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Picturing Parkinson's: Game Changer?

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LOS ANGELES, CA ( Ivanhoe NewsWire) - More than one million Americans are living with Parkinson's disease. Right now , doctors diagnose it by conducting a physical exam that's often unreliable, but that's about to change.

William used to be a professional welterweight fighter. Today, he's fighting a different yet powerful opponent, Parkinson's disease.

"I got Parkinson's, Parkinson's ain't got me," William "Tank" Hill, a former boxer, told Ivanhoe.

Debora Bergstrom is also battling the condition that causes tremors, balance problems and speech issues. The mom of three was diagnosed four years ago by a neurologist.

"She told me to stand up, walk, she rotated my arms and hands, and she said, yes you have Parkinson's," Bergstrom said.

Many people wait years before getting that diagnosis. Doctors physically examine patients for the telltale symptoms to formulate their conclusion, but their observations aren't always accurate. Forty percent of Parkinson's patients are undiagnosed and at least 10 percent who are diagnosed don't really have it.

Doctor Louise Thomson said a new imaging test called DaTscan is giving doctors a glimpse inside the Parkinson's brain. First, doctors inject patients with a tracer. Then they scan the brain for dopamine a chemical that Parkinson's patients lack.

Thomson said the test can tell doctors if the patient has Parkinson's or just a tremor disorder, which is treated differently

"This is a game changer. It's going to lead to earlier diagnosis and clearer diagnosis for patients with tremor, "Louise Thomson, MBChB, from Cedars-Sinai Medical Center, explained.

An earlier diagnosis means patients can start treatments sooner, potentially slowing symptom development of this devastating disease. For William and Debora, every symptom-free day matters. Now, doctors are one step closer to figuring that out.

RESEARCH SUMMARY

BACKGROUND: Parkinson's disease is a disorder of the brain that leads to shaking (tremors) and difficulty with walking, movement, and coordination. Ten million people worldwide; one million of those being Americans, contract Parkinson Disease. The disease affects both men and women; however men are at a much higher risk. Parkinson's disease usually develops after the age of 50, but, in extremely rare cases, Parkinson's disease can be found in young adults and children. If Parkinson's Disease is left untreated, it can totally disable an individual. It may also lead to a deterioration of all brain functions, and an early death. SOURCE: (www.ncbi.nlm.nih.gov/pubmedhealth); (www.webmd.com

CAUSES: The exact cause of Parkinson's disease is still unknown, it has yet to be discovered why some brain cells waste away, however there are some potential factors that may play a role. Parkinson's disease occurs when the nerve cells in the brain that make dopamine are slowly destroyed. Without dopamine, the nerve cells in that part of the brain cannot properly send messages. This leads to the loss of muscle function. Other factors that may contribute to Parkinson's disease are genetic mutations; being exposed to certain toxins or viruses; low norepinephrine levels; or having lewy bodies—unusual protein clumps which are found in the brain.
SOURCE: (www.ncbi.nlm.nih.gov/pubmedhealth); (www.mayoclinic.com/health/parkinsons-disease/)

TREATMENT: There is no cure for Parkinson's disease; the goal of treatment is to control the symptoms, mostly by increasing the levels of dopamine in the brain; making the disease easier to cope with. There are several medications that help ease the symptoms of Parkinson's disease, such as, Levodopa (L-dopa). Levodopa is used to treat movement-related symptoms of Parkinson's disease — it is the best known drug used to control symptoms. In some cases, surgery, such as brain stimulation, may be an option. A surgeon places wires in the brain; the wires carry tiny electrical signals to the parts in the brain that control movement; helping those parts in the brain work better.
SOURCE: (www.ncbi.nlm.nih.gov/pubmedhealth); (www.webmd.com

SIDE EFFECTS TO TREATMENT: Many medications used to treat Parkinson's disease can cause severe side effects, including hallucinations, nausea, vomiting, diarrhea, and delirium. SOURCE: (www.ncbi.nlm.nih.gov/pubmedhealth)

LATEST BREAKTHROUGH: Physicians for decades have had to rely largely on a keen eye and their experience to properly diagnose Parkinson's disease. In January of 2011, the US Food and Drug Administration (FDA) approved the use of ioflupane iodine-123 injection or DaTscan to aid in early detection. DaTscan is an imaging technology that uses small amounts of a radioactive drug to help determine how much dopamine is available in a person's brain. It is the first diagnostic imaging agent used to assess Parkinson disease approved by the FDA.
SOURCE: (www.pdf.org/); (www.tampabay.com); (www.michaeljfox.org/)

PREVENTION: Some research suggests that drinking coffee, tea, and cola, beverages high in caffeine may reduce the risk of Parkinson's disease.

INTERVIEW

Dr. Louise Thomson Nuclear Medicine Specialist, at Cedars-Sinai Medical Center, talks about a new scanning technique of the brain to distinguish Parkinson's disease from benign tremors.

Let's talk about how Parkinson's is diagnosed right now, is it mainly just wait and see?

Dr. Thomson: Well the diagnosis of Parkinson's right now is on the basis of a lot of clinical features and time because it's a progressive disease. The clinical presentation may be subtle initially and then it becomes clear that the person has a progressive decline in their movement.

So it's all basically observation on the doctor's part?

Dr. Thomson: There's a lot of clinical input and it's the neurologist who makes the diagnosis most often. But there hasn't been until now any one test that can help distinguish between a benign form of a tremor that's the shaking that's just a little bit of shakiness as opposed to the shakiness that is Parkinson type disease.

How many people will come in to an office that has the tremor and not Parkinson's?

Dr. Thomson: Well I'm an imaging doctor so I see a selected group of people who are sent for a diagnostic test. The exciting thing about this for us and for all of the people like me is that we have a test now that will help the neurologist define what's going on.

This test gives you a clear picture of a very specific region right?

Dr. Thomson: The existing tests before this agent was available were all based on looking at the anatomy of the whole brain or looking at the glucose metabolism or the blood supply to the whole brain. And the test that we're going to have available now is a targeted receptor imaging test. Historically we just had the imaging of anatomy or generalized brain blood flow or brain metabolism which has been really, really useful for defining diseases like Alzheimer's disease for helping neurologists to work out whether someone has a progressive dementia or not. But now with this agent WE IMAGE a transporter. This is a targeted dopamine transporter agent that helps to light up that one little bit of the brain which is involved in the movement disorder.

How does it work, is it just like an MRI scan?

Dr. Thomson: This imaging has been available in Europe for a decade and this agent is now approved for use in the United States. So we're going to be catching up with what Europe is doing already. It's an injection of a specific substance that binds itself to that part of the brain that's involved with the movement. And the label that supplied the radioactive part of the stuff that's injected is a radioactive iodine molecule. It's only in the body for a matter of hours so it's going to just get rid of itself. But while it's in the brain it specifically targets that part that's involved with the movement. And you can see a big difference between the normal pattern of uptake of that tracer as opposed to the abnormal in someone with a progressive movement disorder.

This also means you're going to be able to detect whether it's Parkinson's or not much earlier and then you can treat it much earlier.

Dr. Thomson: Parkinson's disease comes in to a group of disorders which are progressive and progressive decline in the way in which the body moves and this agent helps to differentiate between that type of disorder and a more benign essential tremor.

Why is it important to figure this out?

Dr. Thomson: I think for a patient with this kind of symptom that is disabling and it gives you a lot of anxiety to know that something is going on. You want to know whether you've got something that's going to get worse over time or whether it's something that's benign, that's just going to be there. It helps also for the doctor looking after the patient; you can know whether or not to treat it with one form of medication or not to treat it. So it helps to know whether someone has a Parkinson's like syndrome, one of these progressive diseases such as Parkinson's disease, or whether the symptom of the tremor is a benign essential tremor. And the decision to treat or not treat and what sort of medication to use is based on the test result.

Show me what's going on back here.

Dr. Thomson: The anatomy of the brain on the far left from an MRI or here the brains metabolism from a PET scan shows you the whole brain and the part that we're interested in is just this little part of the brain in here called the Basal ganglia. And that's where the movement part of the brain is centrally. And in the DAT scan where you target the dopamine transporter the agent is taken up just by that little part of the brain. And that's really, really obvious in this normal example. They look like little commas. In the abnormal you get a depletion of that substance in the brain and in the abnormal scan those little commas are going to be misshapen. You're going to see some symmetric or asymmetric decrease in the amount of the stuff that's taken up by that dopamine transporter.

Would it be the more severe the disease the less comma?

Dr. Thomson: That's right.

You were really at a disadvantage when you only had the normal MRI scan?

Dr. Thomson: There hasn't been a test before now that's been so specific for this part of the brain. But this is the way that imaging is moving forward it's becoming much more specific at the molecular level this is an example of molecular imaging.

Would you call this a game changer?

Dr. Thomson: Oh yes, this is a game changer. There are a lot of people with tremor, there are a lot of people with Parkinson's type syndromes. This is a game changer it's going to lead to earlier diagnoses and clearer diagnoses for patients with tremor.

Do you think this is going to be widely used in the next year?

Dr. Thomson: I think that's it's going to be widely used and then we will find the time exactly at what place it plays in the neurologists management of these sorts of disorders. But we're looking forward to having the scan available because its been available in Europe for a decade already so it's about time we had it here as well.

FOR MORE INFORMATION, PLEASE CONTACT:

Nilou Salimpour
Media Relations
Cedars-Sinai Medical Center
(310) 292-6536
salimpourn@cshs. org

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