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Neuroscience News
Texas Health Presbyterian Hospital Dallas
Vol. 1, No. 2 - June 2009
In this Issue
The Importance of Research for Parkinson's Disease
By R. Malcolm Stewart, M.D.
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R. Malcolm
Stewart, M.D.
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Research has different meanings to different people, but the essence of research is one of discovery and creation of new knowledge. Research on Parkinson's disease is complex, slow and expensive, but the hope for the future is finding the cure or improving the quality of life for the patient afflicted with Parkinson's.
Research is a highly regulated endeavor. In the United States, research is regulated by the Food and Drug Administration, which is charged with overseeing the development of new devices and drugs. This activity requires constant vigilance to assess the efficacy and safety of a product. Today only about one in 5,000 compounds tested sees the light of day as a finished product, at a cost of more than $350 million and more than 10 years of research.
Everyone wants the benefit of a new drug, device or procedure, but most people naturally want it to be safe and effective. In order to obtain such a result, the product or process must undergo testing under fairly rigorous conditions.
What is the benefit of participating in research? The benefits can come at different levels — for individuals or for society or the cause.
We have a number of ongoing research projects at Texas Health Presbyterian Hospital Dallas, including the Anne C. Slicker Center for the Early Detection of Parkinson's Disease, funded by the Cabe Foundation; and the Human Performance Laboratory, which uses advanced computer technology to quantitatively evaluate patients in regard to deep brain stimulator surgery, response to medications and driving evaluations. We are also participating in clinical studies by pharmaceutical companies and other device sponsors. We are involved in collaborative studies with UT-Arlington, UT-Dallas and Louisiana State University at Shreveport.
Clinical trials may not be appropriate for everyone, but if this article has piqued your interest, we invite you to call our program coordinator at 214-345-4224 to get more information about research currently being conducted at Texas Health Dallas.
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Neurosurgery for Parkinson's: Past, Present and Future
By R. Malcolm Stewart, M.D.
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R. Malcolm
Stewart, M.D.
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A surgical approach to the treatment of Parkinson's disease (PD) is not new; surgical procedures were used as early as 1912. These early procedures, however, had little effect on tremor and bradykinesia associated with PD. In the 1950s, ablation of the thalamus (thalamotomy) became the surgical target of choice for PD, following the observation that lesions of the thalamus produced dramatic reduction of Parkinson's tremor.
The introduction of L-dopa in the 1960s provided dramatic symptomatic improvement for many PD patients and reduced the use of surgical therapies for PD. Within a decade, though, the limitations of L-dopa became apparent. The medication did not prevent disease progression and was associated with complications and side effects, including the progressive shortening of duration of action of the drug effect throughout the day, unpredictable and abrupt loss of drug effect, and involuntary movements (dyskinesias).
These complications highlighted the limitation of L-dopa in the management of PD and prompted the resurgence of surgical treatment of the disease.
Currently, deep brain stimulation (DBS) of the subthalamic nucleus has become the neurosurgical treatment of choice in the alleviation of the cardinal symptoms of PD in patients for whom medication does not provide relief.
DBS is achieved through the implantation of an electrode containing four electrical contacts into the subthalamic nucleus (STN), which, via a wire extending through a burr hole in the skull, leads to an impulse generator implanted under the skin over the chest. The therapeutic effects of DBS are obtained by high-frequency stimulation of the STN, which reduces, by unknown mechanisms, the neuronal activity of that site.
There is no destructive damage to neuronal tissue, so the long-term complication rates are less than with ablative surgeries. DBS is a reversible process. The implanted electrodes can be removed so that patients can participate in newer treatments if desired.
DBS surgery is appropriate for PD patients who have significant functional impairment that interferes with their daily activities, who develop significant dyskinesia and who have marked motor fluctuations. Patients with advanced PD typically do not fare well with DBS surgery as do the younger, moderately affected PD patients. If a patient does not respond at all to medication, that patient is not a good candidate for DBS.
Many patients experience great improvements in their quality of life after DBS surgery. Several studies have reported an approximately 50 percent improvement, with more than 70 percent of individual patients experiencing significant benefits. For more information about DBS surgery, please call 214-345-4224.
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Advances in Epilepsy Medication
By Jay Harvey, D.O.
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Jay Harvey, D.O.
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According to the Epilepsy Foundation, 30 percent of the people who suffer from epilepsy do not enjoy seizure freedom on a long-term basis. For them, new anti-seizure medications on the near horizon are welcome. It is anticipated that in 2009, three new anti-seizure medications will be available. One such medicine is now on the shelf, with the second soon to follow.
Although all three of these new medications are labeled ideally for a specific generalized epilepsy syndrome, they could each have effects on a broad range of seizures.
Another unique item to note is that at least one of the new medications will be available in tablet form and oral liquid form and through an IV. These options will afford physicians many alternatives in crafting an individualized treatment plan tailored to the specific needs of each patient.
As with most anti-seizure medications, some understanding of how the medications affect the brain and its receptors is still being clarified. However, each of these medications will provide some novel mechanisms of action. Likewise, each medication has some unique features in regard to the way it is metabolized in the body. Given these features, the medications will need to be reviewed in detail when added to other anti-seizure medications.
There continue to be a significant number of individuals who have seizures despite trying multiple medications. Thus new medications are needed. The addition of the three medications to the anti-seizure arsenal is greatly anticipated.
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Still Here, Still Productive, Still Happy
By Judy Williamson, Volunteer
Education and Resource Center for Parkinson's and Movement Disorders at Texas Health Presbyterian Hospital Dallas
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Judy Williamson
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Still here, still productive, still happy. After my diagnosis of Parkinson's disease, I would not have believed this could be so. Yes, it is possible to be happy even after a Parkinson's disease diagnosis.
When I was first diagnosed, I felt both helpless and hopeless. It didn't take very long for me to realize that I didn't like feeling this way. Handle the changes as they happen. Make adjustments as you go along, much the same way you would even without Parkinson's. Don't spend your time and energy worrying about what might happen.
Become involved! I volunteer at the Education and Resource Center for Parkinson's and Movement Disorders at Texas Health Presbyterian Hospital of Dallas. This has given me a way to make a positive difference in the lives of other Parkinsonians, and it has made a powerful difference in me. I have met so many wonderful and amazing people. Some of them have had Parkinson;s disease for many years; they are such an example of strength of spirit.
Empower yourself! Educate yourself! Talk about it! Parkinson's is not a shameful disease, it is not a disease to be hidden away and not discussed. I have found that the more I share, the more I am amazed at the kindness of others.
I remember one day early in my journey with Parkinson's, sitting around mulling over the uncertainty of my plight and wondering what tomorrow would bring. I suddenly realized that I had not known what tomorrow would bring before Parkinson's. I try to live by the three-day rule. Be THANKFUL for yesterday. Choose to be HAPPY today and never give up being HOPEFUL for tomorrow. These are three things we can have control over: THANKFUL, HAPPY and HOPEFUL.
One of the most powerful emotions is hope, and it doesn't require a prescription — it's free! We are never given more than we can handle.
We owe it to our loved ones to do our very best to have a positive, hopeful attitude and to live our best lives. It shows our children and grandchildren how precious life is and that it should be appreciated and cherished.
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Giving Makes You Rich
By Gwyn Anderson, Texas Health Presbyterian Foundation
Times are tough, and yet in spite of all the negativity we hear daily, Americans remain the most generous people on the planet. In 2007, we gave $229.03 billion to charity — more than the gross domestic product of all but 33 countries in the world. Even more impressive is the fact that more than 75 percent of this giving came from private individuals.
Studies have shown that all this generosity correlates with our country's high average levels of prosperity. The Social Capital Community Benchmark Survey (SCCBS) results showed that people who give charitably make significantly more money than those who don't. While this statistic seems like common sense, it turns out that the link in the data between giving and earning is not just one way. People do give more when they become richer, but people also grow wealthier when they give more.
Throughout our country, across all economic levels, communities have been built and sustained on the service and philanthropy of their residents. Paulette Maehara, president and CEO of American Fundraising Professionals, states, "The need for charitable programs rises dramatically when profits fall, costs skyrocket, and families struggle to make ends meet. The large majority of charitable programs in this country are made possible through contributions by everyday citizens, not big corporations or foundation grants."
You can make a difference right here in North Texas. If you would like to know more about Texas Health Presbyterian Hospital Dallas programs or about ways you can become involved, visit the Texas Health Presbyterian Foundation website at www.texashealth.org/giving, or call us at 214-345-8442.
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