Parkinson's: There's No Cure, But New Treatments Help Patients Cope

April 22, 2003

- PATRICIA GUTHRIE, Staff
The Atlanta Journal-Constitution

It started in her 50s, just a twitch, just her little finger.

"Now I have a whole lot of symptoms," Lyn Frank says, itemizing the
characteristics of Parkinson's disease like a grocery list. "Muscle
spasm. Slowness of movement, involuntary movement, visual problems.

"It's almost every part of my body."

Not enough dopamine in her brain is the single source of Frank's
problems. Dopamine, a vital chemical enabling people to move normally
and smoothly, erodes in Parkinson's patients, although scientists
still can't pinpoint exactly why. How to halt the erosion also
remains elusive.

But advances in drug therapy and improved surgical techniques have
made the disease more manageable than other neurological disorders,
explains Dr. Mahlon DeLong, chairman of Emory University School of
Medicine's department of neurology.

Just this month, researchers reported on two new studies--- one from
an Emory researcher, Dr. Ray Watts --- showing that experimental
treatments involving retinal cells and proteins greatly restored
movement in participants.

Whether alternative approaches, such as tai chi for movement and
herbs for sleep, can help Parkinson's patients is also under study at
Emory, funded by a $6.2 million grant from the National Institutes of
Health.

"When I diagnose a patient, I tell them, 'You've got Parkinson's;
you're lucky. You can be treated, and in maybe the next five or 10
years, there'll be even better treatment,' " DeLong says.

At least 1 million Americans are estimated to have Parkinson's; up to
50 percent may be undiagnosed. The disorder often occurs after age
50, but early onset is possible.

Although the disease affects people differently, those in advanced
stages can become too stiff to walk, suffer "freezing spells" and
experience confusion, slurred speech and memory difficulties.

Tough on its sufferers, Parkinson's also weighs heavy on families.
"It's almost like I have Parkinson's. There's just no break," says
Sue Young, 44, who's watched her mother's physical abilities
deteriorate for the past 16 years. "She's got her mind but her body
just won't work."

Young, an only child, lives with her parents in Dunwoody, attending
to her mother's needs when not in the skies as a Northwest Airlines
flight attendant. She's also active with Parkinson's Action Network,
a national lobbying group. "You have to accept it and make
adjustments in order to live with it," she often tells others.

Because of the loss of the brain cells that make dopamine, most
treatments aim at restoring the essential link of body and mind. But
such drugs lose their effectiveness in time, leaving many patients
with just a couple of "on" hours in the day when they are steady
enough to write, read, go for a walk, tap away at the keyboards and
"not be a Parkinson's patient," as Frank puts it.

When Frank's feeling good, the mother of three adult children
explores cyberspace, e-mails family and friends, gets out her trowel.
Three hundred orchids posed in striking color await her tender touch
throughout her Vinings home, where she lives with her husband,
Werner.

"The fears are when you think you can only go downhill," says Frank,
who was diagnosed in 1989. "There's no cure. I have been able to
handle these fears of the future by letting [my doctor] worry about
that and I concentrate on my hobby, my orchids."

Doctors now prescribe more of a "drug cocktail" for Parkinson's
patients in hopes of sustaining efficacy.

Frank's pill case has 10 sections, each filled with a different
medication to help with symptom management. Every two hours, she
takes another dose. Among the rainbow of pills are many new classes
of drugs found to help with dopamine interaction.

The drug levodopa was the first dramatic breakthrough in the
treatment of Parkinson's some 40 years ago. It remained the gold
standard for decades, even though many patients experienced severe
side effects, such as nausea and vomiting.

Sinemet, a more recent levodopa-type drug, goes more directly to the
brain and causes less gastrointestinal distress.

But long-term use of these powerful drugs leads to a side effect that
many people mistakenly believe is a symptom of Parkinson's: the wide,
erratic swinging of limbs known as dyskinesia.

Parkinson's experts often refer to actor Michael J. Fox as an example
of this phenomenon, which is caused by treatment, not the disease.
Although Fox may seem just a natural hyperactive kind of guy, his
body is in constant motion from high doses of levodopa, which mask
the telltale tremors and shakes of Parkinson's but cause dyskinesia.

Patients experiencing such side effects are possible candidates for
two surgeries proved highly effective in stopping uncontrollable
movement. One operation, called pallidotomy, uses magnetic imaging
and electrodes to destroy affected brain tissue. Another procedure,
known as deep-brain stimulation, implants a pacemakerlike device that
delivers controlled electrical stimulation to specific points within
the brain.

"We think of Parkinson's as a circuit disorder of the pathway in the
brain," DeLong explains. "It's a circuit that's been hijacked. We
have to free up the circuit by interrupting it." Making lesions ---
essentially burning the brain tissue causing the misfiring --- is one
way to do that. Doctors recognized that 60 years ago, but they didn't
know where or how to make the incisions precisely.

Questionable techniques --- such as inserting probes in the brain
with hot wax --- were tried, resulting in Parkinson's surgery falling
out of favor for decades.

"Back then, they had no idea what the physiology of the brain was,"
explains Dr. Jerrold Vitek, who helped pioneer the brain-mapping
technique at Emory needed for movement disorder surgery. "It was more
kind of a 'poke and hope' approach."

Most of the time, Parkinson's strikes people who have no family
history of the disease and are blissfully ignorant of it --- until
strange things start happening.

Like shaking hands that won't stop or a left leg with a mind of its
own --- Barbara Forcier's experience two years ago. Working at Rhodes
Furniture, the 48-year-old soon couldn't meet her sales quota.

"Flapping around is not good if you're in sales," she jokes.

Forcier, who now works full time in Emory's department of neurology,
still finds relief from low doses of medication for her spasms and
fatigue. She knows what could lie ahead, but remains optimistic.

"I'm young enough that I see a cure in my lifetime," says Forcier,
active with the Atlanta chapter of the American Parkinson Disease
Association. Many with the disease can work and live independently
because of recent therapeutic advances, she's quick to point out.

Some scientists predict a cure for Parkinson's within a decade.

"We know a lot more about the brain than we did 30 years ago," says
DeLong, sitting in his windowless office brimming with brains. Not
real ones, but photos, X-rays and computer models. Mushy three-
dimensional cerebral models rest by the doctor's cup of steaming
green tea.

From one wall smiles Muhammad Ali. The small photo is signed with
small, slanted, scrunched-up words --- more evidence of Parkinson's
that the prizefighter has publicly challenged for decades, including
dramatically lighting Atlanta's Olympic torch in 1996.

DeLong says he's witnessed patients from ages 20 to 80 transformed by
deep-brain stimulation. Emory's Parkinson's team has completed it on
more than 100 individuals.

"You can make people with Parkinson's new. You can't do that with
Alzheimer's or Huntington's," says DeLong, energetic despite a
previous night's 10-hour stint in the operating room. "It's one of
the most amazing things in neurology I've witnessed."

SOURCE: The Atlanta Journal-Constitution
http://www.accessatlanta.com/health/special/parkinsons0422.html
http://magazines.ivillage.com/goodhousekeeping/hb/news/article/0,,ajc_
2003_04_22_E_35293305-0005-Home~ew~xml,00.html

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