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Hot Topics: Advances in Parkinson's

What works and what doesn't work in Parkinson's? We asked four experts in the field for their take.  Their answers encompassed surgical interventions, levodopa as the "gold standard," managing disease, and the role of exercise. To see the full interview please click below:

http://www.medpagetoday.com/HOTTOPICSWhatWorksWhatDoesnt/special-reports/SpecialReports-Videos/407

High-intensity strength training shows benefit for Parkinson's patients

Researchers at the University of Alabama at Birmingham say that high-intensity strength training produced significant improvements in quality of life, mood and motor function in older patients with Parkinson’s disease. The findings were published Jan. 9 online in the Journal of Applied Physiology.  Fifteen subjects with moderate Parkinson’s underwent 16 weeks of high-intensity resistance training combined with interval training designed to simultaneously challenge strength, power, endurance, balance and mobility function. Before and after the 16 weeks, the subjects were compared to age-matched controls who did not have Parkinson’s and did not undergo the exercise regimen.

“We saw improvements in strength, muscle size and power, which we expected after rigorous weight training; but we also saw improvement in balance and muscle control,” said Marcas Bamman, Ph.D., professor in the Department of Cell, Developmental and Integrative Biology and lead author of the study. “We also saw improvement in cognition, mood and sense of well-being.”

Parkinson’s disease is a debilitating, neurodegenerative disease that dramatically affects mobility function and quality of life. Patients often experience weakness, low muscle power and fatigue.

Bamman, who heads the UAB Center for Exercise Medicine, devised a strenuous exercise regimen for the participants. Subjects performed three sets of eight to 12 repetitions of a variety of strength training exercises, such as leg or overhead presses, with a one-minute interval between sets for high-repetition, bodyweight exercises, such as lunges or pushups.

“We pushed these patients throughout the exercise period,” said Neil Kelly, M.A., a graduate student trainee and first author of the study. “We used a heart rate monitor to measure exercise intensity — keeping the heart rate high through the entire 40-minute session.”

Bamman says this was the first study of its kind to look at the biology of the muscles. Biopsies of muscle tissue were collected before and after the 16 weeks.

“We found favorable changes in skeletal muscle at the cellular and subcellular levels that are associated with improvements in motor function and physical capacity,” Bamman said. 

Physicians who treat Parkinson’s patients, such as UAB’s David Standaert, M.D., Ph.D., chair of the Department of Neurology, say they have long believed that exercise is beneficial to their patients.
Physicians who treat Parkinson’s patients, such as UAB’s David Standaert, M.D., Ph.D., chair of the Department of Neurology, say they have long believed that exercise is beneficial to their patients.

“What we do not know is what kind of exercise and how much exercise will prove best for individual patients with Parkinson’s,” Standaert said. “This study is concrete evidence that patients can benefit from an exercise program and can do so rapidly in only 16 weeks.”

Standaert says he hopes this study will open the door to a more complete understanding of the role of exercise in this patient population.

“My patients who participated in the study told me that they enjoyed the exercise regimen and that they saw distinct improvement in their health and physical condition,” he said. “Future studies should be able to help answer questions such as optimal frequency, intensity and type of exercise.”

Study participants showed significant improvement of six points on average on a measure called the Unified Parkinson’s Disease Rating Scale. On another measure, a seven-point fatigue scale, the group improved from a score above the clinical threshold for undue fatigue to a score below this threshold. 

A sit-to-stand test showed that, after strength training, participants dropped from requiring 90 percent of maximum muscle recruitment to rise to a standing position to just 60 percent, which put them on par with their same-age, non-Parkinson’s peers.

“These are all indications that strength training produced a major improvement in the ability to activate muscles, to generate power and to produce energy,” Bamman said, “all of which can contribute to improved quality of life and reduction of injury risk from falls.”

The study was funded by the UAB School of Medicine and the Department of Neurology, along with the UAB Center for Exercise Medicine. Bamman hopes the findings will pave the way for larger studies to define optimal exercise doses for Parkinson’s patients across the disease spectrum.

“This is the first step in an important direction to maximize the therapeutic benefits of exercise training for people with Parkinson’s disease,” he said.

Author: Bob Shepard - UAB Media Relations

Roberson and West take the reins of CNET

Erik Roberson, M.D., Ph.D., and Andrew West, Ph.D., have been named co-directors of the Center for Neurodegeneration and Experimental Therapeutics at the University of Alabama at Birmingham. The duo succeeds David Standaert, M.D., Ph.D., who became chair of the Department of Neurology in 2012.

Standaert established CNET in 2007, and it has since grown to include 50 scientists, postdoctoral researchers, students and staff. CNET promotes the discovery of novel treatments for neurodegenerative disorders, teaches scientists and clinicians about these diseases, and facilitates the application of these discoveries to the clinical care of patients.

Roberson and West are associate professors in the UAB Department of Neurology. Roberson’s primary focus is Alzheimer’s disease. West works in Parkinson’s disease.

“Scientists at CNET have led the way in recent advances in our knowledge and understanding of these diseases,” Standaert said. “We are on the cusp of exciting developments in these areas, and Drs. West and Roberson are uniquely qualified to take CNET to the next level.”

CNET is a major participant in the Alabama Drug Discovery Alliance, a partnership of UAB, Southern Research Institute and the Birmingham Business Alliance that is designed to speed the translation of UAB discoveries into clinic-ready treatments.

CNET’s focus includes neurodegenerative disorders such as Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, amyotrophic lateral sclerosis (or ALS, also known as Lou Gehrig’s disease) and other less common neurodegenerative disorders that occur more frequently with advancing age.

CNET was made possible by visionary donors committed to discovering new drugs that may slow, halt and ultimately reverse the effects of neurodegenerative diseases. UAB continues to aggressively recruit top scientists to expand and accelerate research.

Author: Bob Shepard - UAB Media Relations



Gel reduced daily tremors in Parkinson’s disease

 An experimental treatment for Parkinson’s disease reduced by nearly two hours on average the period each day when medication failed to control patients’ slowness and shaking, according to results from a double-blind, phase III clinical trial published in December 2013, in Lancet Neurology

The study compared AbbVie’s levodopa-carbidopa intestinal gel against the same medication in pill form in patients with advanced disease. 

The University of Alabama at Birmingham was among the sites for the study, with David G. Standaert, M.D., Ph.D., chair of the UAB Department of Neurology, an author. Led by the Mount Sinai School of Medicine, preliminary results from the study were first presented at the annual meeting of the American Academy of Neurology in April 2012. 

Parkinson’s disease results from the loss of brain cells that make dopamine, which helps to control movement. As dopamine levels fall, patients experience tremors, muscle stiffness and loss of balance. A commonly prescribed treatment, the levodopa-carbidopa combination works as the body converts levodopa into dopamine and carbidopa escorts levodopa to the right part of the brain. The problem is that patients face hours of uncontrolled slowness, freezing and tremors each day — called “off-time” — as the treatment gets into place or wears off.

One reason for the break in treatment coverage is that it comes in a pill, and pills sit in the stomach for up to six hours waiting for it to empty into the small intestine. It is only there that levodopa encounters the proteins capable of transporting it into the bloodstream en route to the brain. Thus, researchers envisioned a system that steadily delivers levodopa gel directly into the small intestine through a surgically placed tube, and with the help of a pump worn on the belt.

“The results are very exciting, considering that other recently approved drugs on the market reduce off-time by, at most, just over an hour,” said Standaert. “In the study, the gel treatment helped patients who had run out of alternatives with current medications. We believe it may be an important new option for patients with severe Parkinson’s, with benefits comparable to more invasive techniques like deep brain stimulation.”

Patients using the gel system saw an average reduction in daily off-time of 1.91 hours, and an increase in “on-time” without troublesome dyskinesia of 1.86 hours compared with the pill form. Nearly all subjects experienced at least one side effect, although most were short-lived and moderate. 

This study was sponsored by AbbVie, with Standaert and other authors receiving compensation from AbbVie for serving as consultants.


(Courtsey of Bob Shepard)