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PARKINSON DISEASE IN 2018

New therapeutic developments for Parkinson disease

Nature Reviews Neurology volume 15, pages 68–69 (2019)Cite this article

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In 2018, developments in Parkinson disease (PD) research yielded improved diagnostic criteria and provided evidence for the effects of some treatments, both old and new. These developments enrich the treatment options available for PD and are likely to change important guideline recommendations.

Key advances

  • The new diagnostic criteria for Parkinson disease (PD) yield high diagnostic specificity, but modest sensitivity2.

  • Although many drugs have failed to protect against disease progression in trials, exenatide is a promising new candidate5.

  • Subcutaneous infusion of apomorphine, a dopamine agonist, shortens the off-time of patients with advanced PD according to a confirmatory double-blind study6.

  • A secondary analysis of a trial testing deep brain stimulation of the subthalamic nucleus against the best available medical treatment has shown that it improves impulse control disorders8.

  • Pulsed focused ultrasound lesioning, an invasive procedure without incision, was successfully used in the subthalamic nucleus as a treatment of PD with motor response fluctuations10.

The year 2018 saw the publication of new Movement Disorder Society clinical diagnostic criteria for early PD1. These criteria will help to identify PD with high accuracy at an early stage, and will be particularly helpful for clinical studies. The use of a catalogue of simple clinical criteria that support or exclude the diagnosis makes it possible to separate clinically established PD from probable PD. A first validation study of these criteria2 has confirmed that the criteria for clinically probable PD have a sensitivity of 94% and a specificity of 88%, whereas criteria for clinically definite PD were — as expected — highly specific (98%) at the expense of sensitivity (60%).

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References

  1. Berg, D. et al. Movement disorder society criteria for clinically established early Parkinson’s disease. Mov. Disord. 33, 1643–1646 (2018).

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  2. Postuma, R. B. et al. Validation of the MDS clinical diagnostic criteria for Parkinson’s disease. Mov. Disord. 33, 1601–1608 (2018).

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  3. Athauda, D. et al. Exenatide once weekly versus placebo in Parkinson’s disease: a randomised, double-blind, placebo-controlled trial. Lancet 390, 1664–1675 (2017).

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  8. Lhommee, E. et al. Behavioural outcomes of subthalamic stimulation and medical therapy versus medical therapy alone for Parkinson’s disease with early motor complications (EARLYSTIM trial): secondary analysis of an open-label randomised trial. Lancet Neurol. 17, 223–231 (2018).

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  9. Elias, W. J. A trial of focused ultrasound thalamotomy for essential tremor. N. Engl. J. Med. 375, 2202–2203 (2016).

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  10. Martinez-Fernandez, R. et al. Focused ultrasound subthalamotomy in patients with asymmetric Parkinson’s disease: a pilot study. Lancet Neurol. 17, 54–63 (2018).

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Author information

Authors and Affiliations

  1. Department of Neurology, Christian-Albrechts-University, Kiel, Germany

    Günther Deuschl

  2. Department of Neurology, Academic Medical Center, Amsterdam, Netherlands

    Rob M. A. de Bie

Authors
  1. Günther Deuschl
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  2. Rob M. A. de Bie
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Corresponding author

Correspondence to Günther Deuschl.

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Competing interests

G.D. has received lecture fees from Boston Scientific and has been serving as a consultant for Boston Scientific. He received royalties from Thieme publishers. He is a government employee and receives through his institution funding for his research from the German Research Council, the German Ministry of Education and Research and Medtronic. R.M.A.de B. reports grants from ZonMw, Parkinson Vereniging (Netherlands patient organization), Stichting ParkinsonFonds (charitable foundation) and Stichting Parkinson Nederland (charitable foundation), and unrestricted research grants from GE Health and from Medtronic.

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Deuschl, G., de Bie, R.M.A. New therapeutic developments for Parkinson disease. Nat Rev Neurol 15, 68–69 (2019). https://doi.org/10.1038/s41582-019-0133-0

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