An Emerging Era in the Management of Parkinson's disease: Wearable Technologies and the Internet of Things

Harnessing a tidal wave of wearable tech and sorting the wheat from the chaff is vitally important... There are so many devices and programmes that have been 'validated' in handfuls of patients before attention switches to the 'next best thing'. But perhaps the regulatory bodies share a large proportion of the blame for this... the red tape that impedes the possibility of high throughput testing and validation. We need better strategies for getting good tools to the patient market place and clinical setting quickly so that we can ride this wave rather than trail in its wake...

IEEE J Biomed Health Inform. 2015 Jul 28. [Epub ahead of print]

Pasluosta C, Gassner H, Winkler J, Klucken J, Eskofier B.

Current challenges demand a profound restructuration of the global healthcare system. A more efficient system is required to cope with the growing world population and increased life expectancy, which is associated with a marked prevalence of chronic neurological disorders such as Parkinson's disease. One possible approach to meet this demand is a laterally distributed platform such as the Internet of Things. Real time motion metrics in Parkinson's disease could be obtained in virtually any scenario by placing lightweight wearable sensors in the patient's clothes, and connecting them to a medical database through mobile devices such as cell phones or tablets. Technologies exist to collect huge amounts of patient data not only during regular medical visits, but also at home during activities of daily life. These data could be fed into intelligent algorithms to first discriminate relevant threatening conditions, adjust medications based on online obtained physical deficits, and facilitate strategies to modify disease progression. A major impact of this approach lies in its efficiency, by maximizing resources and drastically improving the patient experience. The patient participates actively in disease management via combined objective device- and self-assessment and by sharing information within both medical and peer groups. Here, we review and discuss the existing wearable technologies and the Internet of Things concept applied to Parkinson's disease with an emphasis on how this technological platform may lead to a shift in paradigm in terms of diagnostics and treatment.

Cell-based therapies for Parkinson disease-past insights and future potential

Are we about to see a new dawn of stem cell based therapies...??

Nat Rev Neurol. 2015 Aug 4. doi: 10.1038/nrneurol.2015.123. [Epub ahead of print]

Barker RA, Drouin-Ouellet J, Parmar M.

Parkinson disease (PD) is characterized by loss of the A9 nigral neurons that provide dopaminergic innervation to the striatum. This discovery led to the successful instigation of dopaminergic drug treatments in the 1960s, although these drugs were soon recognized to lose some of their efficacy and generate their own adverse effects over time. Despite the fact that PD is now known to have extensive non-nigral pathology with a wide range of clinical features, dopaminergic drug therapies are still the mainstay of therapy, and work well for many years. Given the success of pharmacological dopamine replacement, pursuit of cell-based dopamine replacement strategies seemed to be the next logical step, and studies were initiated over 30 years ago to explore the possibility of dopaminergic cell transplantation. In this Review, we outline the history of this therapeutic approach to PD and highlight the lessons that we have learned en route. We discuss how the best clinical outcomes have been obtained with fetal ventral mesencephalic allografts, while acknowledging inconsistencies in the results owing to problems in trial design, patient selection, tissue preparation, and immunotherapy used post-grafting. We conclude by discussing the challenges of bringing the new generation of stem cell-derived dopamine cells to the clinic.

Genes associated with Parkinson's disease: regulation of autophagy and beyond

J Neurochem. 2015 Jul 30. doi: 10.1111/jnc.13266. [Epub ahead of print]

Beilina A, Cookson MR.

Abstract

Substantial progress has been made in the genetic basis of Parkinson's disease (PD). In particular, by identifying genes that segregate with inherited PD or show robust association with sporadic disease, and by showing the same genes are found on both lists, we have generated an outline of the cause of this condition. Here, we will discuss what those genes tell us about the underlying biology of PD. We specifically discuss the relationships between protein products of PD genes and show that common links include regulation of the autophagy-lysosome system, an important way by which cells recycle proteins and organelles. We also discuss whether all PD genes should be considered to be in the same pathway and propose that in some cases the relationships are closer while in other cases the interactions are more distant and might be considered separate.