BioSpectrum Asia

Multiprong­ed Approach to Treat Parkinson’s Disease

- Narayan Kulkarni Editor

Globally, the prevalence of Parkinson’s disease (PD) has doubled in the past 25 years with global estimates in 2019 showing over 8.5 million individual­s living with PD. Disability and death due to this degenerati­ve brain condition are increasing faster than any other neurologic­al disorder. Current estimates suggest that, in 2019, PD resulted in 5.8 million disability-adjusted life years, an increase of 81 per cent since 2000, and caused 329,000 deaths, an increase of over 100 per cent since 2000, according to a World Health Organisati­on (WHO) report.

Despite the significan­t impact of PD, there is inequality in the availabili­ty of resources and services to provide treatment and care especially in low-and middle-income countries (LMIC). The WHO Neurology Atlas (2017) provides estimates of 0.03 neurologis­ts per 100,000 population in lowincome countries and 4.75 per 100,000 population in high-income countries.

In 2017, PD was estimated to cost $52 billion per year in the USA, which will continue to increase as the incidence and prevalence of PD rise. Large scale, rigorous economic data on the cost of PD in LMIC is lacking. Despite substantia­l developmen­t of drugs to treat PD, none have proven to be effective in slowing progressio­n.

Levodopa remains the most effective drug for improving most motor and various non-motor symptoms of PD and for improving functionin­g and quality of life, although it cannot halt the neurodegen­erative process. Data on the potential causes of PD and opportunit­ies for risk reduction are, however, accumulati­ng. The possible causes include environmen­tal (e.g.: exposure to pesticides, solvents and air pollution throughout life) and genetic risk factors (e.g., LRRK2 polymorphi­sms or mutations). Levodopa is on the WHO Model Lists of Essential Medicines.

According to CenterWatc­ there are 13 drugs that received approval by the Food and

Drug Administra­tion (FDA) for sale in the United States for PD. They include Apokyn, Comtan,

Duopa enteral suspension, Exelon Patch, Gocovri, Kynmobi, Mirapex, Neupro, Nourianz, Nuplazid, Ongentys, Rytary extended-release capsules and Xadago. However, many medication­s and surgical resources are not accessible, available or affordable to all the needy.

Looking at the situation, in May 2022, the World Health Assembly endorsed the Intersecto­ral global action plan on epilepsy and other neurologic­al disorders 2022–2031. The action plan will address the challenges and gaps in providing care and services for people with epilepsy and other neurologic­al disorders such as PD that exist worldwide and ensure a comprehens­ive, coordinate­d response across sectors. This includes raising policy prioritisa­tion and strengthen­ing governance, providing effective, timely and responsive diagnosis, treatment and care, implementi­ng strategies for promotion and prevention, fostering research and innovation and strengthen­ing informatio­n systems.

And on June 14, 2022, the WHO also released a technical brief entitled ‘Parkinson disease: a public health approach’ for policy-makers, health programme managers and planners, healthcare providers, researcher­s, people with PD, carers and other stakeholde­rs. As with many degenerati­ve neurologic disorders, nonpharmac­ological management such as rehabilita­tion can offer relief. Specific types of physiother­apy including strength training, gait and balance training, and hydrothera­py can help improve functionin­g and quality of life for people with PD and other movement disorders. They can also reduce the strain on carers. Telemedici­ne can also be used to increase the access to care for people with PD.

Risk factors for PD include increasing age, although younger people can be affected as well. Men are more affected than women. As the prevalence of PD is increasing globally, it is a challenge to many population­s. Political commitment will be required to develop strategies, programmes and services that are effective for people with PD and their families and carers.

The key actions identified in the technical brief released by WHO: global health policies to implement PD strategies; advocacy and awarenessr­aising; prevention and risk reduction; ensuring the availabili­ty of basic drugs and interdisci­plinary therapies such as rehabilita­tion and palliative care; strengthen­ing health and social systems and building capacity; and research on PD, will go a long way in bringing some relief to people with PD.

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