MDS 2022 | Highlights from MDS: multidisciplinary teams, fluctuations & DBS
Francisco Cardoso, MD, PhD, FAAN, The Federal University of Minas Gerais, Belo Horizonte, Brazil, and President of the International Parkinson and Movement Disorder Society (MDS), shares the key news and updates from this year’s MDS Congress, which showcased high-quality research in the field. The meeting’s program included several sessions highlighting the need to create multidisciplinary teams in Parkinson’s disease (PD) care. Various PD-related complications, such as speech and gait problems, are resistant to medication or surgery, where speech therapy and physical therapy offer remarkable improvements. Another critical area of focus during the International MDS Congress was the recognition and management of levodopa-induced motor and non-motor fluctuations, with data being presented on novel levodopa delivery strategies. Finally, promising advances in deep brain stimulation (DBS) were also highlighted during the meeting. This interview took place at the 2022 International Congress of Parkinson’s Disease and Movement Disorders in Madrid, Spain.
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Transcript (edited for clarity)
Being the President of the organization and along with the chair of the Scientific Organizing Committee, who happens to be my dear friend and colleague, Dr Steve Frucht from New York, so we have had access to the entire program. Actually, we designed the program and also to the abstracts. I can assure you that we are pleasantly surprised by the high quality of the scientific material that is being presented here, to the point that other organizations, they are requesting permission for presenting in their future meeting some of the material that is shown here...
Being the President of the organization and along with the chair of the Scientific Organizing Committee, who happens to be my dear friend and colleague, Dr Steve Frucht from New York, so we have had access to the entire program. Actually, we designed the program and also to the abstracts. I can assure you that we are pleasantly surprised by the high quality of the scientific material that is being presented here, to the point that other organizations, they are requesting permission for presenting in their future meeting some of the material that is shown here.
So, that means that we are really the premier organization. I’m very proud to say that in terms of as Forum for Movement Disorder, but I could highlight some interesting points. Let’s get started then first with nonphysician-based approach. So, there are several sessions here, which will discuss how we can actually engage different allied health professionals in creating a multidisciplinary team because there are some problems. Let’s take the example of Parkinson’s disease, which are not really solvable or improved by medications or surgical procedures and so on. So, there are some specific problems, and I can speak, I can say for instance, speech problems. They are very much resistant to what we physicians offer.
In contrast, speech therapy can be very helpful. Gait problems, which are a major source of problems, disability to people with PD, they start tripping over, falling. This can be improved by physical therapy techniques and so on. So, there is a lot of emphasis on the creation of these multidisciplinary teams, and we have evidence being presented here.
Second point now, coming more to the medical aspect, and again, taking Parkinson’s disease as really the prototype of the problem we deal with. The disease is characterized by a low level of dopamine, and we are capable of replacing this dopamine with tablets. However, as time goes by, it is not the case that the tablets stop working, but the patients develop some sudden changes in the manner that the brain reacts to these medications. These can be extremely disabled, and fluctuations, sometimes, they are on. Others, they are off. When they are on, occasionally, they will have excessive unwanted involuntary movements.
If we have a way of really controlling completely or at least partially these complications of the medical treatment, the quality of life of people improve very much. One of the really key areas right now is they use, not of oral levodopa but infusions. So, there is a lot of place for infusions. Some of them, they are already available. They are perhaps a bit complex because they require the placement of a feeding tube directly into the intestine and so on, but there is new exciting data showing that subcutaneous infusion with small pumps can be very, very helpful. So, it’s quite likely that before we have some really effective treatment to prevent Parkinson’s disease or even to slow down the progression, that these improvements in the way of providing levodopa and dopamine will be quite important.
Finally, my last comment regarding these new developments, there is a new generation of ways of doing deep brain stimulation, which is a technique that rather than using a chemical way of trying to improve the brain function, it’s an electric. So, it’s essentially a pacemaker. Most people are familiar with that by now. That is it’s a pacemaker with an electrode deep in the brain. So, there are new advances in this area that seem quite promising in terms of improving a treatment, which is already, on its own right now, quite effective for a group of patients.
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