BRAIN STORMS

Prospects for better treatments for Parkinson’s disease are the hope that lies at the end of this well-researched history and overview of the current state of research.

Palfreman (Emeritus, Broadcast Journalism/Univ. of Oregon; co-author: The Case of the Frozen Addicts, 1996, etc.) brings his skill as a science writer and a deep personal commitment to an initially dark narrative. A generation ago, L-dopa was the breakthrough drug that would supply dopamine, the neurotransmitter no longer available from diseased brain cells, to neurons in movement control centers. Thus it would stop the tremors, falls, and other signs of Parkinson’s—except when it didn’t. L-dopa is notoriously difficult to deliver to the brain, and when it arrives, its release fluctuates, producing on-again, off-again effects. So the race was on to protect, revive, or transplant new cells to replace the dying ones. None of these approaches really worked, writes the author, probably because by the time movement symptoms appear, most of the dopamine cells are gone. In that sense, the tremors are only the tip of the iceberg. Among Parkinson’s “prodromal” symptoms are constipation, loss of the sense of smell, sleep disorders, anxiety, and depression. Moreover, Parkinson’s comes in many varieties, with different ages of onset and different rates of progression. Fortunately, there are promising developments on the horizon—e.g., the chance discovery that a particular phage can invade and devour the misfolded proteins in brain cells, restoring function. A small company has now developed a phage-derived protein that forms the key to opening the cells, and they are planning human trials. Other developments include new forms of L-dopa to ensure stable amounts and sustained delivery and possible exploitation of the placebo effect, which has been shown to stimulate dopamine release from other brain systems.

In this illuminating book, Palfreman reminds patients that exercise and a positive attitude help, and he urges them to participate in clinical trials and take to task drug companies reluctant to initiate huge trials for what they dismiss as a non–life-threatening disease. Just ask Michael J. Fox.