Parkinson’s disease attacks more and more often. “We don’t know the reasons”

Parkinson’s disease cannot be cured or stopped, and it is not entirely clear why it occurs. And it appears more and more often. “We can see that this is especially true in countries where industrialization is growing” – says Prof. Jarosław Sławek, president of the Polish Neurological Society.

1. In 2016, there were about 6 million in the world. Parkinson’s patients, in 2040 there will be twice as many. In Poland, 60-90 thousand are ill. people.
2. The first symptoms of Parkinson’s disease are not specific and often do not allow 100 percent. diagnosis
3. Were patients treated with amantadine less likely to suffer from COVID-19, and if so, did they develop it more mildly? Prof. Sławek: I think that we will be able to answer this question by the end of June
4. More current information can be found on the Onet homepage.

Iwona Schymalla / Medexpress: Parkinson’s disease cannot be cured. For the patient, his family and caregivers, this means that she has to be dealt with for many years. It is often impossible to slow down its progress. How many patients have Parkinson’s disease? It is often said that this is a problem for the elderly, but it is a stereotype. So what are the epidemiological data?

Prof. Jarosław Sławek, president of the Polish Neurological Society: First of all, communicating to the patient about the disease is a traumatic experience for him and his family, and also for the doctor.

We do not have new data for Poland, but we do have data published in the world that say the incidence of the disease is increasing. We don’t know the causes, so we wonder why. We can see that this is especially true in countries where industrialization is increasing.

World data say that in 2016 there were about 6 million. Parkinson’s patients, but by 2040 it will be twice as many. In Poland, we have between 60 and 90 thousand. sick. This is difficult to estimate because the disease is part of the spectrum of disorders we call parkinsonism, i.e. diseases in which the typical symptoms of Parkinson’s also exist, but there are others, and therefore we classify them differently. Hence the discrepancy in the number of reported cases.

It is an age-related disease. We are seeing an increase in the number of sick people in the elderly population. But 15 percent. people get sick at an earlier age. The average incidence of 58 years is not as high as in Alzheimer’s disease. The youngest patient I met was 25 years old. There are many 30- and 40-year-olds. This shows that it is a very diverse disease, with a large proportion of genetic factors that play a major role in younger people.

Not all people have tremors that we equate with Parkinson’s disease. 30 percent the sick, it is either not at all or in the “background”. The disease also varies from person to person. Some people get advanced after 10 years, others who get sick for 15 years with standard treatment do well. We are still learning this disease, despite the fact that it was already described over 200 years ago.

And still diagnosing Parkinson’s disease is very difficult. We know that patients wait up to several years for an appropriate diagnosis. What’s the problem?

The problem is that the first symptoms are not specific and often do not allow 100 percent. recognition. We observe the patient and the so-called the gray area before diagnosis is one to two years. Today, we have the opportunity to accelerate diagnosis with the help of modern neuroimaging studies. But they are not cheap, nor are they recommended as routine practice by experts. In most cases, the diagnosis can be made on the basis of the clinical picture and this is enough.

We reserve expensive tests for patients about whom we have a number of doubts, for example, is it parkinsonism related to vascular damage or drug-induced, or is it so-called a functional disorder, which is related more to mental problems than to organic brain damage. This study has recently been reimbursed in Poland. It is expensive and we should not waste it. An appeal to patients not to force it from the doctor. It does not distinguish Parkinson’s disease from other degenerative parkinsonisms, which may look similar at first. Modern neuroimaging tests using high-field magnetic resonance, especially Tesla, may soon replace the more expensive Duncan test in everyday diagnostics.

We often say that a patient with Parkinson’s disease affects the whole body. It follows that the key issue is coordinated, interdisciplinary care of the patient. But, it seems we are at the beginning of the road when it comes to such care?

It is true that the disease, especially in its advanced stage, becomes “interdisciplinary”. The help of a psychiatrist, psychologist, urologist, physiotherapist or physiotherapist is often needed. There are chronic diseases in neurology or in medicine in general, where interdisciplinarity is present and we should create specialized centers.

Multiple sclerosis is a good example in neurology. For Parkinson’s disease, together with the Brain Diseases Foundation and the headquarters of the National Health Fund, we have prepared a document that was to introduce a pilot of coordinated care in several centers. It was submitted to the Ministry of Health in 2018 and was lost in some cavernous drawer. We’re trying to get him out of her. Such centers are a coordinated process of patient care, especially in two moments of his life – diagnosis and when the patient enters the advanced period, when movement disorders dominate and non-motor disorders intensify. This spectrum is very broad and sometimes dominates motor symptoms. Such centers should also provide training for staff: general practitioners, general neurologists, and physiotherapists.

The model of multicenter care exists in the Netherlands. It does not use any specific method of treatment, pharmacotherapy or surgery, only education and physiotherapy. Comprehensive patient care at his place of residence. It gives spectacular results. We managed to reduce the number of falls and halve the incidence of hip fractures, which often end the mobility period. In the general population, such a fracture occurs five times less frequently than in the Parkinson’s population. The Dutch government noted that the saving of EUR 20 million is worth coordinated action. We have to deal with many aspects in this disease. Someone has to coordinate this. It is best done by a neurologist who cooperates with others and educates how to care for patients.

COVID-19 treatment with amantadine has been a hot topic in recent months. We know that parkinson’s patients are treated with it. Do we know anything about whether these patients are at lower risk of COVID-19?

In the 60s, amantadine was an antiviral drug that has not proved effective. It has been found to work very well in Parkinson’s patients who have had it used against viruses. This topic has come back with the COVID-19 pandemic because, by looking at the mechanism of action of this drug, there are indications that it may protect against severe infection. There have been reports of isolated cases, for example, of a family member having had COVID-19 while living with a Parkinson’s patient who was taking amantadine. Despite his proximity, the patient with parkinson’s did not contract the coronavirus.

However, we cannot rely on individual reports. It requires a lot of research. Such a study was granted a grant from the Medical Research Agency and is conducted by professor Rejdak’s center in Lublin. We are currently at the stage of a questionnaire survey. We already have 300 surveys from Parkinson’s patients. AND we want to check if patients treated with amantadine suffered from COVID-19 less often, and if so, whether they contracted it more mildly. I think we will be able to answer this question by the end of June. Today, no one is responsibly recommending this drug for routine use in the treatment of SARS-CoV-2 infection. It is also necessary to deny the opinion that amantadine is a toxic drug, because it has relatively few side effects.

1. Amantadine and COVID-19. “The threat of toxicity has no justification here”

Do your observations or other neurologists show that patients with Parkinson’s disease during the pandemic suffered from Parkinson’s disease less frequently or more easily?

The pandemic lasts for a year. It is until and only a year. It’s too short for large studies. Some people may be tempted to conclude that patients with Parkinson’s disease do not actually develop COVID-19. But this cannot be responsibly stated today. We will see it in two or three years.

We know that in Parkinson’s disease research is carried out in many directions, early-stage biomarkers, work on a vaccine, on new drugs, but also gene therapy. Which of these directions is the most promising, giving patients hope to stop or cure the disease?

Asking about a disease that damages different areas of the brain is difficult. We assumed that dopamine deficiency is the image of all evil, i.e. movement disorders. But this is a big oversimplification. Today we know that other neurotransmitters are also involved. Over time, this disease leads to cognitive dysfunction and dementia. And that’s not related to a deficiency of dopamine itself, so finding a one-size-fits-all way to stop the disease is difficult.

However, we know that dopamine-producing cells that undergo degeneration and, as a result, atrophy, have an intracellular pathological protein in their cytoplasm. It’s called Alpha Synuclein. Probably the deposition of this protein in cells is responsible for their worse functioning, and ultimately their disappearance. Exceeding the critical moment in the number of these cells causes the disease to appear. About 50 percent of them must be missing. that we would have the first symptoms. So the disease has a very long run.

You mentioned biomarkers. During this run, which lasts several years, we would like to have indicators (biomarkers) that would signal us quickly, simply and cheaply that someone is at risk. In such a case, it would be necessary to conduct a test and check whether the bomb in the form of Alpha-synuclein deposition and the disappearance of dopamic cells is not ticking. This would create a favorable therapeutic window for early interventions. We test such possibilities. One of the studies begins in Poland – it concerns monoclonal antibodies that are supposed to eliminate pathological protein from cells. The test is intended for patients with very early Parkinson’s disease. We want to see if they will actually get the disease progressing as quickly as those who will not receive monoclonal antibodies.

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For the first time in the history of research, the goal is not only symptomatic treatment. Another option is gene therapy, which is delivering a gene that produces dopamine directly to the brain. The research, which we hoped to start in the center in Bródno, conducted by professors Ząbek and Bankiewicz, has been suspended. Fima Voyager, which acquired the patent rights to this method, withdrew from Europe. There are several centers in the world that try it. We have patients of prof. Bankiewicz from the USA, who were treated with it many years ago. This is a small group of patients. They show that the demand for drugs is not growing. There is no sign of disease progression. In medicine, it is always necessary to confirm an action or hypothesis in other research. Large groups and comparisons with placebo are needed. I hope that this research in Poland will come back.

Could you indicate the most important challenges for the next few months that are ahead of clinicians, but also of patients, when it comes to Parkinson’s disease.

Talking about the coming months is a bit of reading tea leaves. We are surprised by changes every day. The virus mutates. We don’t know if we’ll get back to normal soon. We also do not know whether the COVID-19 pandemic alone will result in an increased number of cases of neurodegenerative diseases. If someone watched the movie “Awakenings”, remember that there were patients with parkinsonian symptoms who underwent the so-called coma encephalitis, which only manifested years later in the form of Parkinson’s syndrome. And such scenarios are unfortunately being written today.

Hopefully COVID-19 won’t stimulate neurodegenerative processes in such a way. Today we can see a number of various complications, also autoimmune and neurological, related to the history of this disease. So it’s hard to make scenarios. We would definitely like to organize the system of care for the sick in Poland, incl. the matter of the process of deep brain stimulation, because despite our efforts for many years, we still cannot break through in the Ministry of Health.

We would like, for example in the form of a pilot, to implement a coordinated care project, and to make the Polish Society for Rehabilitation and Physiotherapy aware of the fact that in people with Parkinson’s disease, a lot can be improved through rehabilitation. We would like modern treatment methods to develop in Poland and that patients would not wait long for its commencement.

And we would like the contact between patient organizations and doctors to be better, that we find various forms of cooperation that will ensure adequate education. We can make a difference in our patients’ lives with education. And as I said about the example of the Netherlands, it can save money for the medical care system in Poland.

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