This month I attended the 18th International Congress of Parkinson’s Disease and Movement Disorders in the city of Stockholm, Sweden. Organised by the International Parkinson and Movement Disorder Society, over 4000 researchers and clinicians met to discuss and disseminate research into Parkinson’s disease and movement disorders.
In the USA alone it’s estimated that over 40 million people have a movement disorder of some type. Movement disorders are a group of neurological disorders that affect the speed, ease, control and quality of people’s movement. Taking many forms and severities, they result in excessive and involuntary movement, or slow or absent voluntary movement.
The term covers a huge range of conditions, including Parkinson’s disease, ataxias and tremor. They’re often progressive conditions and can impact considerably on a person’s quality of life and independence. Great advances have been made in the diagnosis and treatment of movement disorders over the past few decades, but at the same time, a lot of remains to be understood in diagnosing and treating these complex conditions.
The topics covered at this year’s meeting were extensive, and one of the focuses of the meeting was Parkinson’s disease, its diagnosis, management and treatment.
Parkinson’s disease is a neurodegenerative disorder caused by the death of the dopamine-containing cells in the substantia nigra of the brain. Dopamine is vital for movement regulation, and its reduction leads to symptoms like tremor and inflexible muscles.
In the first plenary session of the conference, Nobel laureate Prof Arvid Carlsson gave an insight into the history of the development of Levodopa; a dopamine drug that was developed to treat Parkinson’s disease.
His work in the 1950s showed that L-dopa caused a reduction in Parkinsonism symptom intensity in animals. In fact, despite a number of other available drug treatments, L-dopa is still widely used today, and was recently shown to outperform newer medications in long-term Parkinson’s care.
Prof Carlsson concluded with the advice “Don’t give in – stick it out!” – If you have a research idea that you really believe in, then don’t give up on it.
So what about the treatment for early Parkinson’s disease?
Prof Heinz Reichmann touched upon patient-specific treatment, how we should decide which patient should be treated, and with what. It’s widely recognised that there are side-effects associated with drugs used in the treatment of Parkinson’s; some have even been found to cause side-effects similar to Parkinson’s disease symptoms themselves.
Should we treat immediately if we see problems, or should we treat depending on the patient’s quality of life, and how this affects them?
Prof Reichmann used an analogy based on a watchmaker and a bricklayer to explain this. A watchmaker, who spends hours working on tiny intricate details of a watch, may find that the early symptoms of Parkinson’s disease such as tremor significantly affect their daily life, and they may want to start treatment early. But what about someone like a bricklayer, where the slight tremor may not have as much of an impact? What if they don’t want to start treatment because of the side-effects of the drugs? Is it best to leave treatment until the symptoms worsen?
Discussion around when it’s best to start treatment is still ongoing, and, as Prof Reichmann concluded, we have climbed mountains with diagnosis and treatment, but the area ahead is still a little foggy.
How should we treat advancing Parkinson’s disease?
Prof Lars Timmermann presented on treatment strategies and their delivery methods. It’s clear that there are some major complications in treating advancing Parkinson’s disease. In clinical practice, there tends to the ‘honeymoon period’ of a drug; it initially has a positive therapeutic effect on the patient, but after about 5 years this can start to wear off and patients can become less satisfied with their treatment.
Advanced Parkinson’s disease is multi-dimensional, and can be associated with a number of psychiatric and motor complications, amongst others. As part of its treatment, it’s important that we address both the motor and non-motor aspects that affect daily life.
People tend to associate Parkinson’s disease with tremor and difficulty walking, but symptoms of the disease extend further than this. Non-motor aspects of the disease are vast, and can include psychological problems, insomnia and impulse-control disorders. These symptoms often don’t respond to dopamine in Parkinson’s disease drugs, and can drastically affect an individual’s quality of life.
At this year’s congress, Dr Susan Fox discussed management strategies for the extensive non-motor symptoms, including recommendations of which drugs to consider using and when, and emphasising the need for multi-disciplinary cooperation when treating patients.
I’ve only touched upon one aspect of the congress here, and the week continued with much more discussion surrounding the research and treatment of various movement disorders. The overarching aim of this year’s congress was “Emerging and Experimental Therapies”; from new treatments and clinical trials, to stem cell and gene therapy, it was clear from the discussions just how dynamic the field of movement disorder research is.
It was fascinating to hear about the great work being undertaken to improve the daily lives of the millions of people affected by these often extremely debilitating conditions.
BioMed Central’s new journal, Journal of Clinical Movement Disorders is accepting submissions. Visit the website for more information.