Parkinson's, where is the research at?

There are over 300,000 Italians living with Parkinson's disease, for which there is no definitive cure. Yet, today we have tools that allow us to live better and control the disease. Over 800 specialists who will be in Rome from 14 to 16 May for the 11th National Congress of the Italian Society of Parkinson's and Movement Disorders - Limpe-Dismov will provide an overview of the progress of research.

And the message coming from the experts is certainly positive: "When we communicate a diagnosis of Parkinson's disease we are clearly not giving good news. But there is a lot that can be done: there are numerous studies underway and many aspects are being clarified - says Giovanni Fabbrini , president of the scientific society, full professor of neurology at Sapienza University of Rome and director of the Department of Human Neurosciences at the Policlinico Umberto I -. Perhaps the goal of a cure is not immediate, but it is not that far away either".

Looking for signals in saliva and tears

Let's start with the innovations in diagnosis, which today is based exclusively on the evaluation of clinical symptoms. "As already happens for other diseases such as diabetes and tumors, there is a lot of interest in the search for markers on easily accessible biological fluids, such as blood, saliva or even tears, and it is clear that it is only a matter of time - continues Fabbrini -. This does not mean that we must continue to pay great clinical attention, to be able to see the symptoms in people". And the initial symptoms are not what one might think.

Anticipate the diagnosis

Although tremor is present in about two-thirds of patients, we now know that the main symptom of Parkinson's disease is slowed movement. "For several years now we have been looking for signals that indicate a greater probability of the disease developing in certain people," explains Fabbrini. In particular, these are a series of signals, called pre-motor symptoms, such as reduced sense of smell, particular sleep disorders (REM behavior disorders, or the presence of motor activity during the dream phase in which one normally becomes atonic), depression and constipation. "We are trying to understand which people may one day develop the disease," he adds. "But there is still a lot of work to do on this front."

Clinical studies on patients carrying pathogenic variants also fall within this scope, also in the hope of developing targeted therapies: "The data are still preliminary - underlines the expert -. But it is one of the elements on which clinical research is oriented".

Making better use of old drugs

On the therapeutic front, one of the innovations concerns the method of administration: subcutaneous infusions of drugs such as apomorphine and levodopa, which usually have a short duration of action when administered orally. This administration, the expert explains, avoids having to take the drugs every 2-3 hours.

Not only that. If on the one hand the discoveries are fundamental, on the other hand today we are learning to use old drugs better and better, such as levodopa, to attenuate the symptoms of patients as much as possible, says the neurologist, "we are learning to use them differently and to have realistic and achievable therapeutic objectives". This also applies to side effects, such as nausea and drowsiness: "Some appear only when the disease worsens - Fabbrini specifies -. For example, involuntary movements induced by levodopa known as dyskinesias. Other categories of drugs can cause psychiatric disorders, but which can be predicted and controlled". Another fact that is emerging is the greater sensitivity to some drugs, with some side effects more frequent in women. "This is why today there is greater attention to drug doses in relation to gender", highlights the expert.

AI-Controlled Deep Stimulation

When drugs are no longer effective, it is possible to intervene with deep brain stimulation, a surgical procedure that consists of placing electrodes in the brain that send impulses to some brain nuclei to inhibit or activate them. Today, thanks to artificial intelligence, we have moved from continuous to adaptive stimulation: "The stimulators are able to understand whether they should turn on or off at that moment in relation to the activity of the brain nuclei and how the patient is doing - explains Fabbrini -. This obviously applies to the phases in which the disease is no longer well controlled by drugs and in patients who are cognitively well, who do not have psychiatric disorders and who are able to undergo neurological surgery, which is quite invasive".

In fact, we are still far behind in the treatments for cognitive disorders up to dementia, which appear after many years of illness: "Unfortunately - he adds - we do not have at the moment solutions and interventions that really allow for improvement when the illness becomes so complicated".

Quality of Life: From Physical Activity to Digital Therapies

As in many other diseases, also in Parkinson's experimental studies and epidemiological evaluations show how lifestyle is fundamental in all phases of the disease. "Diet and continuous physical exercise are strategies that have, especially at the beginning of the disease, a truly remarkable efficacy - underlines Fabbrini - The first thing we say at the diagnosis, in fact, is to do more physical exercise, because the more you are physically and mentally active, the better you control the disease".

While it is true that symptoms in Parkinson's patients can vary greatly even in the course of a single day, thanks to new devices and telemonitoring systems today it is much easier to keep them under observation. You can have a 24-hour recording of what really happens to the patient, who sometimes has difficulty reconstructing his day precisely, explaining that the aim is to collect objective data on the basis of which to give therapeutic advice. "The other aspect - concludes the doctor - is that of telemedicine, to be able to see the patient remotely without having him come to the clinic, in which there are large investments".