Parkinson’s disease is a complex disease that requires individualized treatment. “No two people are alike. You have to decide what each person needs and treat accordingly.” That was the over-riding message of the 8th Donald Calne Lecture delivered by Dr. Stanley Fahn, the H. Houston Merritt Professor of Neurology and Director of the Centre for Parkinson’s Disease and Other Movement Disorders at Columbia University in New York.
Dr. Fahn, who is the Scientific Director of the (American) Parkinson’s Disease Foundation and Past President of the American Academy of Neurology, addressed over 150 attendees at the Donald Calne Lecture on Tuesday, June 7th in Toronto at the Hyatt Regency Toronto Hotel, with his presentation titled, Misperceptions and Mistakes made by patients and doctors in treating Parkinson’s disease. The event was hosted by Parkinson Society Canada and Parkinson Society Central & Northern Ontario.
Starting with the most common misperception on the part of patients that Sinemet lasts only 5 years or levodopa loses its effectiveness after 5 years, Dr. Fahn noted, “Levodopa never loses its effectiveness. What happens is that Parkinson’s disease worsens over time. The early-stage symptoms such as tremor, slowness of movement and rigidity are responsive to levodopa. However, the late-onset symptoms such as difficulty with posture, loss of balance and freezing of gait are areas that levodopa doesn’t touch. Levodopa never did treat those symptoms.”
Dr. Fahn then proceeded to expose a variety of myths and mistakes relating to starting therapy for Parkinson’s – when to start, when to delay, which drugs are effective and for which age group, whether there are relationships between Parkinson’s medications and disease progression, if and when combining medications is effective – all the while backing up his assertions with findings from published studies.
Dr. Fahn also addressed motor complications such as dyskinesias and “off” states in Parkinson’s – possible causes, susceptibility, strategies for reducing them. With a show of hands from audience members with Parkinson’s, he debunked the notion of many doctors that Dyskinesias are more of a problem for the patient than “off” states. He said, “I haven’t yet had a patient who would rather be “off.” They all want to be “on” and have the ability to move.”
In response to an audience question about non-drug therapies for Parkinson’s, Dr. Fahn cited the benefits of exercise and the availability of surgery such as deep brain stimulation (DBS), explaining what it is, when and why it is used. He also discussed the potential of continuous dopaminergic stimulation, using infusion therapies such as DuodopaTM, to pump levodopa directly into the small intestine and deliver it evenly throughout the day, to minimize and/or prevent motor complications. The intervention is widely used in Europe. It is approved in Canada on the condition that additional clinical trials are carried out to verify benefits. See Medication Info Sheet at parkinson.ca.
Looking ahead, Dr. Fahn anticipated there will be better drugs and better surgical techniques for Parkinson’s. He said, “We’ve solved most of the motor problems, with surgery and medicines. Now, we have to find ways to solve the intractable problems in Parkinson’s, such as the cognitive decline that comes with age.” He expressed hope that ongoing research into pathogenesis – understanding the mechanisms underlying neurodegenerative diseases like Parkinson’s – will unlock the key to understanding why dopamine neurons decline and die in Parkinson’s and provide a basis for finding ways to stop the process.
Thanks to Abbott Canada and Rx&D who sponsored this year’s Donald Calne Lecture.
The Donald Calne Lectureship was established in 2002 to honour Dr. Donald Calne for his outstanding service to the Parkinson’s community as Professor of Neuroscience, University of British Columbia and past chair and long-time member of the Scientific Advisory Board, Parkinson Society Canada. Each year, Parkinson Society Canada awards this lectureship to a distinguished neuroscientist of international reputation, whose work is primarily in the area of Parkinson’s disease.