Dr. Arun Sharma

Latest Advance in Treatment of Parkinson’s Disease Dubai

UPDATE (October 14, 2019): Recently approved by the U.S. Food and Drug Administration (FDA) for the treatment of Parkinson's “off” time – when symptoms re-emerge between doses – Nourianz (istradefylline) now is available by prescription.

Nourianz belongs to a class of medications called “adenosine A2A antagonists,” which work differently from all currently available Parkinson’s drugs. By blocking the brain chemical adenosine, Nourianz boosts the signaling of dopamine, the brain chemical that decreases in Parkinson’s. Nourianz is a once-daily oral drug that can be added to a medication regimen consisting of levodopa/carbidopa (brand name Sinemet ) to decrease “off time.”

The approval of Nourianz adds to the growing list of treatments for “off” time. Other medication options include COMT inhibitors, such as Comtan (entacapone) and MAO-B inhibitors, such as Azilect (rasagiline) and Xadago (safinamide). Another recently approved Inbrija, an inhaled levodopa, works to quickly reverse “off” time that comes on suddenly or unexpectedly. Levodopa has been available for treatment of Parkinson’s Disease in Dubai for a long time.

Magnetic Resonance guided Focused Ultrasound Therapy (MRgFUS)

FDA approves focused ultrasound for tremor-predominant Parkinson’s disease.

December 19, 2018 Tremor-predominant Parkinson’s disease (PD) joins Essential tremor (ET) as an FDA-approved indication for the use of Focused ultrasound. Focused ultrasound is a technology in which beams of ultrasound waves are focused on a designated target thereby concentrating enough energy to create a small lesion. When a lesion is created in very specific locations in the brain, it can disrupt the abnormal Parkinson’s circuitry, thereby treating some of PD’s motor symptoms.

Individual ultrasound waves do not contain enough energy to do any damage as they pass through a patient’s skull and brain tissue. It is not until multiple waves are all focused on a particular spot that a lesion is formed. In the recently approved procedure, MRI is used to precisely direct the ultrasound waves to an area of the thalamus, a structure deep in the brain that acts as a relay station for many of the brain’s functions.

Focused ultrasound is an early-stage, non-invasive, therapeutic technology with the potential to improve the quality of life and decrease the cost of care for patients with Parkinson’s disease. This novel technology focuses beams of ultrasonic energy precisely and accurately on targets deep in the brain without damaging surrounding normal tissue. Where the beams converge, the ultrasound produces a variety of therapeutic effects enabling Parkinson’s disease to be treated without surgery.

Currently, there is no cure for Parkinson’s and the major options for treatment of motor symptoms include drug therapy and invasive surgery (e.g. deep brain stimulation, radiofrequency lesioning).

For certain patients, focused ultrasound could provide a non-invasive alternative to surgery with less risk of complications and lower cost. In the long term, focused ultrasound has the potential to treat the underlying disease pathology and prevent progression and/or restore function.

Relief of Motor Symptoms

The FDA has approved the use of focused ultrasound for treatment of tremor-dominated Parkinson’s disease. See more in the regulation and approval section, below.

Focused ultrasound has the potential to achieve symptomatic relief by making thermal lesions deep in the brain to interrupt circuits involved with tremor and dyskinesia. Symptoms and targets being assessed for treatment using focused ultrasound include:

• Parkinsonian tremor – target in the thalamus (thalamotomy)
• Parkinsonian dyskinesia – target in the globus pallidus (pallidotomy) or subthalamic nucleus
• Parkinsonian tremor or akinesia – target in the pallidothalamic tract

At this time, focused ultrasound is only being assessed to treat one side of the brain, so it will affect tremor or dyskinesia unilaterally. Studies are being organized to assess the possibility of treating patients bilaterally, and one is included below.

Advantages

• Focused ultrasound is non-invasive – no incisions, holes in the skull, electrodes in the brain – and therefore has reduced risk for infection and blood clots.
• Precise targeting minimizes damage to non-targeted healthy brain.
• Compared to deep brain stimulation, focused ultrasound is a single procedure, and does not require subsequent procedures/visits to replace batteries, repair broken wires, or adjust simulator settings. It also does not involve the collateral damage to healthy tissue or the risk of infections associated with implanting a foreign body.

Treating Underlying Pathology

Preclinical studies suggest focused ultrasound’s potential to restore function in Parkinson’s models. Focused ultrasound can temporarily open the blood-brain barrier (BBB) to improve the delivery of:

• Genes, growth factors, stem cells, other neuroprotective and/or neurorestorative drugs
• Anti-alpha synuclein antibodies

How Does It Differ from Deep Brain Stimulation?
The two procedures target the same brain areas. Unlike deep brain stimulation, focused ultrasound does not require placement of wires in the brain, batteries that need recharging or replacement, or devices that entail repeated doctor appointments for programming. However, focused ultrasound also is irreversible because it involves destruction of cells.