Comparative efficacy of surgical approaches to disease modification in Parkinson disease
Abstract Parkinson’s disease (PD) may optimally be treated with a disease-modifying therapy to slow progression. We compare data underlying surgical approaches proposed to impart disease modification in PD: (1) cell transplantation therapy with stem cell-derived dopaminergic neurons to replace damag...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Nature Portfolio
2022-03-01
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| Series: | npj Parkinson's Disease |
| Online Access: | https://doi.org/10.1038/s41531-022-00296-w |
| _version_ | 1797427913282289664 |
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| author | Shervin Rahimpour Su-Chun Zhang Jerrold L. Vitek Kyle T. Mitchell Dennis A. Turner |
| author_facet | Shervin Rahimpour Su-Chun Zhang Jerrold L. Vitek Kyle T. Mitchell Dennis A. Turner |
| author_sort | Shervin Rahimpour |
| collection | DOAJ |
| description | Abstract Parkinson’s disease (PD) may optimally be treated with a disease-modifying therapy to slow progression. We compare data underlying surgical approaches proposed to impart disease modification in PD: (1) cell transplantation therapy with stem cell-derived dopaminergic neurons to replace damaged cells; (2) clinical trials of growth factors to promote survival of existing dopaminergic neurons; (3) subthalamic nucleus deep brain stimulation early in the course of PD; and (4) abdominal vagotomy to lower risk of potential disease spread from gut to brain. Though targeted to engage potential mechanisms of PD these surgical approaches remain experimental, indicating the difficulty in translating therapeutic concepts into clinical practice. The choice of outcome measures to assess disease modification separate from the symptomatic benefit will be critical to evaluate the effect of the disease-modifying intervention on long-term disease burden, including imaging studies and clinical rating scales, i.e., Unified Parkinson Disease Rating Scale. Therapeutic interventions will require long follow-up times (i.e., 5–10 years) to analyze disease modification compared to symptomatic treatments. The promise of invasive, surgical treatments to achieve disease modification through mechanistic approaches has been constrained by the reality of translating these concepts into effective clinical trials. |
| first_indexed | 2024-03-09T08:51:41Z |
| format | Article |
| id | doaj.art-fb91da2a1eee42928b8c6d43c1fb7ecd |
| institution | Directory Open Access Journal |
| issn | 2373-8057 |
| language | English |
| last_indexed | 2024-03-09T08:51:41Z |
| publishDate | 2022-03-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | npj Parkinson's Disease |
| spelling | doaj.art-fb91da2a1eee42928b8c6d43c1fb7ecd2023-12-02T14:25:49ZengNature Portfolionpj Parkinson's Disease2373-80572022-03-01811610.1038/s41531-022-00296-wComparative efficacy of surgical approaches to disease modification in Parkinson diseaseShervin Rahimpour0Su-Chun Zhang1Jerrold L. Vitek2Kyle T. Mitchell3Dennis A. Turner4Department of Neurosurgery, Clinical Neuroscience Center, University of UtahWaisman Center and Departments of Neuroscience and Neurology, University of Wisconsin-MadisonDepartment of Neurology, University of MinnesotaDepartment of Neurology, Duke UniversityDepartment of Neurosurgery, Duke UniversityAbstract Parkinson’s disease (PD) may optimally be treated with a disease-modifying therapy to slow progression. We compare data underlying surgical approaches proposed to impart disease modification in PD: (1) cell transplantation therapy with stem cell-derived dopaminergic neurons to replace damaged cells; (2) clinical trials of growth factors to promote survival of existing dopaminergic neurons; (3) subthalamic nucleus deep brain stimulation early in the course of PD; and (4) abdominal vagotomy to lower risk of potential disease spread from gut to brain. Though targeted to engage potential mechanisms of PD these surgical approaches remain experimental, indicating the difficulty in translating therapeutic concepts into clinical practice. The choice of outcome measures to assess disease modification separate from the symptomatic benefit will be critical to evaluate the effect of the disease-modifying intervention on long-term disease burden, including imaging studies and clinical rating scales, i.e., Unified Parkinson Disease Rating Scale. Therapeutic interventions will require long follow-up times (i.e., 5–10 years) to analyze disease modification compared to symptomatic treatments. The promise of invasive, surgical treatments to achieve disease modification through mechanistic approaches has been constrained by the reality of translating these concepts into effective clinical trials.https://doi.org/10.1038/s41531-022-00296-w |
| spellingShingle | Shervin Rahimpour Su-Chun Zhang Jerrold L. Vitek Kyle T. Mitchell Dennis A. Turner Comparative efficacy of surgical approaches to disease modification in Parkinson disease npj Parkinson's Disease |
| title | Comparative efficacy of surgical approaches to disease modification in Parkinson disease |
| title_full | Comparative efficacy of surgical approaches to disease modification in Parkinson disease |
| title_fullStr | Comparative efficacy of surgical approaches to disease modification in Parkinson disease |
| title_full_unstemmed | Comparative efficacy of surgical approaches to disease modification in Parkinson disease |
| title_short | Comparative efficacy of surgical approaches to disease modification in Parkinson disease |
| title_sort | comparative efficacy of surgical approaches to disease modification in parkinson disease |
| url | https://doi.org/10.1038/s41531-022-00296-w |
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