Parkinson’s, a progressive neurological and neurodegenerative disease, remains a major challenge for the approximately 10 million people affected worldwide and also for the neurologists treating them in practices and clinics. In 2023, some developments have emerged that offer new hope for those affected, at least in the treatment of Parkinson’s symptoms. In this article, we take a comprehensive look at the approaches in Parkinson’s therapy, based on the latest findings from the German Medical Journal (Ärzteblatt). The recommendations in the Parkinson’s DGN guideline from autumn 2023 go even deeper.
Current status of Parkinson’s therapies
The standard treatment for Parkinson’s disease mainly consists of a combination of L-dopa and a DOPA decarboxylase inhibitor, supplemented by other substances such as dopamine agonists, COMT inhibitors or MAO-B inhibitors. These symptomatic therapies help to alleviate motor symptoms, but reach their limits in the case of long-term complications.
Causal therapy approaches: Focus on alpha-synuclein
One promising approach in Parkinson’s research is to combat alpha-synuclein pathology. Alpha-synuclein plays a central role in the development of the disease, particularly in aggregation in Lewy bodies. Various studies are investigating mechanisms of action aimed at inhibiting alpha-synuclein production, aggregation or degradation. For example, buntanetap has shown improvements in small studies, and other substances such as Anle138b, NPT200-11 and ambroxol are also being intensively researched.
Optimisation of symptomatic therapy
There are also new developments in the optimisation of symptomatic therapy. One example is P2B001, a fixed combination of pramipexole and rasagiline, which showed a significantly better effect on motor function than the individual components. In addition, the efficacy of amantadine was confirmed in patients without motor complications under L-dopa. These studies confirm the continuous improvement in the treatment of motor symptoms.
On-demand therapy: quick help for off-phases
New options are available for the rapid treatment of off-phases. For example, an L-dopa powder has been available in Germany since last year, which is applied using an inhaler and enables a rapid improvement in motor function. Another example is the sublingual apomorphine film, which can be used for rapid symptom relief in off-phases.
Escalation therapies: Advances in the treatment of advanced stages
In advanced stages of Parkinson’s disease, escalation therapies such as continuous jejunal infusion of L-dopa/carbidopa (LCIG: levodopa/carbidopa intestinal gel) or continuous subcutaneous infusion of apomorphine as well as deep brain stimulation(DBS) are used. Here, too, there have been technical advances that enable more effective and individualised treatment.
Non-motor Parkinson’s symptoms and their treatment
Parkinson’s is also associated with a variety of non-motor symptoms. Innovations in the treatment of these symptoms include computer-based cognitive training, cognitive behavioural therapy via telemedicine, nocturnal infusions of apomorphine to promote sleep and the use of probiotics to support intestinal motility.
Novel diagnostic methods in Parkinson’s therapy
2023 also brought progress in the diagnosis of Parkinson’s disease. Early detection of the disease plays a crucial role as it enables early and targeted treatment. New imaging techniques and biomarker analyses are helping to make the diagnosis of Parkinson’s more precise and to better monitor the progression of the disease.
Digital health technologies and their role
The integration of digital technologies into Parkinson’s therapy is increasing. Wearables and apps enable continuous monitoring and data collection, which are valuable both for customising therapy and for research purposes. They help to accurately record motor and non-motor symptoms in patients’ everyday lives and adapt therapies accordingly.
The importance of exercise and physiotherapy
Physiotherapy and regular physical activity are important pillars in the treatment of Parkinson’s disease. 2023 has shown that specific exercise programmes tailored to the needs of Parkinson’s patients contribute significantly to improving their quality of life. They help to maintain mobility and alleviate motor and non-motor symptoms. We recently reported on the astonishing success of Tai Chi in Parkinson’s therapy.
Nutrition and Parkinson’s disease
The role of nutrition in the various Parkinson’s therapies is increasingly recognised. A balanced diet, rich in antioxidants and anti-inflammatory foods, can have a positive effect on symptoms. The importance of the gut microbiome in the development and progression of Parkinson’s disease is also being researched. See also this article on the importance of the gut.
Patient participation and self-management
Involving patients in the treatment and management of their disease is an essential aspect. Self-management programmes that help patients to monitor their symptoms and deal with their disease are becoming increasingly important. This promotes patients’ understanding and self-efficacy in dealing with their disease.
Conclusion and outlook
Parkinson’s therapy has made progress in 2023. From new pharmacological approaches and improved diagnostic methods to digital technologies and an emphasis on physiotherapy and nutrition – the treatment of Parkinson’s is becoming increasingly comprehensive and symptomatic treatment is being optimised. Although these developments improve the quality of life of those affected, they are still unable to slow down or stop the progression of Parkinson’s disease.
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References
You can find all the medical details in the original article in the Ärzteblatt, Therapie des Morbus Parkinson – Viel in Bewegung, Link