Most people know about Parkinson’s disease (PD) either because someone they love has it or they’ve watched people like Michael J. Fox and Muhammad Ali valiantly fight it while raising awareness. The details of the disease aren’t as well known, but they should be. The American Parkinson Disease Association estimates that 1 million Americans are living with Parkinson’s, and 10 million are affected worldwide. Understanding Parkinson’s helps raise awareness and support patients with PD.
As medical science evolves, advancements in Parkinson’s disease treatment have improved quality of life for those who have it. There is a new treatment option that shows promise: transcranial magnetic stimulation (TMS). Before understanding what makes this new treatment promising, it’s important to know Parkinson’s symptoms and how it’s currently treated.
Parkinson’s Disease Symptoms
The death of brain cells in the basal ganglia causes the symptoms of PD. This part of the brain is located at the top of the spinal cord, and turns thoughts into movement. Patients with Parkinson’s also have reduced dopamine in the brain. Dopamine is known as the “feel-good hormone.”
Signs and symptoms develop slowly, but at its core, PD is a movement disorder of the nervous system. It causes motor symptoms, such as tremors (involuntary movements) and bradykinesia (slowness of the body).
- Small handwriting
- Trouble sleeping
- Loss of smell
- Dizziness and fainting
- Having a “hunched-over” posture
The Unified Parkinson’s Disease Rating Scale (UPDRS) tracks a wide range of symptoms to reveal a UPDRS score. There are different stages of Parkinson’s disease, ranging from mild and barely noticeable to being bedridden. A movement disorder specialist is best suited to diagnose Parkinson’s disease. If you think you or someone you love might have it, the Parkinson’s Foundation website has a provider search resource.
Parkinson’s Disease Treatments
The frontline method to treating PD is the medication levodopa. This medication helps bring dopamine levels into balance. The response to levodopa is generally successful, but doctors may prescribe other medicines such as dopamine agonists and monoamine oxidase inhibitors.
As the disease progresses, deep brain stimulation (DBS) becomes a second line of treatment for patients with Parkinson’s. DBS is a surgical option that implants electrodes into the brain that stimulate the subthalamic nucelus and globus palladius. This treatment of stimulation for Parkinson’s disease has been shown to result in motor improvements on the UPDRS iii rating scale. Motor UPDRS scores can show enough improvement to reduce medication doses. Clinical trials are currently underway with a controlled study to determine if DBS can be used at the early stages of PD.
TMS for Parkinson’s Disease
DBS can be a life-changing procedure for many, but it’s invasive. Patients have electrodes implanted in their brains and a battery like a pacemaker installed in the abdomen.
Repetitive TMS (transcranial magnetic stimulation) is non-invasive. And it’s FDA-approved to treat mental health disorders like depression and OCD. It is nothing like electroconvulsive therapy. When you come in for a TMS session, you’ll sit comfortably as a magnetic coil placed gently on your head stimulates the dorsolateral prefrontal cortex of your brain. This creates a chain reaction that helps regrow neuronal connections and “wake up” parts of the brain that have become underactive. Clinical studies are happening to see if TMS can become an effective brain stimulation treatment for Parkinson’s along the lines of DBS, but without a surgical procedure.
One such study was conducted by Dr. Biagioni at the Marlene and Paolo Fresco Institute for Parkinson’s and Movement Disorders at NYU Langone Health. In this controlled study, a group of Parkinson’s disease patients completed aerobic exercise, and some in that group were given TMS. (Others had sham stimulation.) Aerobic exercise and TMS both produce brain derived neurotrophic factor (BDNF) signaling in the brain. Researchers wanted to see what would happen if both treatments were used together. BDNF is a protein in the brain that promotes neuron growth and prevents neurons from dying. Exercise and antidepressants (including TMS) work in part by increasing BDNF. The study showed a sustained improvement over the first month for the patients who received TMS, compared to exercise alone.
Many patients with depression and OCD benefit from maintenance TMS. The same could be needed for Parkinson’s disease patients. NYU Langone Health continues to conduct these clinical studies to collect better data. Hopefully, they’ll develop a protocol that’s a new tool for doctors to treat Parkinson’s.
Treating Comorbid Depression in Parkinson’s Disease
Some estimates say half of Parkinson’s disease patients suffer from clinical depression. This is often treated with antidepressant medications, but TMS could be an excellent alternative because:
- It has none of the side effects associated with antidepressants, such as:
- Sexual dysfunction
- Weight gain
- Studies show TMS has significantly higher rates of response and remission compared to antidepressant medication.
TMS is not yet FDA-approved for treating Parkinson’s, but it does have full approval for depression treatment. This means if you have a major depression diagnosis to go along with Parkinson’s, insurance is likely to cover TMS (with certain qualifiers).
HPR Treatment Centers is a nationwide provider of transcranial magnetic stimulation. To find out if TMS is right for you, visit hprtc.com, or call at 1-800-688-3609. We’re happy to help you with insurance approval and get you started on treatments as soon as you’re ready.