Comment From Mary K: If my mother had Parkinson’s, what's the chance I'll get it?
Fiske: Thanks for asking, Mary; this is an important question.
About 10 to 20 percent of people with Parkinson's report a family history of Parkinson's, but we can only associate less than 10 percent of cases with a specific gene that might cause PD.
There is some evidence that people with a parent or sibling with Parkinson's may be at an increased risk. However there is no clear genetic test for most cases of Parkinson's.
In some cases, like in certain ethnic groups and in young onset cases of Parkinson's, genetic testing has been suggested. But we do not have clear genetic links to the vast majority of Parkinson's disease cases.
Comment From Élan: Are there any known alternative medicines or treatments that are effective for PD?
Facheris: Currently we can treat the motor symptoms of Parkinson's with drugs that replace lost dopamine in the brain. Dopamine is the brain chemical most affected in Parkinson's.
Over time and with continued use, the efficacy of these drugs diminishes over time and can cause side effects.
Eventually some individuals can be candidates for surgical therapies, such as deep brain stimulation and intestinal delivery of levodopa.
There are some alternative ways people with Parkinson's can improve their symptoms.
For example, exercise is always good. It's important that you do something that you enjoy and will stick with.
A complete diet is important, but timing meals and medication can sometimes help alleviate complications.
Comment From Robert: What are the prospects of a treatment beyond what is available today?
Fiske: The drug development pipeline for Parkinson's disease has never been better. There are a lot of treatments in development that are looking to improve how we can deliver dopamine. We're also looking at other brain chemicals that might be able to impact the symptoms of Parkinson's, such as glutamate.
We're also pushing hard on drugs that could treat some of the nonmotor symptoms of Parkinson's, things like cognitive impairment, swallowing problems and constipation.
Although genetics only explains a small number of cases, the genetics of Parkinson's is also pointing us to drug targets that could potentially benefit all patients by altering the actual disease course. For example, LRRK2 and alpha-synuclein are two gene targets that many companies are developing therapies against.