A Biomarker Breakthrough Could Improve Parkinson's Treatment
 

This is great news if further studies confirm this. I've thought for years that we need accurate ways to track disease progression AND whether or not treatments/drugs really help! This will eliminate the large placebo effect and likely will accelerate treatment studies!

The referenced research uses "functional magnetic resonance imaging to reveal areas where Parkinson's disease and related conditions cause progressive decline in brain activity".

The ability to "see" what is happening in the brain is enormously useful in understanding the pathogenesis of the disease. But, I am skeptical about its usefulness as a biomarker: it has high cost; it is hospital based, forcing the patient to go to travel; observations are likely to be infrequent; and most importantly the measure that comes from this imaging, perhaps size of the affected area, is a proxy for the real impact of the disease, which is reflected in the symptoms.

In my opinion, a better way forward is to measure the symptoms of the disease. This can be done objectively, with high frequency (perhaps every second) and as the patient goes about his life. One way to do this is to use accelerometers to measure movements of the body.

On the issue of the placebo effect. I understand that in Parkinson's the placebo effect is more than just the perception that a therapy improves the condition. Rather, it is a stronger effect: as measured externally and objectively, it does improve the condition, and not just the perception of it. Some would argue that a placebo is effective for a shorter period than a "true" therapy. In my opinion, a placebo is as much a true therapy as a drug. It needs to be engineered, measured and judged against more conventional therapies. Fortunately, it is not the case that we can only have an organic effect or a placebo effect, the best therapies will have both.

John

I agree entirely John, it is a similar situation with paradoxical kinesia . It fascinates me that Nigel the clumsy PWP knocks a glass out of the cupboard due to bradykinesia/rigidity and then catches it mid air like a Ninja . Both the placebo effect and paradoxical kinesia point to an 'in house' disease modifying ability, however brief, which is unidentified, largely ignored and could I believe possibly be of great importance.

I vaguely recall reading about a neuro in the uk who is looking into paradoxical kinesia after watching one of his Px's shuffle across the road,slow and stooped only to take off like a bullet to avoid an ambulance racing to casualty. I believe he thought it was something to do with acetylcholine.

On the subject of measuring/monitoring progression to provide effective treatment again I agree. If I'm struggling with my gait or losing confidence in my ability to perform daily tasks then I know, as does my neuro, who observes my level of ability and makes med. change suggestions. I fail to see what having a scan can bring to the party......unless it says ' everything looks normal ' which would upset the apple cart !

There are cases of Dat scan results which show a normal picture yet the subject presents in a classical Parkinsonian manner.
User error or another indication that at least some PD subset types may be due to other additional neurotransmitter involvement ?

Nigel