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Four Key Questions on Parkinson’s Disease

As we continue to remember comedian and actor Robin Williams, and in light of the recently shared news of his being diagnosed with early stage Parkinson’s disease, we sat down with William Dauer, M.D., Associate Professor of Neurology and Director of the University of Michigan Movement Disorders Group to understand more about Parkinson’s and its potential connection with depression.

William Dauer, M.D., Associate Professor of Neurology and Director of the University of Michigan Movement Disorders Group

William Dauer, M.D., Associate Professor of Neurology and Director of the University of Michigan Movement Disorders Group

What is Parkinson’s disease?

Parkinson’s disease is a condition in which there is a progressive death of brain cells, also known as neurodegeneration. The loss of these neurons, which takes place most prominently in areas of the brain that control movement, leads to the characteristic symptoms of the disease: slowness of movement, soft voice, tremors, and difficulties with posture and gait, leading to devastating falls. It is increasingly appreciated, however, that the neurodegeneration in Parkinson’s disease affects the brain widely, leading to many other “non-motor”symptoms – the most feared of which is dementia, but that also includes symptoms such as depression, pain, abnormal sweating, and sleep disturbances.

Is there a cure for Parkinson’s?

No, neurons that use the chemical transmitter dopamine are particularly important for the symptoms of slowness, stiffness and tremor, and there are excellent medications to treat these symptoms. Frustratingly, however, there are no medications that slow the underlying neurodegenerative process, which is typically gradually progressive. Here at U-M, there is a tremendous amount of intensive research focused on understanding the fundamental basis of Parkinson’s disease as well as the related neurodegenerative conditions of Alzheimer’s disease and Lou Gehrig’s disease (also known as ALS). All of these diseases share the feature of abnormal deposits of protein in the brain, so are believed to share some key features. In part because of the critical importance of neurodegeneration as a medical and societal problem, U-M has recently established the Protein Folding Disease Initiative, co-Directed by Andy Lieberman, M.D., Ph.D., pathology, and Hank Paulson, M.D., neurology, which unites investigators across the University in the fight against these and related illnesses.

How has treatment changed over the years and what does the future hold for Parkinsons patients?

While the drugs used to treat Parkinson’s disease have not changed markedly over the years, there is a great deal of effort in academia and industry focused on this problem, and I am hopeful that important advances in drug therapy will be made. The development of deep brain stimulation (DBS) therapy has been a tremendous recent advance in the care of patients with Parkinson’s disease. DBS involves placing tiny wires into key brain structures, and then using these wires to deliver continuous electrical stimulation (like a heart pacemaker) via a battery pack that is permanently implanted under the skin of the patient’s chest, near the collar bone. This electrical stimulation can greatly improve certain complications of advanced Parkinson disease, as well as dramatically help people with a related movement problem known as Essential Tremor. This program, known as Surgical Therapies Improving Movement or STIMis co-Directed by Kelvin Chou, M.D., department of Neurology and Parag Patil, M.D., Ph.D., department of Neurosurgery.

Is there a connection between Parkinson’s and depression?

Yes, patients with Parkinson’s disease are more likely to suffer from depression, a symptom that relates to the neurodegneration I discussed earlier. So, this is not simply a response to having a difficult illness, but an important symptom of the actual disease itself. Fortunately, this depression can typically be treated with the medications used to treat depression generally (including Prozac-like drugs).

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