Bold statement in the title huh?
What’s your point I hear you ask? Parkinson’s is just one disease that fundamentally involves the premature death of dopamine producing neurons, leading to stiffness, rigidity, trem…..ya de ya de yada……..
Yeah I get what you are saying however bear with me. Have you been to a conference with large numbers of people with the condition?
If you have you will notice that there are….
- people who shake, people who don’t
- people who are rigid, but equally some who can’t stop moving
- people who are hunched over, yet others who still stand up tall
- people diagnosed in their 30’s (like me), but mostly older
- people with cognitive impairment, yet others still sharp as a tack
- people who are effected unilaterally, but others bilaterally
- people who still appear ‘normal’ many years post diagnosis, but others tragically wheelchair bound in just a few short years (sometimes even months)
Yet, despite the sheer variety of how the symptoms can present, Parkinson’s is still considered, and thus treated, as a single condition. For the most part, a single treatment pathway is considered — the supplementation of dopamine in the brain.
Science has been a bit slow in catching up on the concept that Parkinson’s is probably not simply one condition, but instead an umbrella term for many different types of condition. This, from this patient’s perspective, is the key challenge in identifying, and achieving better management of, the condition.
The linked article below gives a more technical explanation of how this can be achieved:
Clinical criteria for subtyping Parkinson's disease: biomarkers and longitudinal progression …
Parkinson's disease varies widely in clinical manifestations, course of progression and biomarker profiles from person…
The frustrating thing is that therapies which slow Parkinson’s may already exist.
The above is a bit of another bold statement and not just because of the font. However if you will indulge me one for a few moments for a ‘what if?’…
What if (told you it was coming) clinical trials have been failing and will continue to fail because they are attempting to hit a single target, when in reality multiple targets are involved?
It could well be the case, and I appreciate that this is a bit of a leap, that some of the drugs tested in the past that achieved partial success were successfully modifying one type of Parkinson’s but not another.
If the sub types theory holds, it would make Parkinson’s an umbrella term in the same sense that cancer is an umbrella term for multiple conditions. Clinical trials would therefore need to be more precisely designed to target specific sub types rather than the current one size fits all methodology.
Yet there’s not only potential implications of sub typing on future treatments for Parkinson’s. What if (another one) exercise regimes should be tailored for example on the basis of whether someone is rigidity or tremor dominant? Perhaps stretching is better suited for those with rigidity, and resistance training better for those with tremor?
Sub typing is the key issue in Parkinson’s from my perspective and it is absolutely key that this is brought into practice in both the research and clinical sphere’s. This will be key to realising better treatments and better management in a time frame relevant to my condition.
Martin is a Volunteer Research Blogger at Parkinson’s UK, he writes perspective pieces about Parkinson’s research. Read other blog posts by Martin