World Brain Day: Hot Topics in Parkinson Disease

Jill Giordano Farmer, DO, MPH

On this World Brain Day 2020, neurologists and researchers around the world are turning their attention to Parkinson disease, which affects more than 10 million people globally. The disease, which disproportionately impacts men, is associated with direct and indirect health care costs estimated at $52 billion annually in the US alone.

Long dominated by levodopa therapy, the Parkinson disease treatment pipeline has seen some recent reinvigoration, with more attention turned to symptom control and slowing disease progression. Nonpharmacological treatments have also captured positive attention as the industry works to refine treatment targets and improve the safety and efficacy of the therapy in hopes of broadening the eligible patient pool.

To learn more about top priorities in the sub-specialty, NeurologyLive spoke with movement disorder specialist and NeurologyLive Editorial Advisory Board member Jill Giordano Farmer, DO, MPH.

NeurologyLive: What area of research in Parkinson disease do you find particularly promising or interesting?

Jill Giordano Farmer, DO, MPH: I am particularly interested in research looking at disease-modifying therapies, in particular the repurposing of tyrosine kinase inhibitors since these are readily available and repurposed from oncology. We do not have any medications that modify progression and it is the thing patients always ask about.

What technology/therapeutic innovation are you most excited about in treatment of PD? What advantages will this bring to disease management?

Closed loop deep brain stimulation is a fascinating frontier. It is available in other neuromodulation technologies for other specialties, but has never been used in movement disorders. Real-time response to changes in brain signaling that can be transmitted to adjustments in stimulation to maintain symptom control just oozes with potential.

What is 1 clinical challenge that you deal with in your day-to-day management of PD? What needs to happen to overcome this?

The social aspects of advancing disease with caregiver burden and patient behavior changes are particularly difficult. We need to have a better appreciation for the need for social work as part of any team that manages neurodegenerative disease and value their contribution. Physicians should not have to fight for programs to consider this an essential service.

What aspect of Parkinson disease management do you feel requires more attention? What do you hope to be accomplished?

Better continuous therapy. There are trials that are looking into infused formulations of levodopa which makes sense since everything we do orally is to try and maintain a consistent level in the body. If these phase 3 subQ trials of smaller pumps show promising results, it could revolutionize how Parkinson disease is managed; this is just for symptom management though.

REFERENCE

Statistics. Parkinson’s Foundation. Accessed July 21, 2020. https://www.parkinson.org/Understanding-Parkinsons/Statistics