Mark Lin, MD, Sr. Neurologist and Director of Movement Disorders at MedStar Washington Hospital Center, talks about Parkinson’s and how switching up medication doses may be beneficial to some patients.
Interview conducted by Ivanhoe Broadcast News in October 2019.
For our viewers who might have heard of Parkinson’s but not might not be familiar, can you describe some of the symptoms that patients have that are problematic and troubling that come along with this condition?
LIN: The patients may notice some resting tremor, often one sided. And they may notice stiffness and slow movement. Of course, as disease progresses, they may develop unstable gait, falling and some other symptoms.
For those symptoms, what is the standard treatment? What is the go-to treatment for Parkinson’s?
LIN: I think there’s a few medications on the market. And the most effective one is levodopa. This medication has been used for more than 40 years and is still one of the best to reduce those motor symptoms.
Does it completely rid the patient of the symptoms? Or is it just a matter of degrees it reduces for most?
LIN: I think, for the very early states, it’s much easier to get rid of most of the symptoms. And as disease is progressive, it’s more difficult. So, I am more focused on the functional levels. That means a patient is able to do his/her daily activities without much difficulty.
Over time does levodopa start to lose it effectiveness?
LIN: Yes, that’s true. It is also associated with long term complications such as dyskinesia, one of the medical terms for involuntary movements and other motor complications, including motor fluctuations and sometimes freezing when walking.
What point did you start thinking about this option of changing the dosage and giving it more frequently? Can you describe what led you to think along those terms?
LIN: For the therapy, most doctors will give the patient medication three times a day. After, let’s say, four to five years, almost 40 percent of patients would develop motor complications, such as dyskinesia or motor fluctuations. So, I say why not do it in the beginning so to see what would happen? So, I use the same total daily dose as everyone else use. But I split from three times to six times a day, almost once every three hours.
And it sounds simple because patients are getting the same dose. But what is it doing for their symptoms? What is it doing for their bodies so that they’re not having those symptoms?
LIN: There’s less fluctuation in the level. And they feel kind of persistent benefit over time.
If this is something that’s working, why is it that doctors haven’t prescribed Levodopa for patients six times? Why just three times?
LIN: I think it’s very inconvenient to take pills six times a day. And this theory had been there for almost 30 to 40 years. One of the theories called the continuous dopamine stimulation, had been there for more than 30 years. It’s very inconvenient way. You have to spend time to explain to the patient.
So a matter of compliance? Perhaps patients would not remember or would not be willing to stop all the time to take so many pills during the day. Is that part of it?
LIN: Yes. And even I try really hard, 20-30 percent of patients cannot do it or are not willing to do it. It’s too many times for them.
What are you finding with the patients that you have now who are taking the pills six times a day as opposed three? Can you give us some examples?
LIN: One of the significant ones that I observe is instance of dyskinesia, it’s very low. You’re talking about the paper we had published earlier this year. It’s 90 percent less dyskinesia. So, it’s very low.
You had mentioned most of your patients are being treated this way. Can you tell me a little bit more about that?
LIN: Yes, in addition to my patients getting less dyskinesia, I did notice less motor fluctuation. But I don’t want to say too much about this because I haven’t collected enough data to prove that my observation is really true. So, I’m on the way now to get more data to see whether those data can be published in the near future.
So the dyskinesia is primarily what you were looking at in this paper, however you believe there may be other benefits to dosing this way?
LIN: The reason I published the dyskinesia because it is much easier to observe. Either the patient tells you yes or no. And you can see it. So in this way, of course, you don’t need to really quantitate. But you can just simply answer yes and no question.
You had mentioned the half life of the drug. What’s the best way to describe that to our viewers?
LIN: You can see, when drug level drop by half, that means less drug in the body. Those low levels may not be sufficient to help patients’ symptoms.
We’re seeing your patient Peter tomorrow. Tell me a little bit about his symptoms and his condition and the success he’s had.
LIN: He started to notice left hand resting tremor in January 2017. Later, he noticed some other symptoms such as slow movement, a little bit stiffness and maybe unstable gait. And he had a few falls. And I think he came to our clinic in October 2017. At the time, he got the diagnosis and he was put on a levodopa three times a day. And three months later, it was changed from 3 times to six times. Up to now, I maintain the same dose almost for two years. He has been stable. He told me he’s almost close to 100 percent better. That means he has minimal trouble for any daily activities.
Is there any risk to patients and for patients who are seeing this? This has to be done under a doctor’s supervision.
LIN: I think this would be the right way because patients need to be educated about the benefit. And six times doesn’t mean six times at varying intervals. II prescribe medicine six times thing daily at fixed intervals because the idea is to try to maintain that level, less fluctuation. That’s the idea behind that.
It’s the same dosage over 24 hours but split up into six dosage.
LIN: No. Not 24 hours. Usually it’s only during the daytime. And at night they can go to sleep. But it is the same total daily dose split into six doses.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
So Young Pak, MedStar Washington Hospital Center PR
202-877-2748
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