23 June 2023
Thanks to an innovation pioneered in the whole region, the Department of Neurology in Pécs can now remotely program brain stimulation, a key treatment for Parkinson's disease, making life easier for thousands of patients. The new procedures are much needed as the dreaded disease is spreading rapidly worldwide. We interviewed Dr. Norbert Kovács, Professor at the UP Department of Neurology, about the causes of the "Parkinson's pandemic" and new therapies that offer hope.
Parkinson's disease, with progressively worsening movement and dexterity, walking difficulties and mood disorders, is becoming less and less rare and is less a disease confined only to the elderly. The number of people with Parkinson's doubled between 1990 and 2015 worldwide, and could exceed 12 million by 2040, making it the fastest growing neurodegenerative disease, i.e. a disease involving continuous neuronal death.
It is targeting young people as well
"Although Parkinson's disease still mainly affects people over the age of 60, we have more and more patients much younger than that. More than 10 percent of the patients at our clinic are under the age of 50, while the proportion of patients under the age of 60 is 24 percent. This age distribution shows that a significant proportion of patients are of working age. In other words, the rise in the number of Parkinson's patients is not only due to an ageing society, but unfortunately there are other reasons as well," says Dr. Norbert Kovács, Deputy Director of the UP Department of Neurology and President of the Hungarian Scientific Parkinson's Disease Society.
One of the main causes of what experts have called the "Parkinson's pandemic" is probably environmental pollution, as the chemicals entering our bodies can damage neurons. "We have a lot of relatively young patients who worked with pesticides or solvents, which may be the cause of the disease, but internationally there are also cases when the drinking water of a military base was exposed to chemicals, and subsequently there was a surge in the number of people with Parkinson’s who served there," he says.
Finding the exact causes is made more difficult by the probably not well-known fact that by the time symptoms appear, the disease has been damaging the neurons for decades, since it usually starts in the digestive system and slowly spreads to the brain from there. Even after this, it takes several years for symptoms to appear, as our brains heroically compensate for the neurons that have died.
Incurable, but no longer hopeless
Although the exact cause of Parkinson's disease is still unknown, and, based on our current knowledge, cell death cannot be reversed, there are a growing number of therapies that can reduce symptoms for longer periods of time, or even relieve them. One of the most important of these is the so-called brain stimulation, which involves the insertion of electrodes into the nuclei in the deeper layers of the brain to modulate the abnormal brain function causing the symptoms. The Department in Pécs, which pioneered the method in Hungary, has been performing such interventions since 2001 and has accumulated a huge amount of data.
This is also important because as the disease progresses and more neurons die, the stimulation needs to be 'fine-tuned'. In August 2022, a remote programming procedure has become available in Pécs for the first time in the whole East-Central European region, allowing the necessary fine-tuning to be carried out from a distance of up to several hundred kilometres. This means that the patient's symptoms and their possible deterioration can be checked during an online consultation, and then the programming of the implanted stimulator is carried out in real time using an application. This saves several hours of travel, which is a great relief for both elderly patients, in many cases with reduced mobility, and younger patients, many of whom are still able to work.
In addition to deep brain stimulation requiring major surgery, a growing number of minor interventional therapies are becoming available. For instance, the administration of drugs to reduce the symptoms of the disease through a subcutaneous pump, which can significantly extend the duration of symptom-free medical treatment. Time is thus finally not only in the favour the disease.
"Several new drugs have become available or are expected to become available in the near future. One of these has been used to treat diabetes for some time and has recently been discovered that it may slow the progression of Parkinson's disease. There are also several promising clinical trials underway to stop or slow down neuronal death, and there is a new impetus for research into stem cell therapy as well, which may be a realistic option in a few years. Of course, Parkinson's disease is still a serious disease, but there is hope for those who suffer from it that, in addition to preserving their condition, it may be possible to improve it and find a cure in the near future," concludes Norbert Kovács.
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