SEOUL, South Korea — What if a small sample of skin could warn of Parkinson’s disease before the first tremor? What if a pill could smooth out the rough hours of the day without relying on the brain chemical that nearly every Parkinson’s drug depends on?
Those ideas are being put to the test this week in Seoul, where thousands of doctors and scientists have gathered for the world’s largest meeting on Parkinson’s and related conditions. The International Congress of Parkinson’s Disease and Movement Disorders runs through Thursday.
A new way to handle the bad hours
Anyone living with Parkinson’s for a while knows about OFF time. It is the stretch of the day when medication wears off and the slowness, stiffness and shaking come back.
For more than 50 years, the main treatment has been levodopa, which replaces dopamine, the brain chemical that Parkinson’s depletes. It works well, but over time it tends to become less reliable.
A drug called solengepras takes a different road. The once-daily pill leaves dopamine alone and works on another part of the brain’s movement circuitry.
Results from a large, late-stage trial called ARISE are being presented Wednesday. The study tested two doses against a placebo and measured how much OFF time people had each day after 12 weeks.
Earlier research was encouraging. In a smaller study published in the journal Neurology, people on the higher dose gained back about 1.3 hours a day compared with placebo. Those with the most OFF time gained nearly 1.8 hours.
Taking out the trash
Another experimental drug, ARV-102, goes after a protein called LRRK2 that is strongly tied to Parkinson’s.
Other drugs in development try to block that protein. This one is built to get into the brain and prompt cells to throw the protein away entirely.
In an early safety study, people who took the drug showed changes in their spinal fluid linked to inflammation and brain cell health. Researchers also used eye-tracking technology and saw improvement in the quick, darting eye movements that Parkinson’s can disrupt.
It is far too soon to say whether the drug slows the disease. The study was small and short. But it shows that scientists can reach inside the brain and lower the level of a protein connected to Parkinson’s, something that was hard to imagine not long ago.
A warning sign in the skin
Some people physically act out their dreams, kicking, punching or shouting in their sleep. The condition, called REM sleep behavior disorder, is one of the strongest known early warning signs of Parkinson’s and can show up years before any movement symptoms.
Researchers took small skin samples from people with the sleep disorder and looked for an abnormal form of a protein called alpha-synuclein, the same protein that builds up in the brains of people with Parkinson’s. They found it in 75% of participants at the start of the study and 81% a year later, according to the congress organizers. The amount also grew over time.
A skin test cannot yet tell anyone for certain that Parkinson’s is coming. But it could one day help doctors spot the disease long before a diagnosis, when treatments may have the best chance of working.
Not the same for women and men
A study of more than 10,000 people with Parkinson’s, followed for about a decade, found the disease often looks different depending on sex.
Women were more likely to struggle with depression and with movement problems linked to their medication. Men were more likely to have memory and thinking problems, sleep disturbances and loss of smell.
The two groups were similar in age and in how long they had been living with the disease, which suggests the differences are real and may need more attention in research and care.
Looking at more of the world
Most genetic research on Parkinson’s has been done in people of European descent. That leaves out most of the world.
Studies presented in Seoul begin to change that. Researchers found 12 new genetic links to brain diseases in South Asian and Korean populations. A separate study of U.S. military veterans turned up new Parkinson’s-related genetic signals in people with African and Native American ancestry.
The more populations scientists study, the better their chances of understanding what causes the disease and who is at risk.
Hope for other conditions
Parkinson’s was not the only focus. For essential tremor, a common condition that causes shaking hands, a drug called ulixacaltamide helped people with everyday tasks such as drinking, pouring, eating and carrying a plate. It worked on its own and alongside a standard tremor medication, and it is now under regulatory review.
For multiple system atrophy, a rare and fast-moving disease that can look like Parkinson’s early on, a drug called ATH434 was linked to about 52% slower decline over a year at one dose. Researchers urge caution because the finding comes from a small study that missed its main goal. Still, it is a rare bit of good news for a disease with no treatment that slows it down.
What it all means
None of this changes what happens at the doctor’s office tomorrow. Some of the findings are early, and others need bigger studies or government approval.
But the direction is clear. Parkinson’s has long been diagnosed by what a doctor can see: a tremor, a stiff arm, a slow walk. The work coming out of Seoul points to a future where the disease is found earlier, understood more precisely and treated in ways tailored to the person who has it.
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