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Stocchi F, Bravi D, Emmi A, Antonini A. Parkinson disease therapy: current strategies and future research priorities. Nat Rev Neurol 2024; 20:695-707. [PMID: 39496848 DOI: 10.1038/s41582-024-01034-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2024] [Indexed: 11/06/2024]
Abstract
Parkinson disease (PD) is the fastest growing neurological disorder globally and poses substantial management challenges owing to progressive disability, emergence of levodopa-resistant symptoms, and treatment-related complications. In this Review, we examine the current state of research into PD therapies and outline future priorities for advancing our understanding and treatment of the disease. We identify two main research priorities for the coming years: first, slowing the progression of the disease through the integration of sensitive biomarkers and targeted biological therapies, and second, enhancing existing symptomatic treatments, encompassing surgical and infusion therapies, with the goal of postponing complications and improving long-term patient management. The path towards disease modification is impeded by the multifaceted pathophysiology and diverse mechanisms underlying PD. Ongoing studies are directed at α-synuclein aggregation, complemented by efforts to address specific pathways associated with the less common genetic forms of the disease. The success of these efforts relies on establishing robust end points, incorporating technology, and identifying reliable biomarkers for early diagnosis and continuous monitoring of disease progression. In the context of symptomatic treatment, the focus should shift towards refining existing approaches and fostering the development of novel therapeutic strategies that target levodopa-resistant symptoms and clinical manifestations that substantially impair quality of life.
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Affiliation(s)
- Fabrizio Stocchi
- Department of Neurology, University San Raffaele, Rome, Italy.
- Deptartment of Neurology, Institute for Research and Medical Care, IRCCS San Raffaele, Rome, Italy.
| | - Daniele Bravi
- Deptartment of Neurology, Institute for Research and Medical Care, IRCCS San Raffaele, Rome, Italy
| | - Aron Emmi
- Center for Neurodegenerative Diseases (CESNE), Department of Neuroscience, University of Padova, Padova, Italy
- Institute of Human Anatomy, Department of Neuroscience, University of Padova, Padova, Italy
| | - Angelo Antonini
- Center for Neurodegenerative Diseases (CESNE), Department of Neuroscience, University of Padova, Padova, Italy
- Parkinson and Movement Disorders Unit, Centre for Rare Neurological Diseases (ERN-RND), Department of Neuroscience, Padua Neuroscience Center (PNC), University of Padova, Padova, Italy
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Pennington KR, Debs L, Chung S, Bava J, Garin CM, Vale FL, Bick SK, Englot DJ, Terry AV, Constantinidis C, Blake DT. Basal forebrain activation improves working memory in senescent monkeys. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.01.582925. [PMID: 39574741 PMCID: PMC11580932 DOI: 10.1101/2024.03.01.582925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2024]
Abstract
Brain aging contributes to cognitive decline and risk of dementia. Degeneration of the basal forebrain cholinergic system parallels these changes in aging, Alzheimer's dementia, Parkinson's dementia, and Lewy body dementia, and thus is a common element linked to executive function across the lifespan and in disease states. Here, we tested the potential of one-hour daily intermittent basal forebrain stimulation to improve cognition in senescent monkeys, and its mechanisms of action. Stimulation in five animals improved working memory duration in 8-12 weeks across all animals, with peak improvements observed in the first four weeks. In an ensuing three month period without stimulation, improvements were retained. With additional stimulation, performance remained above baseline throughout the 15 months of the study. Studies with a cholinesterase inhibitor produced inconsistent improvements in behavior. One of five animals improved significantly. Manipulating the stimulation pattern demonstrated selectivity for both stimulation and recovery period duration. Brain stimulation led to acute increases in cerebrospinal levels of tissue plasminogen activator, which is an activating element for two brain neurotrophins, Nerve Growth Factor (NGF) and Brain-Derived Growth Factor (BDNF). Stimulation also led to improved glucose utilization in stimulated hemispheres relative to contralateral. Glucose utilization also consistently declines with aging and some dementias. Together, these findings suggest that intermittent stimulation of the nucleus basalis of Meynert improves executive function and reverses some aspects of brain aging.
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Affiliation(s)
- Kendyl R Pennington
- Dept Neuroscience and Regenerative Medicine, Medical College of Georgia, Augusta University, Augusta, GA
| | - Luca Debs
- Dept Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA
| | - Sophia Chung
- Neuroscience Program, Vanderbilt University, Nashville, TN 37235
| | - Janki Bava
- Dept Biomedical Engineering, Vanderbilt University, Nashville, TN 37235
| | - Clément M Garin
- Dept Biomedical Engineering, Vanderbilt University, Nashville, TN 37235
| | - Fernando L Vale
- Dept Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA
| | - Sarah K Bick
- Dept Biomedical Engineering, Vanderbilt University, Nashville, TN 37235
- Dept Neurosurgery, Vanderbilt University, Nashville TN
| | - Dario J Englot
- Dept Biomedical Engineering, Vanderbilt University, Nashville, TN 37235
- Dept Neurosurgery, Vanderbilt University, Nashville TN
| | - Alvin V Terry
- Dept Pharmacology and Toxicology, Medical College of Georgia, Augusta University, Augusta, GA
| | - Christos Constantinidis
- Neuroscience Program, Vanderbilt University, Nashville, TN 37235
- Dept Biomedical Engineering, Vanderbilt University, Nashville, TN 37235
- Dept Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, TN 37232
| | - David T Blake
- Dept Neuroscience and Regenerative Medicine, Medical College of Georgia, Augusta University, Augusta, GA
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Mohamed AA, Sargent E, Moriconi C, Williams C, Shah SM, Lucke-Wold B. Quantum Computing in the Realm of Neurosurgery. World Neurosurg 2024; 193:8-14. [PMID: 39369789 DOI: 10.1016/j.wneu.2024.09.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Accepted: 09/26/2024] [Indexed: 10/08/2024]
Abstract
Quantum computing leverages the principles of quantum mechanics to provide unprecedented computational power by processing data in a fundamentally different way from classical binary computers. Quantum computers use "qubits" which superimpose 0 and 1. Because qubits can exist in multiple states at the same time, quantum computers can perform "quantum parallelism" wherein data are processed simultaneously rather than sequentially. The quantum parallelism is what enables the computer to have exponentially larger processing capabilities and consider all potential outcomes simultaneously to derive solutions. Our study aims to explore aspects of neurosurgery through which quantum computing could improve patient outcomes and enhance quality of care. Quantum computing has the potential for future applications in neuroprosthetics, neurostimulation, surgical precision, diagnosis, and patient privacy and security. It promises improved patient outcomes, enhanced surgical precision, and personalized healthcare delivery. With its inherent sensitivity and precision, quantum computing could advance the understanding of disease processes and development, providing neurosurgeons with deeper insight into patient pathologies. Challenges such as biocompatibility, cost, and ethical considerations remain significant barriers to integrating the technology into neurosurgical practice. Addressing these challenges will be crucial for realizing the transformative potential of quantum computing in advancing neurosurgical care and improving clinical outcomes.
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Affiliation(s)
- Ali A Mohamed
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA; College of Engineering and Computer Science, Florida Atlantic University, Boca Raton, Florida, USA.
| | - Emma Sargent
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Camberly Moriconi
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Cooper Williams
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Syed Maaz Shah
- College of Osteopathic Medicine, Kansas City University, Kansas City, Missouri, USA
| | - Brandon Lucke-Wold
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
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Cury RG, França C. Tailoring and personalizing deep brain stimulation for Parkinson's disease. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-2. [PMID: 38763145 PMCID: PMC11102809 DOI: 10.1055/s-0044-1786823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/21/2024]
Affiliation(s)
- Rubens Gisbert Cury
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil
- Hospital Israelita Albert Einstein, São Paulo SP, Brazil
| | - Carina França
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil
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