 |
 |
Hi Everyone! I thought you might be interested in a paper that crossed my desk from the Oct.25,1995 issue of the Journal of the Amer. Med. Assn.(vol.274 p.125-6). There was a 2-day workshop on research priorities related to PD held in Wash,D.C. and it was convened at the request of Congress. Initially Congress wanted the institute to hold a consensus meeting to recommend the best ways to treat the disorder. But it was agreed (accord. to Thos.Chase, M.D.,chief of exptl. therapeutics at NINDS) that there wasn't enough knowledge to reach a consensus! So instead several branches of NIH (Natl. Institutes of Health) decided to hold the workshop to identify new opportunities and goals to help plan a research agenda. Several important research paths were identified and I'll try to briefly list below: (1) Look into how brain cells die prematurely...many new and exciting approaches to this...once they find the mechanism then may be able to slow or arrest the programmed cell suicide completely. (2) need to find "biomarkers" so the disease can be diagnosed accurately and effective preventive measures explored..possible approaches include positron emission tomography scanning for ID of preclinical PD and for estimating progression (3) another approach to finding biomarkers...use debrisoquin as a surrogate test for the ability of the liver enzyme P-450 to remove neurotoxins. People with a defect in the metabolism of debrisoquin are at a higher risk for PD (4) further exploration of the genetics of PD.....5 to 10 yrs ago no one mentioned hereditary factors, it was all environmental factors. Now emphasis is on genetic factors and genetic susceptibility...with many patients (not all) there are clearcut family patterns...so there is a subgroup that may be a focus for genetic studies (5) when all the research is done, medical therapy is the bottom line...need good clinical trials to determine if these new ideas are useful to patients. L-DOPA remains the most effective drug for reversing symptoms but need better dopamine agonists (accord. to Stanley Fahn, M.D., Columbia)...L-DOPA only effective short time for some patients..why? He noted that Chase and colleagues at NINDS say "PD is not just a degenerative disease in itself, with a loss of synaptic terminals that stimulate dopamine. Patients with PD also show changes in the dopamine receptors that are probably induced by chronic use of L-DOPA"...this has to be considered. Does L-DOPA cause cell damage over time? In vitro studies have shown it is toxic to neuronal cells. But what happens in patients? (Fahn asked). "Are we hastening the progression of the disease?" In the summary the article states that they (researchers in PD) owe it to their patients to get to the bottom of this because more people are going to be treated by HMOs and primary care physicians as time goes by, not specialists. These doctors are going to be using L-DOPA very early on in their patients' disease. Could this be detrimental? (they used the term "creating disaster") A written report is being prepared by the participants and the NINDS and the conclusions will form a series of recommendations that will be submitted to Congress. Perhaps you/we can get copies from our congressional reps. Sorry this was longish but I thought it was important. It's about time Congress took a long hard look at PD. It always seems that Alzheimer's disease and other neruodegenerative disorders get more attention than PD. If you all write to your COngressmen and ask them to watch for and forward to you copies of this report, they'll know there's at least some very interested constituents out there. Delana Vaughan [log in to unmask]