The therapeutic management of Parkinson's disease is multidisciplinary. The drug treatments used are aimed at restoring synaptic transmission between dopaminergic neurons.
Treatments for Parkinson's Disease
L-DOPA is a precursor that can cross the blood-brain barrier, the cellular barrier responsible for protecting the brain.
Dopamine agonists are molecules that have the same effect as dopamine. They can also be delivered subcutaneously (apomorphine pump), which allows for more regular and continuous treatment and better balance the patient. It is then a treatment in forms of longer duration of evolution (“second-line treatment”).
These treatments for Parkinson’s disease improve patients’ quality of life and delay the disease’s motor progression. However, they result in adverse reactions that are more or less intense and frequent, depending on the patient.
Drug treatments, side effects
These side effects may include nausea, vomiting, low blood pressure, drowsiness, hallucinations or an abnormal perception of reality, compulsive use of medications, all of which should lead you to consult your general practitioner.
The best known of these side effects are impulse control disorders, observed in 20% of patients under dopaminergic agonists. These disorders take the form of an addiction to gambling, shopping, eating disorders, hypersexuality or risky behaviour, for example.
Some of these disorders are reversible by decreasing treatment doses but may require complete discontinuation of medication.
At Paris Brain Institute
A study coordinated by Professor Jean-Christophe CORVOL, Director of the Centre for Clinical Investigation and Team Leader at Paris Brain Institute involved a cohort of 400 patients recruited throughout France through the French network for clinical research on Parkinson’s disease (NS-PARK/FCRIN). Patients were followed for 5 years to assess symptoms, readapt treatments, and identify the development of behavioural problems. This study shows that the onset of behavioural disorders increases with the duration of parkinson’s disease. Inclusively, 20% of patients had these disorders compared to 33% after 5 years. Of the patients without disorders at the beginning of the study, almost 50% developed them during the 5 years of follow-up.
These findings indicate that regular monitoring of patients under Parkinson's therapy is essential. With this in mind, the AD SCIENTIAM start-up incubated at Paris Brain Institute makes it possible to study the fluctuations of the symptoms of the disease on a daily basis in the patient’s home in real life. This device is currently being tested on the NS-PARK cohort and is intended to facilitate the introduction of therapies adapted by neurologists.
Treatment of various disorders of parkinson's disease
Late-onset walking disorders can be treated by HealthTrends Stimulations. In this therapy an electrode is implanted in the target brain region most often in the subthalamic nucleus or internal pallidum. This implantation is very often done under local anaesthesia in order to adjust the location of the electrode for an optimal reduction of symptoms. The implanted electrode acts by the same mechanism as a pace maker, delivering electrical pulses at high frequencies regularly. For example, stimulation of the thalamus reduced resting tremor in 80% of cases.
Stimulation in the internal pallidum reduces involuntary abnormal movements in an average of 60% of patients. Subhalamic nucleus stimulation resulted in a 60% decrease in motor symptoms characteristic of parkinsonian syndrome.
At Paris Brain Institute
The team of Dr. Carine KARACHI and Brian LAU at Paris Brain Institute is studying the anatomy of the subcortical region with the ultimate goal of developing new therapies and applications for deep brain stimulation.
The Brain e-NOVATION joint laboratory at Paris Brain Institute has developed a therapeutic game “Toap Run” aimed at improving balance and walking disorders of Parkinson’s patients. In this interactive game, the patient must perform movements that concern the whole body and the axial motor in particular, with lateral movements, movements of the trunk in order to collect as many pieces as possible while avoiding obstacles.
