Parkinson’s: ways to combat insomnia and difficulty walking – World

“Orthostatic hypotension” is one of the symptoms that explains the walking disability: if the person concerned sits up, their blood pressure drops and their brain is no longer supplied with sufficient blood. The patient faints after a few steps.

Parkinson’s disease and related pathologies are disorders of the nervous system. Patients no longer benefit from the reflex that normally ensures adequate blood flow to the brain.

electrodes in the spinal cord

A paper published in the New England Journal of Medicine (NEJM) in early April offers an innovative way to give advanced Parkinson’s patients hope for a little walking again. Electrodes are implanted in the spinal cord.
This experiment was supervised by the same researchers – surgeon Jocelyne Bloch and neuroscientist Grégoire Courtine – who recently got three people paralyzed after accidents walking again. These results, published in early 2022, marked the culmination of ten years of research.

Restore the reflex that allows the blood to arrive properly in the brain

This time, a similar technology was used on a severely disabled patient. Strictly speaking, she did not suffer from Parkinson’s disease, but from a pathology with similar symptoms, including orthostatic hypotension. In the case of injured paralytics, the electrode system should restore the connection through which the brain controls the gesture. Here the objective is to restore the reflex that allows a good arrival of the blood in the brain.

Prior to the implantation of this system, the patient would only walk a few meters before passing out. Three months later, she was able to walk more than 250 meters with the help of a walker, according to the report of this work, led by researcher Jordan Squair. “She’s not cured, she wouldn’t run a marathon, but this operation has significantly improved her quality of life,” says Jocelyne Bloch.

An experience to be repeated

However, this is only an isolated case and it will be necessary to repeat the experience with other people in order to consider a therapeutic use, especially in Parkinson’s patients. In the case of the latter, however, it is not certain whether this form of hypotension can be improved by simply stimulating the reflex concerned.

Another scourge for Parkinson’s sufferers: insomnia. Sleep disturbances are common during the illness. The causes are manifold. Sometimes the patient is simply anxious because of the illness, or he is awakened by uncontrolled movements. Finally, his sleep can be directly affected by the lack of dopamine, the hormone whose progressive disappearance explains Parkinson’s disease.

Insomnia: a pump for administering apomorphine

Therefore, treatments for insomnia, including melatonin, may not be the same for all Parkinson’s patients. But a study published this Thursday in the Lancet Neurology offers a promising lead: using a pump to deliver a drug, apomorphine. This is the same system some diabetics use to continuously inject insulin.
But the study, led by neurologist Emmanuel Flamand-Roze and his colleague Valérie Cochen de Cock, looked at using the pump only at night. “So there is no need to wear a small pump during the day,” he explains.

Encouraging results

The results are quite encouraging. Compared to patients who received a placebo, patients who benefited from this device reported a more significant improvement in their sleep.
However, the study was only conducted on a small sample — about forty participants — meaning more extensive work needs to be done to confirm the device’s effectiveness. In addition, it focused on patients who were already at an advanced stage.
“It’s more people who have been evolving for about ten years,” specifies Emmanuel Flamand-Roze, who had already obtained initial encouraging results regarding the interest of this pump in other aspects of the treatment of Parkinson’s disease.

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