An update on advanced therapies for Parkinson's disease: From gene therapy to neuromodulation

Abstract

Advanced Parkinson's disease (PD) is characterized by increasingly debilitating impaired movements that include motor fluctuations and dyskinesias. At this stage of the disease, pharmacological management can result in unsatisfactory clinical benefits and increase the occurrence of adverse effects, leading to the consideration of advanced therapies. The scope of this review is to provide an overview of currently available therapies for advanced PD, specifically levodopa–carbidopa intestinal gel, continuous subcutaneous apomorphine infusion, radiofrequency ablation, stereotactic radiosurgery, MRI-guided focused ultrasound, and deep brain stimulation. Therapies in clinical trials are also discussed, including novel formulations of subcutaneous carbidopa/levodopa, gene-implantation therapies, and cell-based therapies. This review focuses on the clinical outcomes and adverse effects of the various therapies and also considers patient-specific characteristics that may influence treatment choice. This review can equip providers with updated information on advanced therapies in PD to better counsel patients on the available options.

Some Novel Therapies in Parkinson’s Disease: A Promising Path Forward or Not Yet? A Systematic Review of the Literature

“…While traditional therapies have been the mainstay of PD treatment for many years, new and more effective treatment options are required for PD patients [ 6 ]. In recent years, novel therapies for PD have encompassed a wide range of approaches, including gene therapy, cell-based therapies, targeted drug delivery, neuroprotective agents, and magnetic field therapy [ 7 , 8 , 9 , 10 , 11 , 12 ].…”

Advances in graphene-based nanoplatforms and their application in Parkinson's disease

“…Available therapies for advanced PD also include continuous subcutaneous apomorphine infusion, radiofrequency ablation, stereotactic radiosurgery, magnetic resonance imaging-guided focused ultrasound, and deep brain stimulation. 13,14 Strategies such as gene- and cell-based therapies, immunotherapy, and fecal microbiota transplantations are being developed at clinical stages. 13,15…”

“…13,14 Strategies such as gene- and cell-based therapies, immunotherapy, and fecal microbiota transplantations are being developed at clinical stages. 13,15…”

“…12 Available therapies for advanced PD also include continuous subcutaneous apomorphine infusion, radiofrequency ablation, stereotactic radiosurgery, magnetic resonance imaging-guided focused ultrasound, and deep brain stimulation. 13,14 Strategies such as gene-and cell-based therapies, immunotherapy, and fecal microbiota transplantations are being developed at clinical stages. 13,15 Interestingly, nanomaterials with unique physicochemical characteristics can traverse the BBB via different mechanisms, exhibit high drug-loading capacity, provide sustained release, protect cargo from immune recognition, increase drug half-life, permit cell-specific targeting, and offer a physical structure that can support cell growth.…”

“…13,14 Strategies such as gene-and cell-based therapies, immunotherapy, and fecal microbiota transplantations are being developed at clinical stages. 13,15 Interestingly, nanomaterials with unique physicochemical characteristics can traverse the BBB via different mechanisms, exhibit high drug-loading capacity, provide sustained release, protect cargo from immune recognition, increase drug half-life, permit cell-specific targeting, and offer a physical structure that can support cell growth. In addition, due to their intrinsic properties they may bind to fibrils, that results in their disaggregation or contribute to a reduction in oxidative stress.…”