Watch Mayo Clinic neurologist J. Eric Ahlskog, M.D., Ph.D., describe Parkinson’s disease treatment on YouTube.
Hello, I am Dr. Eric Ahlskog from the Mayo Clinic. I’m a neurologist at the Mayo Clinic. I am active in the section of movement disorders where we see a lot of people with Parkinson’s disease.
Parkinson’s disease is a very common disorder. There are about a million people in the United States with Parkinson’s disease and that makes up a big portion of our practice in the Movement Disorders Clinic.
What is Parkinson’s disease? This is a neurodegenerative condition that commonly occurs in people middle-aged and beyond. Sometimes, it occurs in younger people such as the people that are in the public domain — Muhammad Ali, Michael J. Fox, and others but most often it occurs later in life.
Parkinson’s disease, being a neurodegenerative condition, develops without a known cause although there is rather substantial research that is focusing on the cause of Parkinson’s disease and we will talk more about that in a few minutes. However, the focus of the Movement Disorders Clinic here, as at other major medical centers and clinics, is to treat the symptoms of Parkinson’s disease which we can do fairly well up to a point — not everything is perfectly responsive. Sometimes later in life there are other problems that get superimposed but I think overall we do pretty well treating both the movement problems of Parkinson’s disease as well as some of the antecedent conditions that occur with it.
What are the movement problems? Well, the problems that everyone knows about our tremor although it turns out that the majority of tremor conditions are not due to Parkinson’s disease but other disorders. The most common tremor condition is a condition called essential tremor, so if someone has tremor that doesn’t necessarily mean they have Parkinson’s disease and in fact it is more likely they have tremor due to something else. Tremor is just one of the components of Parkinson’s disease.
Also, often keeping company with that is slowness of movement, which physicians call bradykinesia, stiffness of the limbs that physicians call rigidity, as well as gait problems. Sometimes there is imbalance but the prototypical gait problem is a slowed shuffling gait with reduced arm swing. Also a component of Parkinson’s disease relates to loss of many automatic movements that are performed without even thinking about it, such as blinking or swinging your arms when you walk, or gesturing when you talk. Those things tend to get attenuated with Parkinson’s disease. On the other hand, all of those things that I’ve just described tend to respond really quite well to the medications that we have to treat Parkinson’s disease. And that’s the good news and that’s gratifying for both physicians as myself as well as patients.
Sometimes down the road and to variable extents, other problems occur. Not all of the motor symptoms of movement symptoms respond perfectly. They respond much better during the early years. After 10, 15, or 20 years, they’re not as complete in their response and that relates to the natural history of Parkinson’s disease.
Also, there’s a portion of people who over time develop some problems of their autonomic nervous system. What is the autonomic nervous system? Autonomic nervous system is that internal nervous system that regulates blood pressure, pulse, bowel movements and all of those internal things that we don’t think about but occur automatically.
So, with passage of time some people with Parkinson’s disease get constipated. In fact, a lot of people with Parkinson’s disease are constipated. They may have trouble passing their urine or controlling their urine. They may have problems with their blood pressure plummeting to low levels when they stand up. These are treatable conditions, but the treatment is different than what doctors used to treat the movement problems of Parkinson’s disease.
What else occurs in Parkinson’s disease? Well, there’s a portion of people that develop thinking and memory problems and that happens over time. Usually, that’s not present in their early years but happens is one ages and years pass. That is less treatable, but there are medicines that help with that as well as the occasional complications from medications plus Parkinson’s disease, such as hallucinations and delusions. Fortunately, those are fairly treatable most of the time but obviously this gets more and more complicated and challenges physicians if these problems are occurring together.
What about research into Parkinson’s disease? Well, it turns out that to date we do not have good medicines where there is any proof of slowing the progression of Parkinson’s disease. But, I should mention that with the adding of the primary medicine that was used to treat Parkinson’s disease at the very inception of this modern era, levodopa, or carbidopa levodopa, brand-name Sinemet, every study that’s looked at longevity found a substantial increase in longevity time lock to the initiation of levodopa therapy back about 40 years ago.
So that’s very gratifying and presumably levodopa, carbidopa levodopa, is not getting at the underlying problem that causes Parkinson’s disease, but as mobilized people kept them active and that ability to remain active throughout the course of their life has added rather remarkably to longevity. So, for example, here in Olmsted County, Minnesota where the Mayo Clinic is located, the longevity rates based on actuarial tables are reduced only about three years with Parkinson’s disease. So that’s pretty good, I think. For example, if your actuarial prediction indicates that you would live to about age 81, as a of ladies would live to, you might only live to age 78. So that’s still pretty close although it’s not quite on target.
What about research directed at what causes Parkinson’s disease? Well, there is a remarkable set of discoveries that I think now are making at least me optimistic that we are on the right track to discover the cause. There is a protein that is a natural protein that accumulates in the brains of people with Parkinson’s disease. We don’t identify this by way of any tests but if people died from whatever they died from and one looks at their brains, you can see an accumulation of this natural protein called alpha-synuclein. It’s thought that the aggregation of natural alpha-synuclein plays a fundamental role in what causes Parkinson’s disease.
The research that’s ongoing is now directed at refining our understanding of that and if it does turn out to be alpha-synuclein, then there hopefully will be strategies for preventing the aggregation and reducing the production.
Where is that occurring? Well, in many centers around the world. At Mayo Scottsdale, Jacksonville, and Rochester there’s substantial research that’s directed at this overall problem. Mayo, Jacksonville’s bench researchers have had a number of very important discoveries that have focused on alpha-synuclein. And with the epidemiology research that’s being done here in
Rochester, we have collaborated with our colleagues at the other two Mayo centers and work is proceeding that hopefully someday will translate into an effective treatment for not just slowing the progression of Parkinson’s disease, but halting the progression in returning people to normality. Thank you very much for listening.