Drs Indu Subramanian and Alfonso Fasano discuss some of the 2024 highlights in Parkinson’s disease research, including a paradigm shift in diagnosis and the potential role of GLP-1s.
Clinical Professor, Department of Neurology, University of California, Los Angeles; PADRECC Director, West Los Angeles Veterans Association, Los Angeles, CaliforniaAlfonso Fasano, MD, PhD, FAAN
Received research grant from: AbbVie; Boston Scientific; Dystonia Medical Research Foundation; University of Toronto; Michael J. Fox Foundation; Medtronic; MSA coalition; Praxis; ES We’ve known for years the genetic contribution of Parkinson’s. We have a number of biomarkers — think about DaTscan, but also alpha-synuclein deposition in the skin. Now, with the recent introduction of a seeding assay — you mentioned RT-QuIC — clearly our understanding and diagnostic accuracy of synucleinopathy has improved so much that the field has now come to the conclusion that we really need to implement this new framework into what we call Parkinson’s disease.
Right now, we have many genes involved in the disease. There are very strong genes that we call monogenic type of Parkinson’s, where if you have a mutation, you have a certain risk, depending on the penetrance, to develop the disease. A classic example would beWe also have genes that are more common in the population, but they are seen more as risk factors. Probably the most important in this context will be.
In Parkinson’s, we know that, especially early on in the pathophysiology of the disease, there are inflammatory changes in the brain, obviously with the role of microglia. This is a mainly American study, published in. These colleagues looked at this product, and they said, okay, this is a perfect situation because it’s a drug that works like exenatide, so it might do something good to Parkinson’s and also have an effect on microglia.
I think in a frail population, certainly, we need to be very mindful of trying medications that could result in weight loss that then have other adverse effects down the road. At the moment, I’m being quite cautious of using the GLP-1 drugs, unless, of course, the patients have diabetes, as you mentioned.
This is the very first time that I’ve seen a Cochrane database systematic review be so specific about exercise for Parkinson’s disease. In the past, they have published similar meta-analyses where the conclusion was always, well, we need more studies. The evidence is poor. We’re moving on now to the advanced therapies. I know this is an area that’s near and dear to your heart. Maybe we could talk briefly about infusions and what’s been new this year and hot. Then also perhaps, we’ll get a quick update onThe idea that a neurologist could treat Parkinson’s disease by infusing a dopaminergic agent such as apomorphine under the skin has been around for decades, as I said.
This paper adds that, looking at the best spot in the subthalamus to help the different conditions that they were dealing with, they could identify different circuits that were tapping in different areas of the cortex, particularly the frontal cortex.
Parkinson Disease Parkinsons Parkinson Parkinson Disease (PD) Exercise Physical Activity Brain Deep Brain Stimulation Deep Brain Stimulation (DBS) Brain Stimulation Tremor Ultrasonography Ultrasound Sonogram Essential Tremor Genetics L-Dopa Levodopa Meta-Analysis GLP-1 Receptor Agonists Glucagon-Like Peptide-1 Receptor Agonists Europe European
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