I recently read an interesting approach to treating Parkinson, it did not involve any drugs, and it's a natural resource we have in long supply: compensatory mechanisms and our reserve endogenous dopamine. Imagine if researchers took a different perspective? Instead of filling the half full glass, they worked on taking the good still in the glass and working with it? I started thinking in terms of how great an improvement Imad has made...and then I thought of Ron....Max...Fiona...Nan. What they all share in common is that they seem to have tapped into their systems natural ability to heal and in the process enhanced their remaining compensatory ability to restore the balance we felt when health.
Two key articles out there are saying the same thing. Our brains are so plastic that we might be able to manipulate it at the molecular level to ease symptoms of the disease on our own for longer than we do now. The fact that we get such a long run on compensation is amazing in and of itself! It takes PD on average 15 years or longer in YO to degenerate to the point of cardinal signs, so that means the disease is fairly silent for quite some time save for the non-motor autonomic nervous system signs being named as potential biomarkers. However, researchers agree that our neurons take their largest blow within the first few years of insult or pathogenesis, so that 15 years later we present with a tremor. So, bang! right away we lose close to 80% or our neurons...yet we remain asymptomatic. This is compensatory mechanism. Our brain picks up the slack and our bodies follow suit. It is a natural symptom control, and motor symptoms emerge only after we start to lose our ability to compensate.
Further supporting the importance of compensation is the fact that those with YOPD lose many more neurons right off the cuff, in late onset less is loss. Yet, there is no correlation between amount of neuronal loss and symptom or disease severity. There is no real linear path in PD. Our symptom severity can seemingly fluctuate by the hour.
These researchers are suggesting two novel things here and suggesting a 180 in how we treat this disorder: 1) use and enhance our innate ability to compensate 2) not all of our neurons are dying; many may just be held hostage as dysfunctional. So let's focus on the good ones we have left and try to revive the others! Forget about the lost. Personally, I think this is why GDNF was so remarkable in reversing symptoms.
They are hypothesizing, and I believe that some of us are living it out now. It has been suggested by one author that at the very least to stimulate our remaining dopamine stores and to enhance function, we should look to as a foundation for all treatment a hypocaloric diet and exercise as a way to nourish compensatory ability and in regenerating any remaining healthy neurons.
A global view of Parkinson's disease pathogenesis: Implications for natural history and neuroprotection Parkinsonism & Related Disorders
Just what are some of the compensations...
The MPTP (N-methyl-4-phenyl-1,2,3,6-tetrahydropyridine) monkey model of PD has contributed to gaining insight into compensatory mechanisms. The most relevant ones are the increase in D2-receptor binding at the striatal level, the increase in the expression and activity of encephalin, the overactivity of the subthalamic nucleus (STN) and internal globus pallidus (Gpi) and the increase in the activity of some premotor cortical regions [19].
A network dysfunction perspective on neurodegenerative diseases.
Nature. Oct 2006 Palop, et al.