Parkinson's disease (PD) is the second-most common neurodegenerative disease worldwide, with 10 million sufferers. Parkinson’s Disease is a progressive movement disorder caused by degeneration of dopamine-producing neurons in the substantia nigra specifically in the Pars Compacta, which leads to resting tremor, rigidity, problems initiating movement and postural instability. In this article, we will discuss the conventional treatment, advanced treatments and ongoing studies on Parkinson’s disease. Conventional Treatments All the therapies for treating Parkinson’s disease primarily focuses on increasing the level of Brain dopamine. The following conventional treatment protocols are commonly followed for Parkinson’s disease. A pharmacological and non-pharmacological approach is adopted based on the severity, stage, and grade of the disease. If the diagnosis is not relative to PD, then the non-pharmacological approach may be associated with/without Monoamine Oxidase B (MAO-B) inhibitors which are also used in early-stage patients for symptomatic treatment. If the patient has a confirmed diagnosis of PD, then an evaluation is made to assess whether the cognition is intact or impaired. If the cognition is intact, drug therapies include Dopamine agonist, Anticholinergics, Amantadine, Levodopa, Carbidopa/ COMT Combination therapy, +/- MAO-B inhibitors. Alternatively, if the cognition is impaired drug therapy include Stalevo/ Levodopa. Anti-cholinergic and amantadine are preferably avoided in this case. Based on the disease progression and severity of motor fluctuations, surgical mode of treatment may be adopted which includes deep brain stimulation (DBS), Pallidotomy, thalamotomy, etc. Advanced Treatments 1. Medical Therapies: Exenatide is a glucagon-like peptide-1 (GLP-1) agonist. Pre-clinical studies with Exenatide revealed its role in inhibiting cell death, reducing oxidative stress, enhancing mitochondria function, and promoting neuronal functioning. Opicapone is a phase 3 trial tested drug which could be of particular benefit for motor fluctuations since it works by preventing the breakdown of levodopa, thereby extending levels of levodopa in plasma. Istradefylline blocks adenosine A2A receptors. In a recent meta-analysis, istradefylline was found to be a well-tolerated drug. It decreased “off” periods and improved motor symptoms. Cooling brain on fire- A promising new therapy to stop Parkinson's disease has been developed by scientists who found that a small molecule, MCC950, which blocked NLRP3 activation in the brain and stopped the development of Parkinson's in several animal models. 2. Surgical Advances: Focused Ultrasound Sub thalamotomy: Ablative neurosurgery was widely used to treat movement disorders which involve the removal of a specific brain area. A new technique has been developed for ablating specific brain areas. Gamma-knife and MRI-guided focused ultrasound (MRgFUS), allows for deep brain ablating without opening the skull. This new technique will possibly become another treatment option in the future for patients who don’t want their brain to be opened. Wireless ‘Pacemaker for the brain’: A new neurotransmitter developed by engineers works like a "pacemaker for the brain," monitoring the brain's electrical activity and delivering electrical stimulation if it detects something amiss. The name of the device is WAND, which stands for wireless artifact-free neuromodulation device. The device can listen to and stimulate electric current in the brain at the same time, potentially delivering fine-tuned treatments to patients with diseases like epilepsy and Parkinson's. The WAND can record electrical activity from 128 points in the brain. Ongoing Studies/Trials On Parkinson’s Disease Diagnosis And Treatment There has been rapid advancement in diagnosis and treatment modalities of Parkinson’s disease. 1. Sniffing out Parkinson’s Disease: Researchers report the identification of compounds that make up the signature odour of the disease with the help an individual who can detect Parkinson's through smell. While the researchers acknowledge the limited scope of this study, they say it opens the door to the development of a non-invasive screening test for Parkinson's, potentially leading to earlier detection. 2. Sensor created to detect dopamine, brain disorders, in seconds: Using nanotechnology, researchers have developed the first rapid detector for dopamine using altered cerium oxide nanostructures. The capture of dopamine molecules subsequently changes how light is reflected from the sensor and creates an optical readout indicating the level of dopamine. 3. Exercise can improve non-motor symptoms of Parkinson's disease: Exercise has the potential to improve non-motor as well as motor symptoms of Parkinson's disease (PD). The investigators concluded that all modes of exercise are associated with improved cognitive function in individuals with PD, however, no clear picture of which exercise mode is most effective emerged as they may influence cognitive function differently. 4. The possibility of slowing, stopping, or even reversing Parkinson's disease: A clinical trials program offers hope that it may be possible to restore the cells damaged in Parkinson's disease. The study investigated whether boosting the levels of a naturally-occurring growth factor, Glial Cell Line-Derived Neurotrophic Factor (GDNF), can regenerate dying dopamine brain cells in patients with Parkinson's and reverse their condition, something no existing treatment can do. 5. Voluntary control of brainwaves in deep brain of patients with Parkinson's disease: A study group at Osaka University developed a neurofeedback system which enables patients with Parkinson's disease to voluntarily control beta wave activity in their deep brain associated with symptoms of the disorder. Conclusion: PD is a heterogeneous disorder and every patient is unique. So, it becomes essential to obtain the latest medical information and to select therapies that are most suitable for each patient. This Parkinson’s Day lets us spread knowledge and awareness of the global theme “Awareness #key to PD”.
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