Clinical Movement Disorders Fellowship - Dr. Ariel Levy, Clinical Fellow - Smoothing the course of Parkinson’s medication
Dr. Ariel Levy, Clinical Fellow
People with Parkinson’s disease who have been taking the main drug treatment prescribed to relieve their symptoms often experience a roller coaster ride in terms of the way their body responds.
Levodopa-carbidopa, the medication used to relieve the tremors, shuffling and stiffness of Parkinson’s disease, compensates for drops in the amount of dopamine, a neurotransmitter or signaling chemical that occurs naturally in the brain. But when taken in conventional pill form, the drug can’t compensate, over time, for the continuing decrease in dopamine that occurs in the brain.
As a result, the amount of levodopa each pill releases generates a sharp spike in dopamine levels, eventually followed by another drop. This instability results in fluctuations in the symptoms of Parkinson’s that people experience.
“It’s very difficult,” says Ariel Levy, a clinical fellow at the Movement Disorders Clinic at Toronto Western Hospital. “You get the side effects of having too much medication and the side effects of too little medication.”
Levy, a neurologist, is studying ways to alleviate this drug-fuelled roller coaster ride. His research is focused on a new pump that delivers levodopa-carbidopa in a gel form, directly into the intestinal tract. The pump ensures a continuous, stable dose of medicine that goes directly where the body will absorb it best.
This pump is an important innovation, Levy says, because the changes people experience at advanced stages of Parkinson’s have received comparatively little attention from researchers.
Levy hopes a stable dose of the medication will also alleviate some of the non-motor symptoms of Parkinson’s, such as sleep disturbances, memory problems, incontinence and digestive difficulties.
Levy’s work is part of a 26-week study on the performance of this intestinal gel and the design of the gel pump, which is comparatively large for patients to carry around and challenging for clinicians to program. His work will help the manufacturer of this technology refine the design. Levy also hopes to identify the type of person most likely to benefit from using the pump.
Although it remains important to diagnose Parkinson’s as early as possible so treatment has the best chance of slowing the disease, Levy underscores the need to establish effective strategies for dealing with later stages of Parkinson’s as well.
“We need to assess these changes as the disease proceeds so as to retain the best quality of life for these patients,” he says.