Snowflakes. That’s what we are. Parkinson’s snowflakes. No two people with PD alike. We know it and medical research has finally accepted what every person with Parkinson’s knows. The disease is unique to each of us. We each have our own set of symptoms, we progress at different rates and in different ways, and we respond differently to meds and treatments. The disease itself is a chameleon, changing and different every day. Each morning when I wake up I discover my symptoms for that day. Will it be tremors or fatigue, balance or dystonia, anxiety or … the list goes on. What will be will be. Then just when I think I have the day figured out and under control my symptoms change. What is going on here? The answer, Parkinson’s is not one disease, it is many, or really a disease with many different subtypes.
Researchers now believe that PD is not a single disease as has been previously thought and therefore treated with similar treatment for all, basically either Sinemet (levodopa), an agonist, or DBS. It is a disease with many different subtypes and should be treated as such. Think of it like cancer with its many subtypes based on genetic, biological and molecular differences needing customized medical treatment depending on the specific molecular subtype of the cancer.
"The time has come to ask what we should be doing differently” says Alberto Espay, MD, Department of Neurology at the University of Cincinnati College of Medicine and director of the Gardner Family Center for Parkinson’s Disease and Movement Disorders. "Medical science has made a global investment of $23 billion in therapies with the promise to slow down the progression of Parkinson's disease, and the 17 completed phase III clinical trials have yielded little more than disappointment. We need to ask whether the growing number of failed trials might be explained by our single-target and single-disease approach to drug development.”
We are entering the age of personalized precision medicine. That not everyones PD symptoms are the same and not everyone responds to the same therapies leads researchers to believe that there are many PD types or subsets that can best be benefitted by different therapies. A subtype is defined by a cluster of PWP that have the same molecular subtype of disease. The goal is to define and understand the molecular nature of each subtype and then develop a customized precision medicine approach that is rooted in systems biology to target each subtype. "The diagnosis of Parkinson's disease will be complete only when a biomarker profiling is capable of identifying the molecular subtypes of disease and suggest a disease-modifying treatment to apply.”
Seeing Parkinson's as a single disorder that involves dopamine-neuron degeneration helped develop treatments for symptoms such as tremor, balance, and rigidity that affect most PWP but did not help slow, modify, or cure the disease. Sub-typing the disease according to the presence of specific biomarkers would allow for the development and administration of personalized precision medicine based on subtype and the specific symptoms and molecular features of the disease. “Our patients can be divided into subtypes based on genetic, biological and molecular abnormalities. As a result, they will respond differently to different therapies" says Espay.
Sometimes thinking has to change to solve a problem. Common sense and experience tell us that Parkinson’s comes in different shapes and sizes and has many faces. Medical science now agrees and believes that customized precision medical therapy based on the biomarkers of each PD subtype is the future. Hopefully this acknowledgement will help find the way to prevent and cure the disease. May it come speedily and in our day.
Sometimes thinking has to change to solve a problem. Common sense and experience tell us that Parkinson’s comes in different shapes and sizes and has many faces. Medical science now agrees and believes that customized precision medical therapy based on the biomarkers of each PD subtype is the future. Hopefully this acknowledgement will help find the way to prevent and cure the disease. May it come speedily and in our day.
