Latest news from Parkinson's research: causal and symptomatic Therapy in focus

Research on Parkinson's disease is currently working on various approaches to develop both causal and symptomatic therapies. The focus is primarily on improving motor skills and relieving non-motor symptoms.

Causal therapy: focus on alpha-synuclein

A promising approach in the causal therapy of Parkinson's is research into the protein alpha-synuclein, which forms abnormal deposits in the brain cells of Parkinson's patients. Research is being carried out on various active substances that can reduce or prevent these deposits.

A small placebo-controlled study with the active ingredient Buntanetap showed a small but significant improvement in motor skills in Parkinson's patients. However, NPT200-11, another drug, led to hypersensitivity reactions in initial studies. A phase 2 study is currently underway.

The first study results on Ambroxol were not very promising. Cinpanemab and prasinezumab also did not significantly improve motor symptoms in studies.

Optimize symptomatic therapy

In addition to the causal therapy, there are also advances in the symptomatic therapy of Parkinson's. A promising approach is the fixed combination of the dopamine agonist pramipexole and the MAO-B inhibitor rasagiline. The phase 3 study with P2B001 showed a significantly better effect on motor skills than the individual substances and significantly better tolerability.

Physical activity, such as tai chi or brisk walking, can also improve motor symptoms in Parkinson's patients. In patients without motor complications on L-Dopa who also received amantadine, dyskinesia developed less frequently than on placebo.

On Demand Therapy

An L-Dopa powder has been available in Germany since last year, which is used with an inhaler during off-phases. It brings about a significant improvement in motor skills within 30 minutes. A sublingual film of apomorphine can also significantly improve motor symptoms within 30 minutes in an off-phase. The drug is not yet approved in Germany.

escalate therapy

Various approaches are currently being researched in escalating therapy for Parkinson's disease. Levodopa/Entacapone/Carbidopa Intestinal Gel can be administered with a smaller pump than Levodopa/Carbidopa Intestinal Gel. Subcutaneous administration of levodopa/carbidopa is currently being investigated. There are technical advances in magnetic resonance imaging-guided focused ultrasound and deep brain stimulation.

Relieve non-motor symptoms

The alleviation of non-motor symptoms is also an important aspect of Parkinson's therapy. Computer-based cognitive training can significantly improve global cognitive performance in dementia. Cognitive behavioral therapy using telemedicine can reduce anxiety and depression. A nightly infusion of apomorphine may promote sleep. Probiotics support gut motility, while enterin may improve constipation. If you have an overactive bladder, Mirabegron can reduce urination problems. Percutaneous tibial nerve stimulation can improve urodynamic parameters.

Overall, Parkinson's research is currently showing promising approaches for causal and symptomatic therapy. It remains to be seen which active substances and forms of therapy will prove to be effective in further studies.

Jürgen Zender in May 2023 (source Deutsches Ärzteblatt)