“Orthostatic hypotension” is one of the symptoms that explains the difficulty in walking: when the person sits down, their blood pressure drops and their brain is no longer fed enough. The patient passes out after a few steps.
In the case of Parkinson’s disease and related pathologies, it is a dysfunction of the nervous system. Patients no longer benefit from the reflex that normally ensures the return of sufficient blood flow to the brain.
Electrodes on the spinal cord
Published at the beginning of April in the New England Journal of Medicine (NEJM), a study opens an innovative way to restore the hope of walking a little to patients with advanced Parkinson’s. This involves implanting electrodes into the spinal cord.
This experiment was overseen by the same researchers, surgeon Jocelyne Bloch and neuroscientist Grégoire Courtine, who recently made three people paralyzed after an accident walk again. These results, published in early 2022, marked the culmination of ten years of research.
Restore the reflex that allows the good arrival of blood to the brain
This time, similar technology was used on a severely disabled patient. Strictly speaking, she did not suffer from Parkinson’s disease but rather a pathology with similar symptoms, including orthostatic hypotension. In the case of injured paralytics, the electrode system was intended to restore the link by which the brain controls gesture. Here, the goal is to restore the reflex that allows good blood flow to the brain.
Before this system was implanted, the patient only walked a few meters before passing out. Three months later, he 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, in fact, it is not certain that this form of hypotension can be improved by simply stimulating the reflex in question.
Another scourge that plagues Parkinson’s patients: insomnia. Difficulty sleeping is common during illness. The causes are multiple. The patient is sometimes simply anxious about the illness, or may be aroused by uncontrolled movements. Finally, your sleep can be directly affected by a lack of dopamine, the hormone whose progressive disappearance explains Parkinson’s disease.
Insomnia: a pump to administer apomorphine
Therefore, treatments for insomnia, including melatonin, may not be the same for all Parkinson’s patients. But a study published Thursday in the Lancet Neurology gives a promising clue: the use of a pump to deliver a drug, apomorphine. This is the same system that some diabetics use to continuously inject insulin.
But the study, led by neurologist Emmanuel Flamand-Roze and led by colleague Valérie Cochen de Cock, looked at pump use only at night. “So the restriction associated with using a small pump doesn’t exist during the day,” she explains.
The results are quite encouraging. Compared to patients who received a placebo, patients who benefited 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 means that more extensive work needs to be done to confirm the effectiveness of the device. In addition, it focused on patients in an already advanced stage.
“There are more people who have been evolving for about ten years,” specifies Emmanuel Flamand-Roze, who had already obtained encouraging initial results regarding the interest of this pump in other aspects of the treatment of Parkinson’s disease.