Some reflections on Parkinson's disease, and the related Lewy body dementia; which are the second most common cause of degenerative brain disease (after Alzheimer's) - increasingly common in the developed world, probably due to the 'ageing population'.
The current medical treatment of Parkinson's disease seems to be extremely poor.
It is based around L-dopa, which seems to be a miracle cure at first, for a short time, but then almost always produces severe side effects and/or loses its effect.
It looks as if L-dopa is just too powerful a drug (almost a pure neurotransmitter), and the brain responds by 'fighting' the drug - i.e. the brain's homeostatic mechanisms are seriously destabilised by L-dopa, and the patient veers between hyperstimulation and 'freezing'.
On the other hand, electroconvulsive therapy/ ECT/ electroshock has been shown to be effective in some patients with Parkinson's disease in numerous trials - yet this fact is virtually unknown.
ECT is a much safer treatment than L-dopa. And even if it wasn't, Parkinson's is an extremely severe and debilitating illness - indeed people have had experimental brain surgery and transplant procedures (albeit with little success) for Parkinson's.
So there seem no valid reason not to try a course of ECT in Parkinson's, and maintenance ECT if it produces significant benefit.
There is very strong evidence (mostly from studies of tobacco smoking) that nicotine is preventive of Parkinson's disease, and sometimes helps treat it. This is rational, given that nicotine indirectly increases dopamine activity.
Nicotine can be safely given with skin patches with minimal side effects (for most people).
Why is nicotine not used in prevention/ early-treatment of Parkinson's?
Why is it not even tried?
There is also evidence that caffeine (coffee) is preventive of Parkinson's disease, and there is also a rationale for this because caffeine is a mild psychostimulant with dopamine boosting actions.
So, in Parkinson's disease we have a very serious and common disease with hopeless conventional treatment - we have in ECT a powerful treatment which almost certainly helps some people, even with severe PD - and we have in nicotine and caffeine two non-prescription treatments which almost certainly prevent the illness, and improve the early stage of the illness.
Why are they virtually unknown, why don't people try them?
Obviously, if they are tried and they don't work, or make things worse; then stop.
But why not try, especially when current treatment is so bad?
With ECT there is a very obvious prejudice against the treatment - a fear and horror which is ignorantly and dishonestly stimulated.
At root, probably this is because ECT is opposed by Big Pharma who want people to take ineffective/ harmful medication instead of an effective physical treatment. Drugs are marketed to the tune of 1000 dollars per head of population in the USA. IN a competitive world, with a rate of turnover and change, simply by not being marketed, agents drop out of use.
With nicotine and caffeine there is the problem (folk belief, media manipulation) that these drugs are supposed to be 'bad for you' according to the mainstream mass media ideas of 'health promotion'. There is therefore an underlying discomfort in recommending for health reasons a lifestyle or treatment associated with smoking and drinking strong coffee.
Whatever the reasons, the complete uninterest in effective treatment for people with very severe, common, debilitating, distressing, progressive disease is altogether typical of modern society.
Contrary to what might be imagined, modernity cares little for functionality, is all-but indifferent to effectiveness.
So it really is possible for effective, safe and available treatments of a common and severe illness to languish, unused; despite that anyone with Google Scholar could find out about them in five minutes...
This is the actuality of the information revolution: knowledge hidden in plain sight.
Another treatment to add to your list: a ketogenic diet is said to be effective at arresting the progress of Parkinson's in many, perhaps most, patients.
@Jonathan - maybe, I haven't looked at that one.
Charlton: "It looks as if L-dopa is just too powerful a drug (almost a pure neurotransmitter), and the brain responds by 'fighting' the drug - i.e. the brain's homeostatic mechanisms are seriously destabilised by L-dopa, and the patient veers between hyperstimulation and 'freezing'."
- Can this kind of prolonged overstimulation and destabilization cause psychosis? And if so, can you approximately estimate how large part of psychoses is caused or facilitated by stimulants?
@Valkea - yes, it sometimes causes psychosis - usually a delirium. L-dopa sometimes causes a hyper-stimulated state a bit like mania, aggressive, sometimes hypersexualized.
Another method which seems to be promising is deep brain stimulation. Electrodes are inserted into the brain so that one can stimulate a certain area of the brain via small currents. This way specific groups of neurons can be activated. Another method which could be used (and which has been tried out quite successfully in animals) is to implant embryonic dopaminergic neurons into the basal ganglia. It seems that the diffuse secretion of dopamin by these neurons mitigates some of the symptons of parkinson associated with the misfunction of the substantia nigra.
@VLAI - well, poking electrodes into the brain etc is getting pretty desperate. The really amazing things is that so many people have these and other wholly experimental procedures done on them, will never even have tried ECT.
Peter S. said…
Is my (perfectly British) ‘four cups of tea a day’ habit – every four hours, like clockwork – a sufficient preventative against Parkinson’s disease, or do I need to shift over to the harder stuff? As for nicotine patches, it appears that Benedict Cumberbatch’s Sherlock has already put the method into practice…
When you touch on Big Pharma's role in drug treatment of this disease as opposed to physical I immediately consider the plight of diabetics forced into a long lifetime of maintenance with expensive supplies and drugs. Could there be a more perfect disease for profit? Parkinson's - usually - strikes the elderly so Big Pharma must strike while the iron's hot.
I've been thinking about using nicotine/tobacco as a cognitive enhancer for the past year, but for a few reasons such as the cost and the addictiveness of tobacco/nicotine I haven't yet made the decision to start, other than the occasional experimental use of snus.
Initially I was interested in it to help with adult ADD. More recently, I'm recovering from a concussion, and concerned about the possibility of Chronic Traumatic Encephalopathy later in life. I wonder if tobacco/nicotine has any preventive usefulness for CTE. Based on a couple of experimental uses of snus, tobacco does seem to have a fairly significant positive effect on concussion symptoms.
Apparently tobacco/nicotine is preventive for some forms of dementia. I wonder if it has been researched for effectiveness with CTE. I suspect not. Concussion and CTE seem to be conditions that are not looked at to closely by the medical community.
What have I overlooked>
If L-dopa is so "strong", why not just reduce the dosage?
Here is an excerpt from The Economist in 2000.
"Dopamine, however, has roles other than the generation of a feel-good factor. Both Parkinson’s and Alzheimer’s diseases, for example, are associated with a dopamine deficit. So attacking them with nicotine seems worth a try.
Pursuing this line of reasoning, Paul Newhouse, a psychiatrist at the University of Vermont, and his colleagues, have been administering the stuff to their Parkinson’s and Alzheimer’s patients. And they have, indeed, found that people with Parkinson’s disease are better able to stand up, walk and resume sitting following the administration of nicotine. They also saw enhanced learning and memory skills in these patients and in a group of people with Alzheimer’s disease that they tested. "
@JR - If L-dopa is 'too powerful' it may be for reasons discussed in this article by David L Horrobin
The dose that is swallowed is only part of the story - after that the drug may go everywhere, including many places it is not wanted.
I suppose the analogy might be trying to bang in a thumb tack with a five pound iron mallet - the drug dose would represent how hard you hit the tack - very difficult to get right, either it does nothing or the tack is bent and flattened...
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