Parkinson's Disease Plays Havoc With Common Orthopaedic Conditions

Although Parkinson's disease (PD) is a neurological disorder, according to an article in the January 2009 issue of the Journal of the American Academy of Orthopaedic Surgeons, the disease also increases a person's risk of experiencing complicated orthopaedic conditions. The author recommends that all Parkinson's treatment plans include a multidisciplinary approach in order to address additional accompanying musculoskeletal health issues.

According to the author Dr. Lee Zuckerman, M.D., chief resident of orthopaedic surgery, Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center in Brooklyn, New York, tremors, body rigidity, and problems with movement caused by PD may lead to other secondary, medical issues. One often-noted example relates to the fact that people with Parkinson's often move and walk less than non-suffers and generally stay indoors.

Decreased movement may lead to bone loss, and the reduced exposure to sunlight that generally occurs when patients spend little time outdoors is likely to generate a decrease in vitamin D, which is needed to keep bones strong. This is particularly harmful to Parkinson's patients, since the combination of decreased bone density and instability from tremors and rigidity caused by PD greatly increase a person's risk of:

Falling

Breaking bones

Osteoporosis

Ensuring family members are involved in care can have a positive impact on patient health. Dr. Zuckerman says, "I recommend patients and their families read up on Parkinson's disease so they can prepare themselves for the challenges that come with it. This type of early education is important, because it can prevent these secondary problems from occurring. For instance checking bone mineral density and getting treatment for at-risk patients can help reduce the risk of fracture."

Recommended actions to prevent orthopaedic problems in Parkinson's disease include:

Bone density

Physical therapy

Vitamin therapy

Medication to increase bone density

Optimizing therapies for gait and rigidity

The author recommends that patients with PD who are being treated by an orthopaedic surgeon should also be treated by a medical team that includes a neurologist, a neurosurgeon, a primary care physician, a physical medicine and rehabilitation physician, and a social worker. Including family members can ease the complexity of care by ensuring the patient is seeing the correct doctors while getting referrals to other members of the multidisciplinary team.

Although there are surgical treatments for orthopaedic conditions experienced by people with PD, the disease can have a negative effect on recovery. In one example, the tremors associated with PD have been shown to interfere with the repair and rehabilitation of bone injuries. Those who have had a joint replacement are often relieved of pain and initially have improvements in mobility, but these improvements only last about a year.

Dr. Zuckerman comments: "Whether this is because the disease is progressing or because the rehabilitation was insufficient is unclear. So patients now have to decide what they want to accomplish -- more mobility or decreased pain. They have to know that although their pain level should improve, their function may get worse after a year."

Treatments for PD patients have allowed them to live longer lives with improved quality of life. As these patients age, there are strong predictions that there will be an increased need for medical and surgical interventions for complicated orthopaedic issues.

Disclosure: Neither Dr. Zuckerman nor a member of his immediate family, has received anything of value from, or owns stock in, a commercial company or institution related directly or indirectly to the subject of this article.

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Michael J. Fox Foundation Awards $2.4M For Parkinson's Research

The Michael J. Fox Foundation (MJFF) for Parkinson's Research today announced approximately $2.4 million in total funding to nine research teams under its Target Validation initiative. This annual MJFF program provides intellectual and financial resources to help push potential Parkinson's drug targets forward toward clinical trials and ultimately the nearly 5 million Parkinson's patients worldwide.

Founded in 2000, the foundation is named for the famed actor who suffers from Parkinson's. The foundation says it has funded $123 million in research to date.

"The discovery of a new potential therapeutic target generates great excitement among patients and researchers," says Katie Hood, CEO of The Michael J. Fox Foundation. "But to attract an industry sponsor with the resources and expertise to chaperone it through optimization, preclinical work and ultimately clinical testing, that target needs a critical mass of evidence behind it, demonstrating that it is involved in the disease and that manipulating it impacts symptoms or progression. MJFF's Target Validation program helps accumulate this evidence, reducing the risk of investment for industry and building the case for prioritization of the
most promising targets in the pipeline."

Target validation is an essential and historically under-resourced phase of drug development in which researchers work to determine whether a molecule or mechanism of interest is a true drug target, the foundation says. While researchers have continued to identify novel targets in recent years through genetic, biochemical and epidemiological studies, a lack of funding for validation studies has long been a major roadblock to the efficient translation of these discoveries into practical therapies that benefit people living with Parkinson's.

Projects funded in this cohort of Target Validation awardees fall into three categories: targets for therapies to alleviate symptoms of Parkinson's; approaches focused on dyskinesias, the excessive, uncontrollable movements brought on by long-term dopamine replacement therapy; and targets with potential to slow or stop progression of Parkinson's, something no currently approved treatment has been proven to do.

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Michael J. Fox Foundation for Parkinson's Research Announces $1.2 Million to Advance Development of Drug Targets

The Michael J. Fox Foundation for Parkinson's Research (MJFF) announced $1.2 million in total awards to four research teams working to advance potentially disease-modifying therapeutic targets for PD along the drug development pipeline. The funding was awarded under the Novel Approaches to Drug Discovery for Parkinson's Disease program, made possible by funding from Elan Corp., plc, a
neuroscience-based biotechnology company.

"For successful translation into real-world PD therapies, early stage therapeutic approaches must be chaperoned through the necessary preclinical and clinical stages of drug development," says Sarah Orsay, MJFF's CEO. "The Foundation uses creative strategies to provide the opportunity for researchers working on novel therapeutic strategies to partner with first class, large industry organizations. If projects funded under Novel Approaches to Drug Discovery for Parkinson's Disease warrant further development, Elan has the option to participate more actively and further
the progress made by the awardees -- taking us that much closer to our
shared goal of delivering new treatments to patients."

Novel Approaches complements the foundation's annual Target Validation initiative, whose awardees were announced last month. Whereas the latter program supports initial work to determine the validity of cellular proteins and pathways as potentially promising drug targets, Novel Approaches seeks to push work forward in developing therapies against targets that already have some promising initial data. Both programs provide critical resources for underfunded stages of the drug development process and reflect the Foundation's emphasis on bridging early discovery work and late-stage translational research to reduce industry's risk around investment in new PD therapeutics.

The Novel Approaches program is also an important element of the foundation's increasing engagement with pharmaceutical and biotech company partners. This engagement is multi-pronged, including not only funding industry researchers under any Foundation initiative, but also working with companies as strategic partners to accelerate the rate at which new PD therapeutics are brought to market. Awardees under Novel Approaches include both academic and industry scientists.

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Drug Slows and May Halt Parkinson's Disease

Northwestern University researchers have discovered a drug that slows – and may even halt – the progression of Parkinson’s disease. The drug rejuvenates aging dopamine cells, whose death in the brain causes the symptoms of this devastating and widespread disease.

D. James Surmeier, the Nathan Smith Davis professor and chair of physiology at Northwestern University’s Feinberg School of Medicine, and his team of researchers have found that isradipine, a drug widely used for hypertension and stroke, restores stressed-out dopamine neurons to their vigorous younger selves. The study is described in a feature article in the international journal Nature, which will be published online June 10.

Dopamine is a critical chemical messenger in the brain that affects a person’s ability to direct his movements. In Parkinson’s disease, the neurons that release dopamine die, causing movement to become more and more difficult.

Ultimately, a person loses the ability to walk, talk or pick up a glass of water. The illness is the second most common neurodegenenerative disease in the country, affecting about 1 million people. The incidence of Parkinson’s disease increases with age, soaring after age 60.

“Our hope is that this drug will protect dopamine neurons, so that if you began taking it early enough, you won’t get Parkinson’s disease, even if you were at risk. ” says Surmeier, who heads the Morris K. Udall Center of Excellence for Parkinson’s Disease Research at Northwestern. “It would be like taking a baby aspirin everyday to protect your heart.”

Isradipine may also significantly benefit people who already have Parkinson’s disease. In animal models of the disease, Surmeier’s team found the drug protected dopamine neurons from toxins that would normally kill them by restoring the neurons to a younger state in which they are less vulnerable.

The principal therapy for Parkinson’s disease patients currently is L-DOPA, which is converted in the brain to dopamine. Although L-DOPA relieves many symptoms of the disease in its early stages, the drug becomes less effective over time. As the disease progresses, higher doses of L-DOPA are required to help patients, leading to unwanted side-effects that include involuntary movements. The hope is that by slowing the death of dopamine neurons, isradipine could significantly extend the time in which L-DOPA works effectively.

“If we could double or triple the therapeutic window for L-DOPA, it would be a huge advance,” Surmeier says.

The work by Surmeier’s group is particularly exciting because nothing is known to prevent or slow the progression of Parkinson’s disease.


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