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DECEMBER 2014

VOL. 17 – NO.4

ISSN 1177-0635

Parkinson’s Awareness: an everyday challenge Parkinson’s and creativity was the theme for Parkinson’s Awareness Week 2014 (1 to 7 November) and great fun was had raising awareness and much needed funds around the country.

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OTAGO VOLUNTEERS AND STAFF RAISING FUNDS AT THIS BUNNINGS SAUSAGE SIZZLE AS PART OF AWARENESS WEEK ANNETTE KING MP AND MALCOLM AITKEN COLLECTING

A heartfelt thank you to everyone who participated. Parkinson’s New Zealand also wants to remind people that although the week is a very special one, for people living with the challenges Parkinson’s brings, it was just another week, in many ways. We would love it if more people got involved outside of the week as well, or instead if they don’t have time during that particular week. Supporting our cause and the thousands of New Zealanders whose lives are affected by Parkinson’s doesn’t necessarily mean a big commitment. However, it can be really helpful if people could volunteer for their nearest Parkinson’s branch or division or national office, just asking to maybe help out with anything that’s required whether its sending out some mail, stuffing envelopes, shaking a collection can or giving someone a ride. If you have a bit of time to give, or you know someone who is looking for a new something to do this could be for you. A little bit of your time could make a big difference. A full list of our divisions and branches and their contact details are available at www.parkinsons.org.nz.

STEPHEN AND CECILIA NG COLLECTING AT BOTANY SHOPPING CENTRE

www.parkinsons.org.nz


NEWS FROM AROUND THE COUNTRY

AUCKLAND

WELLIINGTON: PARKINSON’S NATIONAL OFFICE STAFF MEMBER JULI RYAN COLLECTING AT WELLINGTON RAILWAY STATION.

ROTORUA

OTAGO

Up and down the country people ran information stands, street appeals, seminars and took part in newspaper articles to help raise awareness of living with Parkinson’s and of the work of Parkinson’s New Zealand. Here is just a selection of what our wonderful volunteers and members have been up to.

AUCKLAND Leah Alexander took on the challenge of running the Auckland Marathon during Awareness Week and a target of $1000. She and the rest of her Team Shakey have done an amazing job.

BAY OF PLENTY 2

Bay of Plenty members Dave Birss and Paul Tozer were interviewed on Central TV. Visit this Youtube address to view it. https://www.youtube.com/watch?v=GKvTOP1z3Q4&spfreload=10

ROTORUA Rotorua Intermediate teacher Alex Gayford took up the Pies for Parkinson’s challenge, much to the delight of the 700 students who were watching. He also spoke to the whole school about Parkinson’s. Everyone had so much fun they will be doing it again with another teacher at the end of term.

WELLINGTON Spark (formerly Telecom) staff took up the Pies for Parkinson’s Challenge during Awareness Week thanks to the hard work of Wellington member James Nicolle. Events in both Wellington and Auckland saw the chance to ‘pie’ senior managers get raffled off. A sausage sizzle added to the funds raised.

WAIRARAPA More than 100 members and carers from the Wairarapa and neighbouring regions attended the education seminar held at the elegant Masterton Club in the Wairarapa. The seminar began with a morning tea followed by a welcome from immediate past chairman Mike Lynch and service provision information by Community Educator Jane Flowerday

methods for improving communication and movement in people with Parkinson’s and other neurological conditions. Sarah Martin, Speech Language Therapist, spoke about the LSVT LOUD approach to speech therapy, and Physiotherapist Jane Fairbairn spoke about the LSVT BIG approach to improve movement in people with Parkinson’s. Psychiatrist and consultant in Old Age Psychiatry Dr Colin Peebles from the Canterbury DHB spoke about non motor symptoms that some people with Parkinson’s can experience including depression, anxiety and psychosis, as well as other cognitive symptoms. Dr Pebbles explained dopamine’s importance in non motor brain functions and recommended strategies to manage non motor symptoms. Lunch was an opportunity to get to know people better and catch up with old friends in a warm and inviting atmosphere in the spacious bar or to enjoy the beautiful spring weather on the decking outside. In the afternoon Pharmacy Team Leader Gail Edwards from the Wairarapa DHB offered useful advice about getting the best out of Parkinson’s medications. Dentist David Banks’s presentation about oral health in Parkinson’s had everyone laughing with his funny commentary and also provided useful advice about how to improve and maintain oral health. Physician and Geriatrician Dr Tim Matthews offered advice about how to get the best out of doctors’ appointments. The seminar ended with a presentation from the NZ Fire Service.

OTAGO One of our members (Warren) drove his Ford Hot Rod to our Coffee Group – he kindly gave some of our members a thrilling ride in his vehicle. This brought smiles to many faces – those watching as well as those having the ride.

The seminar speakers’ topics were varied and there was plenty of time for questions. LSVT Global Inc. introduced the Lee Silverman

THE PARKINSONIAN


A WORD FROM THE CHIEF EXECUTIVE

Tena Koutou Katoa A number of varied activities and events have kept us busy at National Office and across the nationwide Parkinson’s community since the last Parkinsonian. In addition to the fun and awareness raising across the country during this year’s Parkinson’s Awareness Week, our Living with Parkinson’s Creativity Competition, entries for which closed on 30 November, was a wonderful showcase for talent and provided powerful insights into the lives of people with Parkinson’s. If you haven’t had the opportunity to view the entries yet I encourage you to do so on our website www.parkinsons.org.nz. I’d like to take this opportunity to thank everyone who participated in Awareness Week. Those hours of volunteering to work at an information stand here, or collect on a street corner there, do make a difference and without the generosity of our many volunteers and supporters we’d all be a lot poorer in more than one sense. You can read more about what happened during Awareness Week and view a number of the entries for Parkinson’s Creativity competition in this Parkinsonian. The article in this issue about optogenetics, a relatively new science with neurological applications that provide

considerable hope for the future, makes for interesting reading. I was mightily impressed; as I am sure you will be, by the dedication and brilliance of the team at Otago University, led by Louise Parr-Brownlie who has worked in this area for 14 years. People with Parkinson’s, their carers and everyone who cares about them are grateful for the sheer industriousness and determination of people like Louise and her team. Our Carers Corner piece on helping people who experience falls aims to provide some practical tips. It’s December again and 2015 is nearly upon us. Happy Christmas and New Year from all of us at Parkinson’s New Zealand. I hope you enjoy your holidays and manage to take pleasure in however much sunshine you get where you are. Nga- mihi o te Kirihimete Deirdre O’Sullivan 3

Parkinson’s New Zealand AGM The AGM of Parkinson’s New Zealand will be held on Saturday 18 April 2015 at 12pm. The AGM is preceded by the annual workshop on Friday 17 April. Both of these meetings will be held at the St John’s Conference Centre in Wellington.

THANK YOU DAVID LEVENE FOUNDATION

Thank you to everyone who has supported us throughout 2014.

PARKINSON’S NEW ZEALAND | PO Box 11-067, Manners St, Wellington 6142 Phone 04 472 2796 | Freephone 0800 473 4636 (0800 4PD INFO) | Fax 04 472 2162 Email info@parkinsons.org.nz | Web www.parkinsons.org.nz www.facebook.com/parkinsonsnz & Twitter @Parkinsonsnz Follow us on Facebook

Please do not interpret anything in this magazine as medical advice. Always check with your doctor. The appearance of any article or other material in this publication does not imply the agreement of Parkinson’s New Zealand with the opinions expressed therein.

DECEMBER 2014


NEWS & RESEARCH AGE SHOULD NOT PREVENT SELECTION FOR DBS Research published in JAMA Neurology in October suggests that the risk of complications related to deep brain stimulation (DBS) does not increase with age in people with Parkinson’s. DBS uses electrical signals from an implant in the brain to help reduce Parkinson’s symptoms. It does involve invasive surgery and as with all surgical procedures can lead to complications. Researchers from Duke University in North Carolina, USA examined the medical records of 1,757 people with Parkinson’s aged 50 to 90 who had DBS between 2000 and 2009. The research team found that the risk of complications during 90 days after surgery was no greater in those over the age of 75 when compared to younger people who received DBS. The team found that 7.5 percent of the people who had DBS experienced complications which included infection, pneumonia, and bleeding in the brain among others. Research has already shown that DBS is more beneficial to people than medication alone, however not everyone with Parkinson’s is suitable for DBS. This study suggests that age should not prevent someone who is a good candidate from receiving DBS. www.parkinsons.org.uk 4

be a useful early warning system to help identify dementia risk in Parkinson’s. www.nci.ac.uk

COULD BRISK WALKING BE BENEFICIAL FOR PEOPLE WITH PARKINSON’S? A study published in Neurology in July may suggest another method to relieve the symptoms of Parkinson’s. The research team led by Dr Ergun Y. Uc of the University of Iowa in Iowa City, USA analysed 60 people with Parkinson’s aged 50 to 80 years to determine the effects of aerobic walking on the symptoms of Parkinson’s. They also wanted to find out if a moderate intensity exercise programme was beneficial, safe and tolerable. Participants took part in three 45-minute sessions of moderate intensity walking a week for 6 months. The researchers measured the heart rate of participants as well as their aerobic fitness, memory, mood, motor functions, and cognitive abilities. The researchers found that brisk walking led to improved motor function and mood, improved attention and response control, reduced fatigue, and increased aerobic fitness and gait speed. Dr Uc commented Walking may provide a safe and easily accessible way of improving the symptoms of Parkinson’s and quality of life.

GAIT MAY INDICATE THE ADVANCE OF PARKINSON’S Researchers have found that the gait of people with early onset Parkinson’s may indicate how their condition will progress. Previous research had established a link between gait and dementia in older adults, but until now it was not clear how the decrease in motor skills that affects walking styles in Parkinson’s is related to cognitive skills. A paper published in October in Frontiers in Aging Neuroscience confirms a relationship between gait and cognition in Parkinson’s. Lynn Rochester of Newcastle University in Northern England and her colleagues examined the gait of 120 people who had been diagnosed with Parkinson’s in the previous three months and a control group of 180 people without Parkinson’s. There was a correlation between walking styles, such as length of stride and sideways sway, and how well patients scored in cognitive tests. The findings show that subtle changes in gait—some of which cannot be detected by the eye—may be an early sign of cognitive decline and could indicate to medical practitioners that treatment is needed. Professor Rochester commented The relationship between gait and cognition has never been established this early on and in such a large group of [people with] Parkinson’s before. In the future walking patterns may

Further studies will be required to confirm the results of the study. www.medicalnewstoday.com

PARKINSON’S VACCINE SHOWS EARLY PROMISE A phase 1 pilot trial of injections under the skin of a drug called PD01A shows that the vaccine was well tolerated and safe and that it led to an immune response. The vaccine targets the culprit alpha-synuclein protein that is found in the brain and tends to clump in people with Parkinson’s. It is believed that this clumping either interferes with normal alpha-synuclein function or is itself toxic to cells. PD01A is designed to encourage the production of antibodies that attach to and get rid of excess alpha-synuclein. The vaccine is intended to prevent the development of Parkinson’s and thus it is important to identify the condition as early as possible. Researchers are investigating indicators such as loss of smell, sleep disorders, and other signs that might come before the onset of Parkinson’s. The study included 32 people aged 45 to 65 years who had received a Parkinson’s diagnosis in the previous 4 years and who were receiving Parkinson’s medications such as levodopa. The participants were randomly assigned to receive 4 monthly injections of a lower or higher dose of the vaccine or to a

THE PARKINSONIAN


control group that continued to receive regular Parkinson’s related medical treatment. Researchers found that the injections led to a specific immune response. Fifteen of the 24 people who were immunised had alpha-synuclein reactivity. Importantly, these antibodies were found in the cerebrospinal fluid of 6 of the 17 people that the researchers were able to analyse. AFFiRiS, the Austrian pharmaceutical company developing the drug, is planning further research to assess the safety and efficacy of a booster shot of the vaccine.

slow the progression of Parkinson’s at an earlier stage. www.techtimes.com

ANOTHER LOOK AT FOETAL-CELL TRANSPLANTS Several people with Parkinson’s who received foetal-cell transplants in the early 1990s have needed little or no medication to treat the condition ever since. Researchers say that this outcome is extremely rare in the progression of Parkinson’s.

FROM THE GUT TO THE BRAIN

The foetal-cell treatment has been questioned by some researchers. However, European researchers have launched Transeuro, a controversial trial on foetal-cell transplants. Funded by a NZ$19 million grant, surgeons in England are expected to perform the first transplant on a trial participant since the 1990s.

Parkinson’s is associated with degeneration in the movement centre of the brain. Researchers say that the origins of the condition may be in the gut.

The Transeuro trial will test whether transplanted dopamine cells may help people with Parkinson’s beyond current medications and deep brain stimulation.

A decade ago, German neuorpathologist Heiko Braak suggested that Parkinson’s begins in the gut then spreads to the brain. The idea generated intense debate but now researchers from Lund University in Sweden have found initial evidence which shows the condition is able to migrate from the gut into the brain.

Two U.S. clinical trials found that foetal-cell treatments did not significantly benefit the overall group of participants. There were also associated risks, such as developing severe involuntary movements known as graft-induced dyskinesia.

www.medscape.com

People with Parkinson’s often complain about gastrointestinal problems that are not well understood and have been sparsely studied. The findings of the Swedish researchers indicate that Braak’s hypothesis, which suggests that the process leading to Parkinson’s, begins in the digestive tract and in the brain’s olfactory centre, may be accurate.

Evidence from the U.S. trials showed that the transplanted dopamine cells survived, but it wasn’t clear whether the cells joined together with brain circuits normally. The transplant did not show any benefit to participants over the age of 60. However, several of the younger cases showed improvements and were able to come off or reduce their medications.

People with Parkinson’s often have symptoms linked to smell and digestion early in the progression of the condition.

Dr Stanley Fahn of Columbia University in New York was the coprimary investigator in one of the two US transplant trials in the 1990s. He still sees one participant from the trial in his clinical practice who continues to take a lowered dose of medication.

It is thought that misfolded proteins that clump together affecting neighbouring cells drive the progression. The Swedish researchers using rats in experiments report that they have been able to track this clumping action.

Neurologist Thomas Foltynie of University College London cares for two transplant recipients who participated in an 18-person trial in Sweden in the mid-1990s. He and his colleagues published a case report on them in the January issue of JAMA Neurology.

The alpha-synuclein protein reaches the movement centre in the brain which results in the movement disorders that are characteristic of Parkinson’s.

Before the transplants both participants still responded to levodopa and functioned more or less normally when the drug was “on”, but they were disabled during the “off” periods. They responded so well to the transplants that months later, doctors took them off levodopa. Both participants experienced side effects of graft-induced dyskinesia due to the transplant.

Lead researcher Professor Jia-Yi Li commented We have now been able to prove that the disease process actually can travel from the peripheral nervous system to the central nervous system, in this case from the wall of the gut to the brain. Further research will look at the mechanism that drives the transport of the alpha-synuclein protein. The findings of the study suggest that the protein is transferred during communication between nerve cells. It may be a point of interaction that offers a chance for interventions to stop or

Fifteen and 18 years after the transplant, both recipients have nonmotor symptoms of Parkinson’s such as cognitive impairment, but they have stopped and remain free of dopaminergic medication. Further research about cell therapy is needed but the longevity of the benefit of the transplant is difficult to ignore. www.online.wsj.com

DECEMBER 2014

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CARERS CORNER In the October Parkinsonian an item on the World Parkinson Congress also included a quote from a British Parkinson’s doctor around the dangers of carers trying to help their loved ones up after a fall when they were not sure how to do so safely. This Carers Corner addresses that very issue in this piece by Tara Martin, who is Clinical Lead at On the Go Physiotherapy, Christchurch. What to do if you have a fall and how to help someone up off the floor if they fall? It is not recommended to try and stop someone from falling. This can lead to injuries. If someone is slowly losing control of their mobility and is about to fall, it is best, if you can, to help them safely to the floor. If you know how, you can do this by cueing them to kneel if they are falling forward, which is often the case if they are freezing. The best thing to do after someone has had a fall is to try to stay calm. Assess the situation and ask yourself these important questions (if you answer yes to any of them, phone an ambulance): • are they injured and in need of medical attention? • have they lost consciousness? • is there an immediate danger (for example fire or earthquake)? 6

If the answer is no, take a moment to help calm yourself and the person on the floor. Make them comfortable with a pillow. Then decide if it is safe to try and help the person off the floor. • are they able to move around (roll or sit up) without help? • are they able to follow instructions?

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• are they in an area where there is enough space to move?

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If the answer is “no” to any of the above, it is probably not safe to help the person up off the floor and you should phone for an ambulance. To help a person up off the floor use the ACC guidelines. Bring a chair over to the person to help them get up and guide them through the steps. If they are still unable to get up off the floor, phone for an ambulance.

VIBRATIN G BOX N OW AVA IL ABLE

Phoning for an ambulance does not need to mean the person who has fallen will go to hospital. The ambulance crew can help the person up, but will only take them to hospital if they assess that they need medical attention. The ambulance crew can also see to minor injuries (cuts and scrapes) caused by the fall. I recommend that people become familiar with how to get up off the floor and even practice this in a controlled and safe way. There is an Australian public health video that helps. Go to www.youtube.com and search on “Getting off the floor safely after a fall.” Select the first video listed. Or visit www.parkinsons.org.nz where it has been linked through. A physiotherapist can help you with learning how to get up off the floor. You can contact your nearest Parkinson’s branch or division for more information.

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FACT SHEET

Parkinson’s and the bladder Bladder problems are more common for people with Parkinson’s than in the general population.

HOW DOES THE BLADDER WORK? The bladder stores urine and empties when it’s full. Most people become aware of the bladder filling when it’s about half full, and wait until they find the best time to urinate. Someone with an “average” bladder needs to use the toilet four to six times a day and once or not at all at night. The sphincter muscles around the bladder outlet (the urethra) and the muscles of the pelvic floor help to maintain a watertight seal, even when the bladder is put under pressure, for example, when coughing or jumping. When the bladder is full, a signal is sent to the brain to tell it that the bladder needs emptying. Then the brain sends a message to the pelvic floor muscles and the sphincter to relax and to the bladder so it contracts and pushes the urine out. This may sound simple, but the control of filling and emptying is very complex.

HOW PARKINSON’S AFFECTS THE BLADDER While the bladder is being filled a person isn’t conscious of the process. When the bladder is full it sends a signal to the brain that it’s time for emptying. The brain – consciously now – keeps the bladder from emptying until the person is ready. Then, the brain gives the bladder the go ahead to release. The part of the brain that controls this process is in the basal ganglia, where Parkinson’s symptoms originate. People with Parkinson’s may experience an unstable or irritable bladder that contracts when it contains low amounts of urine. These contractions aren’t strong enough to cause the bladder to empty, but they do create a strong urge to urinate – urinary urgency.

doesn’t start contracting when you want it to; the sphincter doesn’t relax to allow urine out; or a combination of these. This means residual urine is often left in the bladder. This may cause a feeling of needing to empty the bladder very often, and, if the residue is large enough, overflow as an uncontrollable dribbling. This incomplete emptying can be worse for people taking anticholinergic drugs such as Artane or Disipal.

PRACTICALITIES Mobility problems can make getting to the toilet slow. People with Parkinson’s often have reduced dopamine levels at night which can make it even more difficult to get out of bed, get to the toilet or pass urine. Sleep may be interrupted by several pointless trips to the toilet.

OTHER BLADDER PROBLEMS There are several other problems common to many people, and not just those with Parkinson’s. 7

STRESS INCONTINENCE Many people experience leakage of urine upon physical stress or exertion such as coughing, laughing or exercise. Stress incontinence is more common in women, especially after childbirth and menopause.

PROSTATE PROBLEMS

There are two main problems that may occur with the bladder in Parkinson’s:

As men get older, a small gland around the neck of the bladder (the prostate) gradually gets bigger. This is normal in all men over 50, but for some it causes problems by making it difficult or slow to empty the bladder. It may be hard to distinguish between an enlarged prostate and the problems caused by Parkinson’s without specific tests.

THE UNSTABLE BLADDER

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Messages from the brain telling the bladder to hang on and relax don’t get through properly. Instead of being able to delay finding a toilet, you experience urgency. If you can’t reach the toilet in time, incontinence may result. This is called “urge incontinence”. Your bladder may also need emptying more often than before, and may wake you at night, or even empty while you sleep.

It’s important not to cut down excessively on fluids. However, it may help to eliminate caffeine and alcohol.

DIFFICULTY EMPTYING Your Parkinson’s may give you problems with starting to empty your bladder because you have trouble maintaining bladder contractions until the bladder is quite empty; the bladder

If you have stress incontinence, pelvic floor exercises may help. However, sometimes it’s best to seek professional help. There are several options for making going to the toilet easier: • If the toilet is too low, a raised toilet seat can make the toilet up to 15 cm higher. It’s important to get a seat that has adjustable clips to fix it securely and directly to the bowl. • Rails can be fixed to the walls or floor. It’s important that the right design is chosen to help with each person’s difficulties.

DECEMBER 2014


FACT SHEET – CONTINUED FROM PREVIOUS PAGE

• Clothing is easier to remove if it is not too tight-fitting and has as few fastenings and layers as possible. Velcro fasteners are easier to use than buttons and zips, and many people find tracksuit trousers very useful. Talk to a Parkinson’s Community Educator or occupational therapist for other suggestions. • If getting to the toilet, especially at night, is a major problem then a commode in the bedroom may help. There is also a variety of hand held urinals for men and women that may be useful if you can’t get out of bed quickly and there is no-one to help.

INCONTINENCE AIDS Although urinary incontinence can often be treated, there are times when incontinence aids are needed. Knowing which aids work best for you and where to get them can restore your freedom and confidence. Incontinence aids are primarily chosen by the degree of absorbency required and the ease of use. During the night, high absorbency pads are usually required. Briefs with elastic around the legs and sticky tabs on the side are the most absorbent. For daytime use, underwear with Velcro or domed fastenings or underwear shields may be sufficient and are easy to pull up and down.

WHAT CAN BE DONE ABOUT IT? 8

It’s important to realise that in many cases, urinary incontinence can be helped. A proper assessment is needed. This can be initiated by your family doctor, who may refer you to a continence clinic.

TREATMENTS Drugs are available to treat an unstable bladder which works too often and too urgently. For people whose sleep is comprised by night trips to the toilet, a drug that reduces down urine production for 8 to10 hours is available. Bladder training involves keeping a record for several days of how often you pass urine, and then trying to hold back when you feel the urge to go. It demands considerable willpower and does not suit everyone. Because stress incontinence is mostly caused by weak pelvic floor muscles, the first type of treatment is usually pelvic floor exercises. These are designed to strengthen the internal muscles around the bladder outlet. Your doctor or physiotherapist will be able to advise you. Surgery: For women with stress incontinence and men with enlarged prostates, there are surgical options available. However it’s important you talk with a neurologist, urologist, or other health professional.

USEFUL CONTACTS Your Parkinson’s Community Educator, Doctor or Neurologist will be able to give you further advice or you may like to contact the New Zealand Continence Association, Freephone 0800 650 659. Ask about a referral to an incontinence nurse. In many centres they will visit you at home. Please do not interpret anything in this fact sheet as personal medical advice, always check any medical problem with your Doctor.

THE PARKINSONIAN


THE HOPE OF OPTOGENETICS

With Dr. Louise Parr-Brownlie The Parkinsonian was pleased to spend time speaking with Dr. Louise Parr-Brownlie recently about her work and what inspires her. Implanting small generators in people with Parkinson’s brains to selectively change cell activity using pulses of light may provide a future treatment for Parkinson’s motor symptoms.

in the brain. Optogenetic stimulation has not yet been reported in patients. Before this could be done we would need to obtain ethical consent, which would require further testing in models.

Optogenetics – a relatively new brain science, which combines fibre optics and genetics – is a possible alternative to drug therapies and Deep Brain Stimulation (DBS).

“We currently use blue light pulses, the pulses have similar intensity, but the intervals between the light pulses can differ a lot depending on the pattern we are testing and whether we are mimicking actual brain activity. However, the colour of light to stimulate cells depends on the construct in the viral vector and what we are trying to achieve i.e. increase or decrease cell activity. To date, we have been mostly stimulating to make cells fire at a particular time; therefore we’ve been using blue light.”

Louise, a neurophysiologist and lecturer in the University of Otago’s Brain Health Research Centre in Dunedin, is one of an exclusive group of researchers around the globe pioneering what is being termed a revolution in brain science. Louise and her team are the first to use optogenetics testing in New Zealand, on rats in the laboratory. When using optogenetics in a controlled environment, a viral vector gets injected into the brain using specialised neurosurgery. Louise says: “[To do this on a human patient], we would need to implant a fibre optic probe into the target brain structure and this would need to be attached to a light source. We have the viral vectors and fibre optic probes [these are the same as the ‘wire’ for broadband internet]. “However, a small implantable light pulse generator would need to be developed. In many ways this would be very similar to the technology implanted into patients for DBS for electrical stimulation, only light pulses would be generated instead of electrical pulses.” A small implantable light source could be developed within a couple of years, she says. Talking about what stands between where optogenetics has advanced to now and when it may be used for Parkinson’s patients on a regular basis, Louise says: “Simply, more testing needs to be done. It is possible that electrical stimulation with these new patterns [of brain cells identified as worthwhile targeting to aid movement] may also improve movements in patients and this should be explored. Viral vectors are currently being trialled in patients in the US and Europe and have been shown to be well tolerated and safe. In these studies viral vectors are being used in very different ways – to change the brain chemical that a specific type of cell in the sub thalamic nucleus makes or increase the production of dopamine

Overseas, Louise says, optogenetics has been used to change cell activity, behaviour, the proteins made by cells, to tease out the function of specific pathways in the brain and investigate neurological disorders. In theory, this technology can be applied to almost any excitable tissue in the body, such as heart cells, cells lining the intestines, in the eye and similar. To work in these other tissues, the constructs would need to be changed, and that is possible with money, time and the skills of an experienced lab team that makes viral vectors, such as the team’s collaborator, Dr Stephanie Hughes, in the Department of Biochemistry at the University of Otago. Louise and her global associates’ work has challenged scientific assumption. Although scientists have until now assumed that activity in the motor thalamus is altered by Parkinson’s, studies only reported very minor changes probably because experiments were conducted in the anaesthetised or resting state. Parkinson’s is a movement disorder therefore changes in cell activity need to be examined during movement, says Louise. Her team has a paper that is currently in press in the Journal of Neuroscience that shows that the firing rate in the motor thalamus normally reduces just before and after a reaching movement and this modulation in activity is lost in Parkinson’s. “This loss means that although movements are completed in Parkinsonism, they are not as precise, and this may account for impaired function such as difficulty grasping an object. With this paper, we know that motor thalamus activity is altered in Parkinson’s. Now we need to understand how those changes relate to different symptoms such as bradykinesia, rigidity or tremor.

“Essentially we are examining if ‘correcting’ brain activity in the Parkinson’s brain restores or significantly improves reaching. In brief, it does.” DECEMBER 2014

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“This is exciting because we are showing that there may be better patterns of stimulation to use in the brain and these may improve movement function for patients.” “Sometimes high frequency DBS is applied to the thalamus of patients to treat tremor but it does not improve bradykinesia or postural rigidity. We have taken the precise timing of neural activity in the motor thalamus during optimal reaching movements and we are using this to determine the timing of stimuli applied to the motor thalamus of Parkinsonian brains using optogenetic stimulation. Essentially we are examining if ‘correcting’ brain activity in the Parkinson’s brain restores or significantly improves reaching. In brief, it does.

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“This is exciting because we are showing that there may be better patterns of stimulation to use in the brain and these may improve movement function for patients. We are about to present these data at the Society for Neuroscience conference in Washington DC [15 to 19 November] and have recently submitted this work to the Journal of Neuroscience. We are also starting to discuss these results with neurologists and neurosurgeons to explore when this new stimulation pattern can be applied to patients using conventional electrical stimulation technology. “We are looking at applying very different patterns of stimulation compared to what is currently used. This could be done initially via electrical DBS technology [already used in patients], but requires development of a new pulse generator. Current version cannot be programmed with complex burst patterns. “Of course we could eventually trial stimulating with these new patterns using optogenetic technology, but it would take longer before we could trial this in patients.”

The science of optogenetics Fifteen years ago Nobel Prize winning scientist, Francis Crick, who was a co-founder of the structure of the DNA molecule in the 1950s, described his dream of “turning on” human nerve cells with the use of light. Crick speculated that light could be delivered specifically and precisely to a single cell to control or change its behaviour. This precision gave light based therapy a crucial point of difference from other medical research and treatment methods being investigated. Crick’s ideas held enormous significance for medicine. If a scientist could normalise the activity of movement cells in Parkinson’s disease or calm the electrical signals in the epileptic brain, alternative therapies were a real possibility. There is the technology available for this new approach to treating human health, including neurological disease and disorders. The field of optogenetics (combining fibre optics and genetics) was named in 2006 by Stanford University Professor of Engineering, Karl Deisseroth and the mysteries of the human brain are being unravelled like never before. Essentially, with optogenetic technology, scientists can “switch on” cells simply by switching on a light. To do this a gene is introduced to the brain cell, which makes the cell light sensitive. Cell activity can be increased or decreased by stimulating these cells with different coloured lights. A blue light will stimulate the cell, and a yellow light will inhibit cell activity. Researchers can use this technology to selectively alter cell functions in pathways that control movement, memory or cognition/ thinking. Optogenetics can be carried out in real time, which allows scientists to observe and record activity within the cells. Optogenetics was named “Breakthrough of the Decade” by the journal Science in 2010.

THE PARKINSONIAN


DR LOUISE PARR-BROWNLIE. PHOTO CREDIT: SHARRON BENNETT

Dr Louise Parr-Brownlie Louise grew up in Auckland. “My Dad was British, but is now a proud Kiwi. My Mum’s family has lived in New Zealand for a long time and is primarily of Ma-ori and British descent. “My ultimate goals are to firstly improve treatment outcomes and quality of life for patients by improving knowledge that enables us to find new ways to target Parkinson’s and, secondly, to train quality neuroscientists so that we can achieve this. “I am very passionate about my work. You only need to spend a few minutes with my husband to know how much this drives so much of my life. Louise has been researching the connections between the basal ganglia, motor thalamus and motor cortex for about 14 years. “We know little about how the motor thalamus functions normally, and very little about changes in Parkinson’s. Someone needed to research it. I find this area complex and interesting so I seemed to keep asking questions about this area of the brain.

Louise has expertise in recording basal ganglia-thalamocortical circuit function and optogenetic stimulation in healthy and Parkinsonian rats. Louise is the only neuroscientist currently in New Zealand who has expertise and experience in optogenetic stimulation and associated electrophysiological recording in awake, behaving animals. “I apply the knowledge obtained from my research to hypothesise and test novel stimulation protocols aimed at improving movement function in rat models of Parkinson’s disease. We have found that stimulating the brain of Parkinsonian rats with physiological patterns, previously obtained in control rats, significantly improves reaching movements, and is better than the 130 Hz pattern currently used in patients. These data may revolutionise deep brain stimulation protocols for patients with many neurological disorders.”

Louise’s team at Otago University

“My husband has another neurological condition so I have an understanding of how these disorders can change the life of someone living with them and that of their family members. The impact can be widespread.”

Dr Sonja Seeger-Armbruster (postdoc) Dr Rachel Sizemore (postdoc) Stella Cameron, PhD student Shane Little, MSc student James Miller, BSc Honours student Roseanna Smither (ARF staff) Dr Clementine Bosch-Bouju (postdoc who recently left the lab).

2003

PhD Neurophysiology University of Otago

1999

MSc Neurophysiology University of Otago

1992

BPhEd Kinesiology

University of Otago

2010-present

Lecturer

University of Otago

2007-2010

Research Fellow

Department of Physiology, University of Otago

2006-2007 Research Fellow

National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), USA

2003-2006

NINDS, NIH, USA

Postdoctoral Fellow

DECEMBER 2014

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PARKINSONIAN PERSPECTIVES Our Living with Parkinson’s visual arts and poetry competition, which closed for entries on 30 November, has provided some powerful insights into how people with Parkinson’s view their lives and their relationship with Parkinson’s. The competition had two visual arts categories (photography and painting and drawing) and a poetry category and each had a section for people with Parkinson’s and another for people who do not have Parkinson’s. Each category has a popular prize voted on by the public and a judged prize. We have selected a few examples for the Parkinsonian, and have had to leave out some great ones simply because of space restraints. We recommend you visit www.parkinsons.org.nz to have a look at the entries. In the next issue of the Parkinsonian in addition to announcing the winners in each category, we will explore perspectives on Parkinson’s that were expressed in entries by people who do not have it.

PHOTOGRAPHY

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PAINTING AND DRAWING

“When my drugs are on the down cycle this picture describes better how I feel than any words I could use. It feels like a bad storm coming you can feel its impending arrival. It fills you with dread and puts a chill down my back. When it arrives your whole world feels like you are being tossed about in an un-ending turbulent wave with control of absolutely nothing. It is scary the cold, pain but most of all the lack of your ability to combat it and its unrelenting ability to take control of your body and do with it what it will. The absolute “sunlight” [Sinemet) is my only Westpac helicopter and I desperately look for this to pluck me from the storm in the form of its little yellow pills (should be a red cape). JEFF S

Tulip Reflections “Rays of light into the darkness – thoughts of past articulation now dispersed in various directions – emphasized by the photographer-myself hoping to capture an undisturbed image.” LESLEY G.

POETRY Where are all your Wrinkles?

“One of the many new friends I have made since being diagnosed. Arben is a resident of Montréal Canada, I met him at the world Parkinsons Congress in 2013. He is a boatbuilder and sailor who spends the northern winters in New Zealand in the Coromandel or on one of the islands offshore. This shot was taken at Great Barrier Island where he was staying this year. He calculated for me that he was 62 years old but has enjoyed 83 summers. I hope he comes back again next year.” LJ THE PARKINSONIAN

Where are all your Wrinkles? My cousins came to visit me Just the other day They had not been here five minutes When I heard one of them say “Why don’t you have some wrinkles?” It gave me quite a start I had to try to tell her That PD had played its part It could be quite a good thing To have no wrinkles there But that’s what shows our character There’s little on a face so bare You can keep your crazy ads And all those special creams If I ever see another one You’ll maybe hear my screams We can’t look young forever There’s nothing wrong with wrinkles It’s what makes a smile so special All those extra little crinkles BEVERLY F.

10579 parkinsonian vol17 iss4 web  
10579 parkinsonian vol17 iss4 web  
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