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Team Parkinson’s: U ramps up treatment and research program to combat a debilitating neurodegenerative disease

For Mike Trok to pursue his avocation as a volunteer eagle handler, he must overcome what he terms the “siren call” of Parkinson’s disease: “Not today. Just don’t go out today.”

He explains, “Parkinson’s has a way of wanting to draw you back, to make you a recluse, because it’s harder to go out in public.”

Mike Trok saw immediate results after his deep brain stimulation surgeries. (Photo: Scott Streble) Trok, 62, developed early-onset Parkinson’s disease at age 46, though he wasn’t diagnosed until five years ago. The second most common neurodegenerative disease after Alzheimer’s, Parkinson’s disease (PD) stems from a loss of brain cells, or neurons, that help control body movements. Symptoms include tremors, slowed movement, and impaired balance.

After pinning down the diagnosis, Trok’s neurologist, Paul Tuite, M.D., director of the University of Minnesota’s Movement Disorders Center, suggested that Trok would be a good candidate for deep brain stimulation (DBS). In this treatment, electrodes are placed in an area of the brain responsible for motor control and then connected by wires to a pacemaker-like device implanted under the chest skin. Once activated, the device delivers electrical impulses to the target area.

University DBS expert Aviva Abosch, M.D., Ph.D., performed Trok’s first surgery in November 2008. Trok saw immediate and impressive results.

“Without electricity, my hand would literally be bouncing off the table,” he says.

He underwent a second surgery in January to have electrodes implanted on the other side of his brain, to relieve symptoms on both sides of the body.

Trok appreciates how his team at the University worked together. “I couldn’t ask for a better relationship between the neurologist, the neurosurgeon, and the person who programs the generators,” he says.

A world-class team

Tuite and Abosch are just two of the leaders in the University’s ramped-up program in Parkinson’s disease treatment. Building on its broad strengths in neurosciences, the University has added top talents who are taking a variety of approaches to understanding and treating this chronic, progressive illness, which affects about 1 million people in the United States. Neurosurgeon Aviva Abosch, M.D., Ph.D., works to improve quality of life for people with Parkinson's disease. (Photo: Bill Alkofer) Tuite arrived at the University in 1996 and worked with Walter Low, Ph.D., and others on one of the first clinical trials of DBS as well as early trials of the drug rasagiline (Azilect®). He balances his thriving clinical practice—he’s known as the “go-to” neurologist in the Twin Cities for early-onset PD—with research that ranges from movement studies to clinical trials of new medications. Tuite has collaborated with colleagues in the University’s School of Kinesiology to investigate the effects of PD on hand control and other aspects motor function.

Tuite also has worked with scientists Gülin Öz, Ph.D., and Shalom Michaeli, Ph.D., at the University’s world-renowned Center for Magnetic Resonance Research (CMRR) to study the brain structure and chemistry of PD and other motor functions.

“I’m trying to connect the dots between the clinic and the research,” Tuite says. “I’m helping translate what we learn into patient care.”

Finding answers

Abosch has led the Department of Neurosurgery’s program in stereotactic and functional neurosurgery since 2005. She performs about two DBS surgeries a week, mainly for PD.

She’s also leading a study, funded by medical device giant Medtronic, Inc., to learn more about how the brain functions in response to electrical stimulation.

Although researchers know that DBS works, they aren’t sure exactly why. Abosch hopes to learn more by listening to the way brain cells communicate with one another, which she hopes will help refine the DBS process and create a new generation of devices so that more patients may benefit from the therapy.

“You’re giving patients back their independence,” Abosch says. “It has a profound impact on their quality of life.”

Still, she adds, “What DBS does is treat the symptoms.What I hope Michael Lee will do is find a cure.”

Scientist Michael Lee, Ph.D., searches for a cure. (Photo: Scott Streble) Michael Lee, Ph.D., came to the University last June from Johns Hopkins University, where he developed one of the first transgenic animal models for PD—a mouse with a genetic mutation that leads to Parkinson’s.

Lee’s achievement was inspired by the discovery, about 10 years ago, of the first genetic mutation linked to PD, in a gene that codes for production of a protein called alpha-synuclein.

After Lee introduced the mutant alphasynuclein gene into mice, they developed tremors and other symptoms of PD. “Not only can you study the progression of the disease [in these animal models], but you can also try therapies that you couldn’t try in humans,” Lee says.

Understanding the disease process at a cellular level will open new routes to intervention, he says. In the near term, this might mean developing and testing compounds that target the protein to keep it from accumulating (as accumulation can disrupt the brain’s normal functioning and lead to deterioration), testing new therapy combinations, or finding new biomarkers for early diagnosis. In the long term, the goal is to detect PD 10 years before symptoms appear and shut it down.

Partnering with Minnesota

The newest addition to the University’s team is Jerrold Vitek, M.D., Ph.D., who will take over as chair of the Department of Neurology in July. He looks forward to tying these pieces together to benefit people with Parkinson’s.

“There’s so much here,” he says. “I’d like to facilitate collaboration across the disciplines and expand that to involve more of the state of Minnesota.”

He points to the many excellent clinical centers around the state and the potential for enrolling more patients into clinical trials at the University.

Vitek envisions developing a stand-alone, “one-stop shopping” specialty care facility for people who have neurodegenerative diseases. The clinic would offer easy access and a range of services, including physical and occupational therapy, clinical trials assessments, and medical and psychological care. He also sees promise in gene therapy and stem cell research.

For his part, Trok tries not to look too far into the future.

“Parkinson’s patients, like the eagle, live for the day,” he says. “I know that my Parkinson’s may someday get me down—but not today.”

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