Thu September 26, 2013
A Look At Parkinson's As Michael J. Fox Returns To TV
Originally published on Thu September 26, 2013 6:03 pm
It’s been 22 years since Michael J. Fox was first diagnosed with Parkinson’s disease — and 15 years since he famously told Barbara Walters that he would be cured of Parkinson’s before his 50th birthday.
That didn’t happen, but neither did his doctor’s stated expectation that he would have only about 10 more years to work in television.
Fox makes his return to television tonight — no longer trying hide his Parkinson’s symptoms, as he did during his six years on “Spin City.”
That’s because “The Michael J. Fox Show” revolves around a TV anchor named Mike Henry who returns to the air after being sidelined for half a decade by the illness.
Fox’s return to television comes as singer Linda Ronstadt reveals in her new memoir “Simple Dreams“ that undiagnosed Parkinson’s created voice changes that have prevented her from singing for the past few years, and now leave her reliant on two canes to navigate her daily activities.
Fox and Ronstadt are among about a million Americans who suffer from Parkinson’s, which strikes with a wide range of symptoms and can look very different from individual to individual.
Dr. Paul Tuite, director of the Movement Disorders Center at the University of Minnesota, joins Here & Now to explain the latest research and treatments.
Interview Highlights: Dr. Paul Tuite
On how Parkinson’s affects people differently
“It is quite variable, it’s different for each person. But we also add, there can be some features that occur years before the motor signs of Parkinson’s disease. So some people may notice loss of smell five to 10 years before they develop tremor or stiffness. They may also have sleep problems, where in the Michael J. Fox program tonight, he alluded to that, where the person may talk in their sleep or have funny dream-like behaviors and act a dream. So those are things that people who are out there who are listening to the program, if they’re experiencing these things, they should bring them up with their physician.”
On the latest Parkinson’s treatment
“The gold standard for Parkinson’s disease remains Levodopa. It’s a precursor to dopamine, so the brain cells that make dopamine use that drug to help them make dopamine. And that’s been around since the 60s. Since that time, in the 80s and 90s, we’ve had dopamine lookalike drugs like Pramipexole, Ropinirole, a patch Rotigotine — so those can augment the brain’s dopamine signaling. The Fox Foundation’s funding studies related to nicotine patches that may help symptoms; caffeine derivatives that are being used in clinical trials. A lot of these therapies however focus primarily on alleviating symptoms — we have yet to acquire a drug that modifies the course of disease.”
On the pursuit of Parkinson’s biomarkers
“The Michael J Fox Foundation is funding a study that we’re part of to look at blood and spinal fluid of people who have Parkinson’s and people who don’t have Parkinson’s — a health control. So the objective is to find some type of a protein or abnormality in blood or spinal fluid that may help diagnose Parkinson’s, track the response to treatment, predict the course of the condition.”
Progress on the Parkinson’s front
“We’re now beginning to map the topography of the disease using MRI, using animal models of disease. We know that synuclein is an important protein that is abnormally accumulated in Parkinson’s disease. It spreads slowly in different regions of the brain and due to the real estate that’s affected, symptoms result. So if you have certain areas related to motor function, those areas of the brain are affected. Cognitive areas, smell areas, we can find the disease in salivary glands that relate to drooling that some patients have with Parkinson’s. You can find changes in the gut that relate to constipation that patients experience.”
JEREMY HOBSON, HOST:
It's HERE AND NOW. It has been 22 years since Michael J. Fox was first diagnosed with Parkinson's disease, and it has been 15 years since he famously told Barbara Walters that he would be cured of Parkinson's before his 50th birthday. That did not happen. But neither did his doctor's prediction that Fox would only have 10 more years to work in television.
Michael J. Fox will be back on TV tonight. But he won't be trying to hide his Parkinson's symptoms this time, as he did during his six years on "Spin City." The new "Michael J. Fox Show" features a TV anchor named Mike Henry who has Parkinson's.
(SOUNDBITE OF TV SHOW, "THE MICHAEL J. FOX SHOW")
BETSY BRANDT: (as Annie Henry) You were talking in your sleep again last night.
MICHAEL J. FOX: (as Mike Henry) Yeah. These new meds, why can't they have cool side effects?
BRANDT: (as Annie Henry) What would be a cool side effect?
FOX: (as Mike Henry) I don't know. Anything Aquaman does.
HOBSON: Michael J. Fox's return to TV comes as singer Linda Ronstadt reveals in her new memoir, "Simple Dreams," that it was undiagnosed Parkinson's that prevented her from singing and now makes her reliant on two canes to get around. Fox and Ronstadt are just two of the 1.5 million Americans who suffer from Parkinson's, though the illness has affected each of them very differently.
For more on Parkinson's disease and how far we have come since Michael J. Fox's diagnosis 22 years ago, we are joined by Dr. Paul Tuite, a Parkinson's specialist and director of the Movement Disorders Center at the University of Minnesota. Dr. Tuite, welcome.
DR. PAUL TUITE: Thank you for inviting me to the program.
HOBSON: Well, let's start at the beginning. What is Parkinson's disease, and how do people figure out that they have it?
TUITE: So it's a degenerative disorder that affects primarily the dopamine cells in the brain that - and dopamine's a chemical in the brain that helps mediate movements. There are other chemical changes that we're now discovering that mediate other features of the disease, but the cardinal, hallmark features of Parkinson's are tremor. Not everyone has a tremor, but it's typically a rest tremor, their handshakes at rest in their lap.
There's stiffness, slowness, change in posture. The first symptoms may be small handwriting or softer voice or lack of arm swing or pain in the shoulder and the side of the body that isn't moving as well.
HOBSON: And the symptoms really vary from person to person. I have one friend who has had Parkinson's for many years but is still working and functioning for the most part, and another friend who's got Parkinson's who had to stop working after - just about a year after his diagnosis.
TUITE: Yeah, it is quite variable. It's different for each person. But let me also add, there can be some features that occur years before the motor signs of Parkinson's disease. So some people may notice loss of smell five to 10 years before they develop tremor or stiffness. They may also have sleep problems, where in the Michael J. Fox program tonight he alluded to that, where the person may talk in their sleep or have funny, dreamlike behaviors enacting a dream.
So those are things that people out there who are listening to the program, if they're experiencing these things, they should bring them up with their physician to talk about these symptoms they may be having.
HOBSON: And right now the treatments for Parkinson's include various drugs as well as brain stimulation. Here is Michael J. Fox talking about his meds.
(SOUNDBITE OF TV SHOW, "THE LATE SHOW WITH DAVID LETTERMAN")
FOX: Everybody has the experience in a different way, and different meds work for different people. And some meds don't work for some and work for others, and you're always try and find the perfect combination, cocktail. So I think I've found it. And then it's just - I'm so lucky. I'm so - I mean I've got this beautiful wife and these great kids, and life is just good.
HOBSON: So tell us about the latest meds, Dr. Tuite. There's been news over the last month about some new ones, but what are people taking right now for the most part?
TUITE: Well, the gold standard for Parkinson's disease remains Levodopa. It's a precursor to dopamine. So the brain cells that make dopamine use that drug, Levodopa, to help them make dopamine. And that's been around since the '60s. Since that time, in the '80s and '90s, we've had dopamine look-alike drugs like Pramipexole, Ropinirole, a patch, Rotigotine. So those can augment the brain's dopamine signaling.
The Fox Foundation's funding studies related to nicotine patches that may help symptoms, caffeine derivatives that are being used in clinical trials. A lot of these therapies all, however, focus primarily on alleviating symptoms. We have yet to acquire a drug that modifies the course of disease.
HOBSON: And they don't fully alleviate the symptoms, right?
HOBSON: There are still symptoms.
TUITE: Yeah. They primarily focus on the motor symptoms. They don't fix balance problems or speech changes that Linda Ronstadt's having. They don't fix cognitive problems that some people may have, others don't.
HOBSON: And there's a new antioxidant treatment?
TUITE: Well, we're working on an over-the-counter supplement called NSCL-15. And other people in the U.S. are doing this as well. Our specialty here is imaging. We have a brain imaging center. We're part of the brain initiative that was in the press a couple months ago. We can measure glutathione and antioxidant in the brain with our MRI scanner.
And we're actually - we did a study that was published showing if you give the drug intravenously, you can show immediately responses in brain glutathione levels while the patient's in the MRI machine. It's primarily a proof of principle that if you give a drug, it can enact(ph) brain chemical changes. That's novel. However, much more work needs to be done to see if an oral formulation is effective in terms of changing brain chemistry. And then ultimately does it have a effect on the course of disease.
HOBSON: Well, there is a study I know that - right now that is checking to see if there's a way you can figure out exactly what the course of the disease will be, right?
TUITE: Exactly. So these are - the pursuit is of biomarkers. So the Michael J. Fox Foundation is funding a study that we're part of to look at blood and spinal fluid of people who have Parkinson's and people who don't have Parkinson's - healthy control. So the objective is to find some type of protein or abnormality in blood or spinal fluid that may help diagnose Parkinson's, track the response to treatment, predict the course of the condition. And that's similar to our MRI method. I mean these all will have to kind of work together. You want to have different strategies to track the topography or the nature of each person's condition.
HOBSON: We're talking with Dr. Paul Tuite, director of the Movement Disorders Center at the University of Minnesota about Parkinson's disease. And you're listening to HERE AND NOW.
And one of the interesting things that you have said is that many Parkinson's patients say they're interested in research, but only 11 percent enroll in clinical trials.
TUITE: We have to do better. We have to match trials with patients to see what's suited for them. The BioFIND study that we're doing, we need people with Parkinson's five to 15 years that haven't had surgery, haven't had brain stimulation surgery. So, you know, there's something out there that one can do - either participate in a trial or just enhance awareness, make sure there's funding.
The Fox Foundation is trying to boost small startup companies to take risks, whereas larger pharmaceutical companies aren't taking those risks presently. NIH is putting some money in. Obviously we've got to solve the sequestration to keep the funding going, so we have great researchers continue on in the field and their careers.
HOBSON: How far have we come in the last 22 years, since Michael J. Fox was diagnosed, in treating this disease and finding a cure?
TUITE: We haven't come far enough. There has to be an urgency, and we've got to continue the urgency. However, we, you know, we're now beginning to map the topography of the disease using MRI, using animal models of the disease. We know that synuclein is an important protein that's abnormally accumulated in Parkinson's disease. It spreads slowly in different regions of the brain and due to the real estate that's affected, symptoms result.
So if you have certain areas related to motor function, those areas of the brain are affected. Cognitive areas, smell areas - we can find the disease in salivary glands that relate to drooling that some patients have with Parkinson's. You can find changes in the gut that relate to constipation that patients experience.
HOBSON: Did it make a difference that Michael J. Fox came out and said that he had been diagnosed, in terms of the research that has happened?
TUITE: Absolutely. He's transformed the field dramatically. He's stepped up to the plate and pushed - and has been a voice for people who aren't speaking up and who are unable to speak up.
You know, Linda Ronstadt's voice isn't perfect, but she should still sing. There's therapists out there who promote loud therapy, a form of therapy for Parkinson's, big therapy to move. Very important to move if you have - and keep active if you have Parkinson's. And it's good for people to promote the awareness like Fox is doing.
HOBSON: Are you going to be watching his show tonight?
TUITE: I definitely will.
HOBSON: Dr. Paul Tuite is director of the Movement Disorders Center at the University of Minnesota, where he treats Parkinson's patients. Dr. Tuite, thanks so much for talking with us.
TUITE: Thank you.
(SOUNDBITE OF SONG, "DESPERADO")
LINDA RONSTADT: (Singing) Oh, you're a hard one.
ROBIN YOUNG, HOST:
From NPR and WBUR Boston, I'm Robin Young.
HOBSON: I'm Jeremy Hobson. And we're listening here to Linda Ronstadt, another person who has come out and spoken out about her Parkinson's. This is her singing "Desperado" in 1977. And this is HERE AND NOW.
(SOUNDBITE OF SONG, "DESPERADO")
RONSTADT: (Singing) Don't you draw the queen of diamonds, boy. She'll beat you if she's able. The queen of hearts is always your best bet. Well, it seems to me some fine things have been laid upon your table, but you only want... Transcript provided by NPR, Copyright NPR.