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PD Research Highlights-1997 By Joe Bruman January 1998 POLITICS: The long-fought Udall Bill is law, directs NIH to allot an additional $100 million a year to PD research. Now let's see, what new research projects this largesse will buy. NEW DRUGS: Generic Brand Action Availability Pramipexole (Mirapex) Dopamine agonist General Ropinirole (Requip) Dopamine agonist General Tolcapone (Tasmar) COMT inhibitor General Entacapone ? COMT inhibitor General Cabergoline ? Long-lasting agonist Outside US Apomorphine ? Fast-acting injectable Outside US Levodopa patch ? Less dose fluctuation ? Levodopa injectable Better dosage control Experimental Glutamate inhibitors Neuroprotection Still looking A striking feature of PD drugs in general is their great range among patients of effectiveness, tolerance, or both. A drug that seems ideal for one PWP may be useless or intolerable to another. ETIOLOGY: Search for the elusive gene continues. Suspicion grows that PD is caused not by inherited susceptibility or environmental exposure alone, but a combination of both, and that there are distinct variants of PD. Negative linkage of smoking and PD seems real, but who knows if it is cause or effect (e.g., is dislike of smoking a feature of PD?). DIAGNOSTIC TOOLS: Sophisticated imaging techniques using various markers are still too costly for screening patients, but in research reveal not only regional mapping of brain activity in a conscious subject, but the function of individual nerve pathways. They are showing that while PD may be defined as degeneration of the substantia nigra, it really affects other parts of the brain in a complex way. Clinical signs are being found which appear long before the "onset" of PD movement symptoms. It's starting to look like there is no definite time of onset, except the point where symptoms appear because compensating reactions no longer overcome the growing neural deficit. SURGERY: As time passes since the surge of pallidotomies began, longer follow-up surveys are possible, with generally favorable results. Successful intervention at ablation sites other than the pallidum suggests that a more general term for this type of surgery may be needed. Deep-brain stimulation likewise has worked at different sites. Successful transplantation of fetal pig tissue raised hopes of overcoming logistic problems of human fetal tissue, but the threat of retroviral infection which may gain a foothold in the human population causes concern. Work continues on implantation of growth factors and other tricks to induce regeneration of diseased brain tissue, which may eventually lead to a genuine cure, but that goal is still distant. Questions, corrections, comments, discussion welcome. Cheers, Joe J. R. Bruman (818) 789-3694 3527 Cody Road Sherman Oaks, CA 91403-5013