Your Questions Answered: Emerging Therapies in Parkinson’s

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We recently hosted a webinar with Dr. Michael Okun about the latest advancements in emerging therapies for Parkinson’s. You can access the recording and related resources here. We received so many questions during the session that we weren’t able to answer them all; so, Dr. Okun was kind enough to answer your questions in a follow up video. You can also find them written below.

To download the transcript for “Your Questions About Emerging Therapies,” click here.

show notes

Can chair exercises produce brain changes, and what about virtual reality exercises?

Yes, any exercise, including chair and virtual reality exercises, can produce changes in brain areas that are beneficial for Parkinson’s and other diseases.

How many days a week should a person exercise?

There is no single answer to this question. It is generally recommended that a person moves in some capacity every day. You don’t need to win an Olympic medal but do something physical every day.

Is meditation a form of mental exercise?

Absolutely. The brain is like a giant muscle, and you have to work that muscle every day to improve mental health.

Can a medication like GOCOVRI® (a form of amantadine) cause retropulsion?

GOCOVRI® does not cause retropulsion (falling backwards). Retropulsion is part of the progression of Parkinson’s.

What are keto or fecal transplants, and do they have any value?

Fecal transplants have to do with the gut microbiome, and while we are seeing some interesting possibilities in this area, there is no solidified research on the value of this kind of transplant.

When people talk about keto or ketosis, typically they are referring to a keto diet. We are seeing some interesting effects of a keto diet on constipation and non-motor symptoms, but we don’t know a lot yet, and so it would be highly beneficial to discuss this with your medical team.

Is there a place where I can donate cord blood from a person with Parkinson’s who passed to help Parkinson’s research?

There’s no data to suggest that cord blood is going to be beneficial for Parkinson’s research in the future. It tends to be more helpful for cancer than degenerative diseases. So, there are many places that will charge a large amount of money to store cord blood, but at this time, this is not something we’d recommend.

If you have a broken bone with inflammation, will this alter your immune system?

Yes, if you have a broken bone, your immune system is going to respond, sending anti-inflammatory cells to rebuild the bone. This can cause a reaction which can set off a cascade, potentially leading to an infection or stress. Infections, stress, and lack of sleep can all greatly impact your Parkinson’s symptoms.

Are there any probiotics proven to reduce symptoms?

The straight truth of probiotics is they change your gut microbiome. This could make things better; this could make things worse. Honestly, we don’t know what probiotics to use and who to use them on. So, talk to your doctor about this possibility, and be aware that probiotics could have no change or even make things worse.

Can you retrain your brain with an interactive metronome?

Yes, absolutely. Rhythm in music, whether through a metronome, a Bee Gees song, or a march, can be especially helpful in walking.

Are there any emerging therapies for levodopa-induced dystonia?

Yes and no. Remember that most dystonia occurs during an OFF period, meaning that when you take more levodopa, the dystonia will likely improve. In the rare case that levodopa is causing the dystonia, as is the case in this question, the primary treatment option that may be considered is deep brain stimulation (DBS). When we understand the physiology of this phenomenon more in the future, we may understand more treatment options.

How can we speed up Parkinson’s drug development?

We need to increase the funding and increase the number of projects that are going on, while working with the FDA to produce an Operation Warp Speed for Parkinson’s, so that therapies and treatments are going through the system faster.

I’ve heard so much about research and clinical trials that address synuclein spreading in the brain, where does it stand?

Over time, the brain builds up plaques (Lewy bodies) much like your teeth build up plaques. There are many therapies including vaccines, designed to clear these plaques away. The big question is, will this improve symptoms, and will this slow down progression? These two things may be possible, but there is further research needed to determine the impact of the side effects of these treatments.

Are there any non-drug methods that have had an impact on advanced Parkinson’s symptoms such as memory, multi-tasking, and delusions?

There are many techniques for training memory. We can first focus on “mono-tasking” rather than multi-tasking so people can do better. I also often recommend “stories memory”, which involves reading a section of a story with another person, discussing what happened in that section, who were the characters, etc., and then moving onto the next section.

Delusions and hallucinations are a little more difficult to treat without drugs. One must take into consideration whether these symptoms are dangerous to the person or to others. If medications are used, the side effects of those medications also have to be considered.

What types of symptoms have been positively impacted by focused ultrasound?

Tremor is the symptom most positively affected by focused ultrasound (FUS). If FUS were able to reach the subthalamic nucleus, there could be potential improvement in things like stiffness and slowness. More research needs to be done to be able to do that procedure safely.

What are your thoughts on B1 deficiency and replacing B1 (thiamine)?

The bottom line is that taking a multivitamin that has B1 in it is usually enough. There is little data that suggests that giving a person high doses of vitamin B1 will make their Parkinson’s better.

Are there any links between Parkinson’s and dairy?

Yes, there are several interesting studies on Parkinson’s and dairy.  At the moment, the link between dairy and Parkinson’s is a discussion about how the consumption of milk may increase risk of getting Parkinson’s, but we don’t have enough research to understand if dairy has any impact on the symptoms or progression of Parkinson’s.

Can a vitamin B12 deficiency be misdiagnosed as dementia caused by Parkinson’s?

Yes, absolutely. You should to get your vitamin B12 levels checked every once in a while. If your B12 is low, and they correct it, that can improve your thinking. So, it’s never a mistake to check it. Most of the time, your levels will be normal, but if it’s not, it’s easily treatable.

What can you tell us about glove therapy?

Glove therapy is essentially a device (a hand glove) with sensors in them. These sensors may be able to equalize mild to moderate tremors in some people. We don’t know a lot about it yet, but it has definite potential.

What is P2B001?

P2B001 is a drug. Often, in the clinical trial phase before drugs get named, they get numbers. This drug is a low dose sustained release combination of a dopamine agonist (pramipexole/Mirapex) and a drug called rasagiline. It’s a combination therapy. Both pramipexole and rasagiline are drugs that can be taken separately.

What is a nutraceutical?

A nutraceutical is a dietary supplement made from foods or food-like substances and are used as a complement or an alternative to a pharmaceutical. Because they’re not regulated like a pharmaceutical, they have far fewer standards they have to adhere to, and so when using a nutraceutical, it’s of particular importance to use with caution.

Is using turmeric or curcumin safe as a dietary supplement?

Across several studies, there is some suggestion that a high consumption of these can increase the risk of getting Parkinson’s. But there are no studies to suggest any impact of turmeric or curcumin once you have Parkinson’s, so there’s no harm is eating foods or taking supplements with turmeric or curcumin, but don’t overdo it.

 

more about Dr. michael okun

Michael Okun, MD

Dr. Michael Okun received his medical degree with honors from the University of Florida. He was fellowship-trained by Mahlon DeLong, Jerrold Vitek, and Ray Watts at Emory University in Atlanta, Georgia, before founding the movement disorders program at the University of Florida. He is currently Chair of Neurology, Professor, and Executive Director of the Norman Fixel Institute for Neurological Diseases at the University of Florida Health College of Medicine. He is a co-author of Ending Parkinson’s, Living with Parkinson’s Disease and Parkinson’s Treatment: 10 Secrets to a Happier Life.

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