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The 9th International Congress of Parkinson's Disease and Movement Disorders - Part One

The Parkinson Alliance/DBS-STN Research Team

In March of 2005, The International Congress of Parkinson's Disease and Movement Disorders gathered in New Orleans to congregate for their conference. The Parkinson Alliance attended this top-tier conference, and we are excited to share with you the copious amounts of information that was revealed during this gathering. It is important to note that delegates from around the world gathered to listen to world-renowned speakers, to learn about the latest research and perspectives and to be exposed to the most current findings in the field of Movement Disorders. Moreover, the world's foremost experts in "movement disorders" facilitated lectures, posters, video sessions, and skilled workshops to enhance the understanding about movement disorders.

Although the conference addressed many different types of movement disorders, such as Parkinson's disease, Huntington's disease, Multiple System Atrophy, Progressive Supernuclear Palsy, Essential Tremor, and others, what follows in this recount of the conference's content focuses on information specifically pertaining to Parkinson's disease. Topics to report in this synopsis will include the following: An overview of advances in understanding Parkinson's disease, Sleep disorders in Parkinson's disease, Balance and gait in Parkinson's disease, and Programming following Deep Brain Stimulation.

A Brief Overview of Advancements in Understanding Parkinson's Disease:

It was Dr. James Parkinson himself who stated "there appears to be sufficient reason hoping that some remedial process may be discovered, by which, at least, the progress of the disease may be stopped." (J. Parkinson, 1817). His words resonated with the audience as our "current" physicians and scientists further educate and instill hope about the understanding and treatment of Parkinson's disease.

Parkinson's disease (PD) is a slowly progressive disorder that affects movement, muscle control, and balance. PD is often referred to as idiopathic, which means that the cause is unknown. What is known, however, is that PD develops as cells are destroyed in certain parts of the brain stem. The loss of these cells results in the depletion of dopamine, an essential neurotransmitter (a chemical messenger in the brain). This process negatively affects the nerves and muscles controlling movement and coordination, resulting in the major symptoms characteristic of PD. As such, individuals with PD present with movement problems that may include postural instability, rigidity, bradykinesia (slowness of movement), and tremor. Idiopathic Parkinson's disease (IPD) commonly begins in late middle age and the course is slowly progressive.

This conference also highlighted the role of familial forms of PD, which are found in specific genetic make-ups. Specific genetic factors appear to play a strong role only in early-onset PD, a relatively uncommon form of the disease. Important research now suggests that three molecules are critical in the development of inherited PD: alpha synuclein, parkin, and ubiquitin, which all interact in the normal brain. Abnormally high levels of alpha synuclein, which is produced in dopamine-rich nerve cells (cells that contain dopamine, a chemical in the brain whose depletion causes many of the symptoms of PD), may play a central role in PD. Normally, two other molecules, parkin and ubiquitin, are involved in the natural self-destruction of synucleina natural process of programmed cell death called apoptosis. If this process goes awry, for instance with a defective parkin gene, then apoptosis fails to occur. If synuclein is not eliminated in these cells, it builds up and becomes toxic to dopamine, thus causing a decreased production of this chemical. Genetic factors are not responsible for the great majority of Parkinson's cases, which occur in older people. Once again, genetic forms of PD are less common than Idiopathic PD; nevertheless, the study of even rare genetic cases is proving to be very useful in understanding the nature of the disease in general. Researchers expect that the recent identification of genes associated with the disease will yield an understanding of how specific proteins contribute to the disease, and may facilitate the development of new therapies.
Dr. Heiko Braak, from the Institute of Clinical Neuroanatomy, J.W. Goethe University, Germany, shared his own insights about the progression of Parkinson's disease (PD). Specifically, he identified 6 major stages about the process of PD. Moreover, he and some of his colleagues have found that idiopathic Parkinson's disease (IPD) is a multi-system disorder in the course of which only a few predisposed nerve cell types in specific regions of the human brain become progressively involved. He found that the underlying neuropathological process begins in clearly defined sites and advances in a predictable sequence.

Dr. Braak described 6 stages of the IPD process. He indicated that there are presymptomatic stages of PD; specifically, there are two stages prior to the onset of the overt physical symptoms of PD (e.g., gait and balance disturbance, rigidity, tremor, bradykinesia). In the presymptomatic stages, the IPD-related pathology remains confined to structures within the brain stem. In stages 3 and 4, the progression of the disease travels its course to the midbrain and slightly beyond and is the focus of initially subtle and, then, severe changes. At this point, the illness reaches its symptomatic phase, meaning that one can begin overtly seeing the cardinal symptoms of PD. In the final stages 5 and 6, the pathological process encroaches upon the cortex of the brain and the outer level of the brain. In the latter stages, IPD manifests itself in all of its dimensions, causing further impairments in physical, cognitive and behavioral/emotional domains.

The implications of this predictable pattern have an importance of great magnitude. As science continues to advance, there is hope that we can identify PD in the presymptomatic stages and hopefully intervene accordingly. Moreover, we can intervene in the presymptomatic stage(s) and avert further pathology in later stages. As such, expectations for the future include increasing the accuracy in diagnosis of PD and creating interventions that will prevent the progression of the disease before the onset of any overt physical symptoms. Thus, as the aforementioned quote by James Parkinson stated, there is hope that scientific advances will eventually find a way to cease the progression of PD.



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