World Parkinson's Day 2024, subcutaneous therapy that prolongs symptom control arrives in Italy too

After Alzheimer's disease, Parkinson's is the most widespread neurodegenerative disease. It affects 6 million people worldwide and in Italy it is estimated that there are over 300 thousand patients, a number that is expected to increase by 2050. Parkinson's is one neurodegenerative disease caused by progressive death of some brain cells that they produce dopamine, a neurotransmitter that controls the body's automatic movements. Exposure to hydrocarbons, pesticides, herbicides, solvents or the indiscriminate intake of typical antipsychotic or anti-nausea drugs favors the onset of the disease. International Parkinson's Day is celebrated on 11 April 2024 to spread greater knowledge and awareness about the disease.

Symptoms

The typical ones symptoms of Parkinson's disease which generally present themselves asymmetrically (one side of the body is more affected than the other) are:

There rigidity sometimes it can cause joint blocks, which determine ache so much so that it is easy for the patient to initially turn to an orthopedist or physiotherapist before a neurologist. The freezing, also called paradoxical akinesia or freezing, can appear at any stage of Parkinson's disease. This is the sudden inability to start movements, especially walking, especially if you are crossing them narrow passages or changes in direction. Patients hear feet as if glued to the ground without being able to take the next step: they may not be able to get on an escalator or, worse, get off at the end of the journey. The freezing lasts from seconds to minutes but there are strategies to avoid it mentally implementing a voluntary motor program that surpasses the automatic one altered in these patients: putting a stick on the ground and thinking about climbing over it while walking, or thinking about marching like soldiers or using a piano metronome to time the steps.

Available pharmacological therapies

There are currently several available pharmacological therapies for Parkinson's disease which, especially in the early stages, guarantee good control of symptoms, but do not modify the natural history of therapy. Since a dopamine deficiency it would be logical to think of administering the neurotransmitter directly into the brain. However, dopamine does not go beyond the blood-brain barrierfor this reason it is possible to assume the levodopaprecursor of dopamine, which is able to cross the blood-brain barrier and reach the brain.

Levodopa

To date, drugs based on levodopa (often combined with other active ingredients) are the most effective in treating the symptoms of the disease. However, in the advanced stage of the disease, oscillations in plasma concentrations of levodopa, due to oral intake and variability in absorption, can cause motor fluctuations and involuntary movements. There levodopa taken orally while always giving a benefit is short-lived, sometimes less than two hours. However, less than a month ago AIFA gave the green light to the first therapy based on foslevodopa/foscarbidopa in continuous subcutaneous infusion for 24 hours which promises to prolong the period in which symptoms are well controlled. «The drug, in the form of a gel, is infused subcutaneously through a pump with a small needle. The therapy is able to optimally control the disease, but we are still at the first administrations, we now need to better understand who the ideal candidates are” he says Gianni Pezzoli, neurologist, president of the Italian Association of Parkinsonians and of the Grigioni Foundation for Parkinson's Disease. It was at the Gaetano Pini-CTO Parkinson Center in Milan that the disease was treated on 13 February first patient with the new therapy formula.

Non-pharmacological options

Non-pharmacological interventions aimed at treating specific symptoms are the speech therapythe psychological therapy and the motor rehabilitation and cognitive. «Physiotherapy is very useful for improving balance, which levodopa does in a very relative way» underlines Pezzoli. Tai Chi, a Chinese martial art, is instead capable of slow down the symptoms associated with Parkinson's, improving patients' balance and gait. For a limited number of patients (under 70 years of age and with intact mental and cognitive functions), when the symptoms become particularly disabling and no longer controllable with classic therapy, it is possible to opt for deep brain stimulation (DBS): the treatment consists of a surgical implant of electrocatheters in the areas of the brain responsible for controlling movements and a medical device, similar to a cardiac pacemaker. The device sends electrical impulses to electrodes located in the brain areas, blocking the signals that cause disabling motor symptoms. However, the surgery to implant the electrodes is invasive (only 10% of Parkinson's patients access this treatment).