Future Outlook for Parkinson’s Disease


Expert neurologist highlights ongoing research in newer mechanisms of action and modes of delivery for treatments of Parkinson’s disease and OFF episodes.

Stuart Isaacson, MD, FAAN: We see a lot of patients with Parkinson disease. There have been suggestions that the incidence has increased with recent studies, suggesting it might have doubled in the United States and might be higher than we ever thought. Instead of 1 million individuals with Parkinson disease in the United States, there might be 2 million. We have better awareness, recognition, and diagnosis. We’re recognizing Parkinson earlier, in earlier age groups. We’re also recognizing it in older age groups. We used to think was mainly in individuals in their 60s and 70s, but we recognize it can begin in the 80s and 90s or in the 30s, 40s, or 50s.

We’re seeing a huge shift in how we approach different patients, who have different problems. Patients who have orthostatic hypotension, cognitive issues, or sleepiness may drive us to different types of medications. Patients who have a good response to medicine where their balance is normal, but don’t have benefit from doses of medication during their OFF time, have trouble with their walking and balancing and are at risk of falling. We may have to have other medications that keep them ON consistently or medications they can use as needed to turn back ON quickly so that they don’t risk a fall. Every patient is different, but we have to recognize the earlier, the younger, the older patients—all our patients—and choose the right therapy based on efficacy, safety, tolerability, utility in different clinical scenarios, and access to therapies, and make the best decision. We need to talk to our patients, their families, and their caregivers, so that we get the best they can do, the best each patient can improve their Parkinson symptoms on a consistent basis, without limits on their quality of life.

We continue to look for new therapies for our patients. Of course, we want to cure. We’re looking at a lot of medications and research programs, trying to slow the progression or delay the onset. We’re looking at subgroups of patients to personalize therapies with gene mutations. We’re looking at groups of patients in certain stages of the disease to try to slow the progression. As we’re doing that, we’re also looking for biomarkers to make the diagnosis clearer, more accurate, and earlier. We want to get better treatments for our patients, for motor and nonmotor symptoms. We have lots of research programs looking for better treatment for individual symptoms. But we’re still left with these times of the day when we have OFF episodes. There’s a benefit of a dose of levodopa, and symptoms are no longer present until patients have these OFF episodes. We’re looking for new ways to approach that.

New ways of administering it beyond inhaled absorption, a subcutaneous pen, or a sublingual mucosal absorption. We’re looking at other ways of getting it into the body. We’re looking at ways of keeping individuals consistently ON, using subcutaneous delivery devices that patients attach to their skin and wear throughout a 24-hour period as it gives a continuous infusion of medication. These are on the horizon for our patients. We’re looking at different mechanisms of action with other neurochemicals. We’re looking at specific D1 receptor agonists because we recognize the D2 receptor agonist may have certain adverse effects that limit their use, but drugs that work more on D1 might have fewer adverse effects. We’re looking at those types of drugs as well.

There’s a lot of research going on, with a lot of expectations that over the next year or 2 or 3, we’re going to have new treatment options. We’re going to continue to improve and revise our paradigm and hopefully translate this so that it’s accessible to patients. That way, they can choose to use different newer medications to improve the benefit from each dose, extend the benefit from each dose, and have something that they can use when there’s no longer benefit. It will hopefully let patients turn back ON, have benefit, and carry out their activities without stopping and waiting. Hopefully they’ll have better days and better-quality days.

Transcript edited for clarity

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