Dancing in the Rain: Lessons Learned on my Personal Journey with PD (more at www.PDPlan4Life.com) Copyright 2013-20 Sheryl Jedlinski
By Sheryl Jedlinski
One of the questions people with Parkinson’s are always asking is, ‘How is it that 50 years after its introduction, billions of research dollars later, and a host of newer medicines, levodopa is still the “gold standard” treatment for Parkinson’s disease?’ Dr. John G. Nutt, Professor of Neurology, Oregon Health & Science University, answered this question during his lecture at the World Parkinson’s Congress 2016.
Levodopa is “as good as it gets” in controlling the symptoms of Parkinson’s disease, and will likely remain so for the next 50 years, he said. Improvements will come from new formulations and delivery systems that reduce or eliminate side effects. These include motor fluctuations (on and off periods) and dyskinesia (uncontrolled movements), which negatively impact quality of life and can become as disabling as the issues caused by PD itself. About half the people who take levodopa develop dyskinesia, ranging from hardly noticeable to intrusive; and motor fluctuations, within five or 10 years of starting the medicine.
Dr. Nutt explained that designing improved therapeutic strategies to obtain constant blood levels of levodopa may not be the answer to preventing complications of long-term use. Rather research should focus on the challenges of delivering levodopa in the blood to the specific location in the brain where it is needed and at the right time and dose. Wearable technology (e.g. wrist computers) already track motion and vital functions that can provide information about when more levodopa is needed. This data could be used to alert the wearer to take more medicine or to control an implanted pump that provides levodopa to the small intestine where it is absorbed. Getting levodopa to cross the blood brain barrier may be aided by combining it with other drugs, or making dietary adjustments.
Levodopa generally retains some effectiveness throughout a person’s life, Nutt says, noting he has a number of patients who continue to benefit from levodopa after taking it for 30 years. With disease progression, however, speech, swallowing and balance impairments are added to the clinical picture and are less amenable to levodopa.
And what about the elusive cure? Nutt says it will likely come in the form of a vaccine, like the one for polio, that will detect infection and prevent it from taking hold, eventually creating a Parkinson’s-free world. Meanwhile, research continues to focus on finding treatments that slow disease progression.
Note: In addition to the information Dr. Nutt presented at WPC2016, this article includes information I obtained from him in a one-on-one interview.