From HealthNewsDigest.com

Disease
Speed Into Battle Against Parkinsons
By
Sep 29, 2015 - 10:26:01 AM

(HealthNewsDigest.com) - Parkinson's disease can cause people to move slowly. In a cruel twist, that symptom also causes the drug that relieves it to take effect slowly.

As a result, patients with advancing Parkinson's disease have multiple episodes during the day when they are waiting for the next dose of medication to take effect. These periods of relative immobility are called "off" periods and interfere with every aspect of a patient's life.

However, two new treatment options recently have become available to combat these issues, each from a different angle. One relieves the off periods in five minutes, and the other one prevents the off period altogether.

Each treatment addresses the problem of delayed drug absorption that Parkinson's causes. Most adults digest oral medication within 30 to 40 minutes, which is the time it takes for a drug to travel through the stomach and intestines before it is released into the bloodstream. In Parkinson's disease patients, though, that time can be significantly longer.

Parkinson's disease damages brain cells that release dopamine, a chemical in the brain that transmits signals to control body movement. Patients with the disease may have slow movement that extends to the muscles involved in swallowing and pushing food through the digestive system. This problem significantly delays the time it takes for oral medication to go into effect - and the main treatment drug for Parkinson's disease is an oral medication called levodopa, which turns into dopamine in the body.

To help address this issue, doctors recently have turned to using autoinjectors and infusion pumps to deliver the drug and to relieve symptoms for Parkinson's disease patients with different challenges. The examples of two patients illustrate the immense impact these new methods are making in the lives of people with Parkinson's disease.

Faster-acting drug delivery

Gerald Zagrodnik wanted to be able to work, and to play. The 62-year-old Oak Forest resident increasingly had trouble doing either in the years after being diagnosed with Parkinson's in 2006.

While he took levodopa, his symptoms began to return in between doses. It's a common problem for people with Parkinson's, who over time require increasing amounts of medication with decreasing benefits.

Levodopa addresses the dopamine production deficit in the brain and "one tablet three times a day can be effective in the beginning; but after some years, symptoms return before the next dose is due," says Leo Verhagen, MD, PhD, professor of neurology at Rush. "Ultimately, this wearing off effect requires patients to take the drug more often."

In 2013, Zagrodnik enrolled in a study at Rush using a new method of delivering his medication, an autoinjector that works within five minutes. Autoinjectors are devices that allow patients to self-administer a single dose of a drug directly into the bloodstream rather than traveling through the digestive system. Autoinjectors typically are spring-loaded syringes in a capped, cylindrical casing that resemble a pen, which is what they're often called.

"Being an electrician, my life depended on my ability to function while making electrical repairs," Zagrodnik says. "When I found out about the clinical trial using the fast-acting rescue pen, I knew that would be the best option for me."

The study used an injection with apomorphine hydrochloride, which is the most potent anti-Parkinson drug. Brand named Apokyn, it is used to alleviate an off episode when symptoms return even though the patient is still taking medication, or a "freezing" episodes when the patient has difficulty moving and can feel "stuck."

These symptoms that occur during these episodes may include muscle stiffness, slow movements, and difficulty starting movements. Such episodes are fairly common in people with Parkinson's disease who take levodopa and increase the longer they use it.

"The medication enabled me to relax sufficiently to play a really good game of pool, which is one of my favorite hobbies," Zagrodnik says. "It helped knowing I can go out and socialize, knowing that I had a backup plan."

One size does not fit all

For some patients, a new continuous delivery is needed rather than a fast-acting pen or oral medicines. John Truesdale, who has suffered from Parkinson's for 12 years, is one of those patients.

As the disease progressed, Truesdale experienced more off episodes, freezing episodes and times when he would fall. It was challenging for him to do anything that required him to be mobile, and made leaving the house very difficult.

Truesdale received an infusion pump for continuous delivery of his medication in mid-June. He was the first patient in Illinois to receive this treatment after it received FDA approval. "This infusion drug treatment began being used in the U.S. this past spring. It involves surgical implantation of a small pump (controlled by the patient), which is attached to a stomach tube that feeds directly into the small intestine absorption site and detached in the evening," Verhagen explains.

"This seemed to be just what John needed, due to the difficulties he had with the oral medications, which he was taking six times a day," says Truesdal's wife Vincee. "His off time and freezing episodes have decreased considerably since he received the pump. His mobility is much better and he doesn't need as much help throughout the day, like he did when he was on oral medication."

"We would recommend the pump to anyone who has had the same challenges as John," she adds.

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