Parkinson’s disease expert Dr. Michael J. Aminoff discusses the field of Parkinson’s research, clinical care, and The Parkinson’s Disease Clinic and Research Center at UCSF. To learn more, tune in to two new programs premiering this month: Parkinson’s: Latest From the Experts and Parkinson’s: A Dose of Hope.
UCTV: Why did you decide to focus your professional life on clinical care and research on Parkinson’s disease?
Michael J. Aminoff: Parkinson’s disease is a chronic, disabling disorder that—when I was an intern—had no effective medical treatment. In those early days, to watch patients respond to a newly discovered therapy with levodopa was both inspiring and touching.
UCTV: The Parkinson’s Disease Clinic and Research Center at UCSF is described as a comprehensive treatment center. What does that mean and why is it important to take a comprehensive approach?
MJA: Parkinson’s disease is a disorder that affects many parts of the nervous system, and thus the body. In addition to disturbances of movement, characterized by slowness, stiffness, and tremor, the disease may cause postural imbalance, intellectual decline, depression, anxiety, disturbances of bladder and bowel functions, disturbances of sweating and blood pressure control, loss of the sense of smell, and other problems. Thus, a comprehensive approach to its management is mandatory. It includes physical, speech, and occupational therapies as well as cognitive assessment and treatment, urological management, and social support. Some patients will also need neurosurgical treatment. The staff at our center has extensive experience with many of these different aspects and has established referral links to help patients receive the multidisciplinary care that they require.
UCTV: What type of interactions do clinicians treating patients have with the researchers doing studies at the center?
MJA: We have a close interaction with translational and basic scientists. Indeed, one of the functions of our center is to bring to the clinic advances made in the laboratory. For example, Dr. Bankiewicz, in his laboratory, developed a form of gene therapy for animals with an experimentally induced type of parkinsonism, and in collaboration with him, we then tested this in humans with Parkinson’s disease. The encouraging results that we obtained will, we anticipate, lead to further and more extensive studies of this approach. Our physicians and scientists meet regularly to discuss clinical or scientific advances and their implications for patients with Parkinson’s disease.
UCTV: Much of the center’s research involves clinical trials. What is the value of a clinical trial and how can people get involved?
MJA: Clinical trials allow participants to receive otherwise unavailable treatments. The aim is to establish whether a particular treatment is beneficial for patients. It is only too easy for physicians or patients to believe they are being helped by a novel therapy, if only because they want to see a beneficial response. Clinical trials provide an objective means of determining whether benefit occurs to a particular treatment, and usually involve comparing the response to active treatment or placebo. Our web site lists current studies in progress at UCSF, and a national web site lists trials throughout the country.
UCTV: Parkinson’s disease research has made huge advances in recent years. What are some of the most interesting discoveries you have seen?
MJA: I have seen the disease move from being untreatable to one for which a variety of treatments are now available, at least for the movement disorder that is a major feature of the disease. Over my career, I have seen the advent of levodopa, drugs that act like it (dopamine agonists), the development of new surgical techniques such as deep brain stimulation, and now the beginnings of gene therapy. These have been truly exciting times.
UCTV: Where do you see Parkinson’s disease research going in the future?
MJA: I see an extension of gene therapies and eventually the development of stem cell therapies. I expect that therapies to slow or even reverse the disease will be developed (at present, treatments are purely symptomatic, i.e., help the symptoms without affecting the underlying disease process). It may eventually be possible to predict a patient’s response to therapy by their genetic make-up. There is much to look forward to.
UCTV: What do you want viewers of this program to learn about Parkinson’s disease?
MJA: That there is an increasing understanding about the nature and varying manifestations of Parkinson’s disease, and growing expertise in its management.