UC Parkinson's treatment shows promise

BY PEGGY O'FARRELL

Every morning, from about 8:30 to 10, Dan Truesdale froze up.

His muscles grew rigid, locked in place because of Parkinson's disease, until the medication finally kicked in, allowing to him get up, move around, live his life.

That changed last year when Truesdale, 47, became the first patient in Ohio to receive an experimental drug delivery system that gives his body a continual dose of the medication that lets him control his muscle movements.

His "frozen" muscles have thawed, Truesdale said.

"It's the best thing that's happened to me since I discovered I had Parkinson's," he said.

Researchers at the University of Cincinnati's Neuroscience Institute at University Hospital are recruiting more patients like Truesdale to test the system as part of a national phase 3 clinical trial.

Phase 3 trials are large-scale tests of new drugs or devices and the final step before federal health regulators decide to allow manufacturers to put new therapies on the market. Earlier phases test safety and effectiveness of new therapies on smaller scales.

Parkinson's disease is a chronic brain disorder in which brain cells that make the chemical dopamine die off. It usually strikes people over 50, and men are about 50 percent more likely to get it than women.

Without dopamine, adults lose control of muscle movements and balance. Symptoms get worse over time, said Alberto Espay, the neurologist heading up UC's arm of the trial, and Parkinson's patients may eventually lose the ability to speak, feed themselves, swallow or chew.

Replacing the lost dopamine helps patients regain muscle control, but standard treatments give dopamine in oral medications taken in several doses throughout the day.

That means the brain gets the dopamine it needs in interrupted allotments, so patients have periods throughout the day where they either can't move at all or they can't stop their bodies from moving involuntarily.

The drug delivery system Espay is testing aims to change that.

Abbott Pharmaceuticals' Levodopa-Carbidopa Intestinal Gel treatment system feeds the medication levodopa, which in the body becomes dopamine, into the upper intestine via a small tube surgically placed directly into the duodenum, or the very tip of the small intestine. The drug is fed through the tube from a cassette worn on the patient's body. A programmable pump lets the patient or doctor adjust the rate at which the medication is delivered.

"With this system, we're basically bathing the patient in dopamine at all times," Espay said.

Truesdale of Maineville used to be able to set his watch by his symptoms. The pump has changed all that. "I don't notice the passing of the hours because my symptoms have been reduced so drastically," he said.

He was diagnosed with Parkinson's in 2000, and has been on disability for the last four years. He recently began studying to become a minister.

The pump system is designed for patients like Truesdale with severe symptoms that are no longer controlled by standard medications, Espay said.

"People who've withdrawn from social and intellectual activities, they can resume them. We've seen people take up new activities after they've gone on the pump," he said.