Simon Says...Sinemet!

There is always a torrent of new therapies in Parkinson’s research but a disproportionate number of them are closely related to the first major therapy, Levodopa, which profoundly changed Parkinson's treatment over fifty years ago. There are therapies which feed Sinemet into your gut, there are new pills which deliver Sinemet into the brain using novel pathways, forms of levodopa that can be effective in a few brief moments, there’s even a new procedure which shunts Levodopa right into the part of the brain where it can have the most effect.

But they all have to do with moving and optimizing Levodopa, which is naturally present in bananas, although you’d have to eat a treeful to feel the slightest effect. In fact, levodopa has been the subject of research for over a century. There’s a documentary to be made about how it came to dominate the world of Parkinson’s. Levodopa isn’t a drug. It’s a religion.

But Levodopa even at its most efficient is not going to send Parkinson’s packing. The best it can do is alleviate symptoms and help to slow down neurodegeneration. According to some senior voices in the PD medical community, the time arrived long ago for research to get away from its ‘obsession’ with levodopa. Sinemet varies in effectiveness between patients, like any other drug, but it nearly always delivers to some or other extent. In fact, it was once frequently used to help diagnose a patient showing symptoms. The patient would take Sinemet, and if their symptoms receded, s/he had PD. Ba-da-bing!

Perhaps it’s natural to focus on the tried and tested agent to be the basis for better versions of itself. It’s certainly easier to focus on levodopa-derived therapies and pharmaceuticals. But in a world of ever expanding medical research (despite America’s taking a voluntary back seat on it these days) when gene editing and immunotherapies, to quote just two examples, are increasingly common procedures, there’s a feeling that we could be making deeper inquiries into seemingly unrelated, or more holistic approaches. From this columnist’s viewpoint, a spirit of adventure might be missing. The same is said to be true of research into Alzheimer’s, which according to many has come to a virtual standstill after decades of focussing on Amyloids, with some expensive drugs failing at their last hurdles.

What’s required for PD, Alzheimer’s, and the elephant in the room, cancer, is a super-financed, public-private, highly coordinated international “moonshot” approach, which we are sadly unlikely to see anytime soon. The amount will have to be large, but if a country can afford B-2 bombers and bunker-busting bombs, it can afford to shell out to conquer major neurological diseases, a growing menace in our polluted world. In the meantime PWP face a harsh reality. Trials, especially for device-based therapies, are slow-moving, and nothing has yet to emerge that truly changes the landscape of Parkison’s in the future.  

Even if everything goes right, even if a revolutionary therapy is seen to be destined to break the PD code, it can take decades to reach the market at prices ordinary patients can afford. Perhaps that’s why the path most taken involves levodopa, because there’s comfort to be had in knowing that it works and why. Plus, there’s a relatively easy pathway to a lucrative patent in modifying an existing therapy. But that’s for another publication to discuss.