Medicine ‘pump’ could help Parkinson’s patients

By Paul Ricard
Agence France-Presse

PARIS — People suffering from advanced Parkinson’s disease could benefit long-term from continuous delivery of medication through a device similar to an insulin pump, a recent French study found.

Published in Nature Partner Journals with the Parkinson’s Foundation, the real-world observational study followed 110 patients being treated at the Pitie-Salpetriere hospital in Paris.

The second most common neurodegenerative disease after Alzheimer’s, Parkinson’s is sometimes treated with the medication apomorphine to lessen symptoms such as shaking, stiffness or slowness of movement.

It helps replace the dopamine typically lacking in Parkinson’s patients, but taken orally it can cause dopamine to spike and then drop, leading to dyskinesia or muscle spasms.

“For those patients, continuous delivery is a good option,” study co-author and neurologist Emmanuel Flamand-Roze told AFP.

A randomised, placebo-controlled study of Parkinson’s patients in 23 European hospitals already found in 2018 that medication administered using the device reduced “off-time” — the period when symptoms worsen as medication wears off.

Flamand-Roze said his real-world observational study provided an essential compliment to the randomised trial, which looked at patients over a period of 12 weeks. 

“Our study is carried out through observations of patients in the real world — some of them are over 80 years old,” he said. 

“The first study provided proof to the scientific community, but it doesn’t look at whether it works in practice and over the long term.”

Over the two-year period of the study roughly a third of patients discontinued treatment. 

But for those who saw it through “health-related quality of life remained stable with a sustained reduction in motor fluctuations”, the study found. 

More ‘natural’ delivery

Flamand-Roze compares the device to an insulin pump — about the size of a pager, it is worn on the body and regulates delivery of insulin via a small tube inserted under the skin.

It can be worn around the clock or just during the day, in a pocket, on a belt or around the neck, and automatically regulates drug delivery.

“With diabetes, sugar is too high and we lower it,” he said. “With Parkinson’s it’s dopamine that’s too low and we administer an equivalent continuously.”

“You’re much closer to what goes on naturally,” he added.

Flamand-Roze said only half of people who could benefit from this treatment — those who have suffered Parkinson’s for 10 years or so — currently do.

He estimated that those people could make up as much as 5 per cent of Parkinson’s patients.

The study found the treatment was effective at stabilising symptoms in patients who suffered movement fluctuations prior to starting the treatment.

“It’s a great result for a degenerative disease because over two years at an advanced stage you would expect symptoms to worsen,” said Flamand-Roze. 

He noted however that the treatment had its limits.

“It doesn’t slow the progression of the disease, it only treats the symptoms,” he said. 

As Parkinson’s progresses it can increasingly affect movement and cognition and even lead to dementia. 

The Parkinson’s Foundation estimates some 10 million people suffer from the disease worldwide.

Flamand-Roze said two similar studies were currently underway in France. One looks at whether the pump could improve sleep in patients; the other at whether it could be useful to patients in the earlier stages of the disease.