’t prevent Parkinson’s disease (PD) or slow or halt its progression. PD is characterized by progressive motor and cognitive impairment. PD patients have a seven-fold increased risk of
nursing home placement and a two-fold increased risk of death. The annual cost of PD in the U.S. exceeds $23 billion. Presently 2% of people will develop PD during their lifetime, and the prevalence of PD is expected to double by 2030. The cumulative burden
of PD to society is and will be staggering. Our patients and their families deserve methods to predict, prevent and halt PD and those will only come through research.
How long have you been conducting research into Parkinson’s disease?
My research in Parkinson’s disease (PD) started in 1989, when I was an honorary clinical and research fellow to the late Professor C. David Marsden at the National Hospital for Neurology and Neurosurgery in London, England. Dr. Marsden was the founder of the
international Movement Disorders Society and its official journal, Movement Disorders. His associate, Professor Anita Harding, was a pioneer in the field of neurogenetics. Together, we launched the first genetic studies of Parkinson’s disease.
That has remained the focus of my research, including for 20 years on the faculty of the Mayo Clinic in Rochester, MN, and in the four years that I have been Chairman of Neurology at NorthShore. While my research at Mayo focused on identifying genetic factors
that contribute to the cause of PD, my research at NorthShore has focused on understanding how those genetic factors influence disease progression and outcomes. Our research aims to develop methods to predict outcomes in PD, and to use that information to
improve neurological health.
Why have you focused the bulk of your career on the study and treatment of Parkinson’s?
As a clinician, it’s very gratifying that there are many treatments that we can employ in the first many years to reduce the burden of the disease on patients and families. However, I recognize that the benefits of the existing treatments wane with
time, and I’m driven by the sense of urgency to identify the factors that contribute to the progression of Parkinson's disease. Our goal is to target those factors so that every individual patient can have the best possible outcome.
For more information on the NorthShore Neurological Institute and the research being done at NorthShore, click
April is National Parkinson’s Disease Awareness Month. All this month, we will feature a series of posts addressing Parkinson’s disease symptoms, genetics, treatment options and more from NorthShore neurologists—Demetrius Maraganore, MD, Aikaterini Markopoulou,
MD, and Ashvini Premkumar, MD— to raise awareness about this common and often disabling neurological disorder.
Ashvini Premkumar, MD
What are the most effective medications for the treament of Parkinson’s disease?
The most effective medications for the treatment of Parkinson’s disease are the dopaminergic medications. Carbdiopa/levodopa is by far the most effective, followed by dopamine agonists and lastly mao-b inhibitors. Non-dopaminergic medications include anticholinergics,
which are sometimes useful for treatment of tremor but have to be used with caution because of the side effect profile, particularly in elderly patients.
What are the most common side effects of carbidopa/levodopa?
The most common side effects for carbidopa/levodopa that we see clinically include: nausea/vomiting, lightheadedness, sleepiness, hallucinations, and dyskinesias.
Do you recommend the early use of carbidopa/levodopa? Delay its use?
The early vs. delayed use of carbidopa/levodopa has been debated for many years. The crux of the debate rests on the concern that early use of carbidopa/levodopa may increase one’s risk for motor complications, namely fluctuations (“on” and “off”
periods) and dyskinesias. The risk is approximately 40 percent within four to six years, particularly among young patients. Whether or not to start carbidopa/levodopa has to be highly individualized decision, which will be based on many factors, including
disease severity, age, co-existing symptoms (i.e. cognitive impairment) and occupational concerns.
Please discuss Neupro transdermal therapy
Neupro transdermal therapy, or the rotigotine patch, is dopamine agonist that is FDA approved for the treatment of Parkinson’s disease. It can be used in early Parkinson’s disease. It also can be used as an adjunctive medication in advanced Parkinson’s
disease as it was shown in studies to reduce “off” time by roughly one hour a day. It has also been approved in the treatment of moderate to severe restless legs. The side effects include: nausea/vomiting, somnolence (sleep attacks), reactions at application
site, dizziness, anorexia and compulsive behavior. The specific benefit of Neupro, like other extended-release dopamine agonists, is that it maintains as constant a level of drug as possible throughout the day.
Some say that exercise eases Parkinson's diease symptoms. What exercises or physical activities are recommended for people with Parkinson’s disease?
We recommend an exercise program that combines aerobic activity and core muscle strengthening. And this should preferably be complemented by exercises aimed at balance and stretching (i.e. yoga and Tai Chi).
Is it safe to ride a bicycle with PD?
This question needs to be routinely addressed by the patient’s treating neurologist. In general, in the early stages of PD, where balance is not significantly affected, it’s considered safe. However, once postural instability becomes noted, either
by reported falls or upon routine examination, then it would be advisable to ride only stationary bicycles.
How can I prevent falls if I have PD?
Prevention of falls should be emphasized at each clinic visit with one’s treating neurologist. The best way to prevent falls is to be educated as to what causes falls in Parkinson’s disease and then to take every precaution to avoid those “missteps.”