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

“Orthostatic hypotension” is one of the symptoms that explains the difficulty of walking: when the person sits up, his blood pressure drops and his brain is no longer fed enough. The patient faints after a few steps.

In the case of Parkinson’s disease and related pathologies, it is a dysfunction of the nervous system that is involved. Patients no longer benefit from the reflex which normally ensures the return of sufficient blood flow to the brain.

Electrodes in the spinal cord

Published in early April in the New England Journal of Medicine (NEJM), a work opens an innovative avenue to restore hope of a little walking to advanced Parkinson’s patients. This involves implanting electrodes in the spinal cord.
This experiment was supervised by the same researchers – surgeon Jocelyne Bloch and neuroscientist Grégoire Courtine – who recently made three people paralyzed following accidents walk again. These results, published in early 2022, marked the culmination of ten years of research.

Restore the reflex which allows the good arrival of blood in the brain

This time, similar technology was used in a severely disabled patient. Strictly speaking, she was not suffering from Parkinson’s disease but from a pathology with similar symptoms, including orthostatic hypotension. In the case of injured paralytics, the electrode system aimed to restore the link by which the brain controls the gesture. Here, the goal is to restore the reflex which allows the good arrival of blood in the brain.

Before having this system implanted, the patient only walked a few meters before fainting. Three months later, she could walk more than 250 meters with the help of a walker, according to the report of this work led by researcher Jordan Squair. “She is not cured, she would not run a marathon, but this surgery has clearly improved her quality of life”, summarizes Jocelyne Bloch.

An experience to repeat

However, this is only an isolated case and it will be necessary to repeat the experience with other people to consider a therapeutic use, in particular with Parkinson’s patients. In the latter, it is indeed not certain that this form of hypotension can be improved by simple stimulation of the reflex in question.

Another scourge to strike Parkinson’s sufferers: insomnia. Difficulty sleeping is common during the disease. The causes are multiple. The patient is sometimes simply anxious because of the disease, or he may be 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 to administer apomorphine

Treatments for insomnia, including melatonin, cannot therefore be the same for all Parkinson’s patients. But a study published this Thursday in the Lancet Neurology gives a promising lead: using a pump to administer a drug, apomorphine. This is the same system that some diabetics use to inject insulin continuously.
But the study, led by neurologist Emmanuel Flamand-Roze and led by his colleague Valérie Cochen de Cock, looked at the fact of only using the pump at night. “Thus, the constraint linked to wearing a small pump does not exist during the day,” he explains.

Encouraging results

The results are quite encouraging. Compared to patients who received a placebo, patients benefiting from this device reported a more marked improvement in their sleep.
However, the study was only carried out on a small sample – around forty participants -, which requires carrying out broader work to confirm the effectiveness of the device. Moreover, it focused on patients at an already 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 as to the interest of this pump in other aspects of the treatment of the disease of Parkinsons.

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