Trials to treatments: Non-drug therapies

What if the next exciting treatment for Parkinson’s isn’t a new pill? What if a headset or handheld device could control specific symptoms of Parkinson’s or even help to slow its progression?

Technology has a growing role to play in the monitoring of our health and wellbeing in the 21st century. Health data is at our fingertips with wearables such as watches that monitor heart rate, tech you can take home to encourage exercise and apps that help people to manage their mood. So it is not surprising that cutting edge technology is being harnessed in medical research.

In Parkinson’s there’s a gradual loss of brain cells, mainly the dopamine-producing cells in the region of the brain that controls movement. This results in people with Parkinson’s experiencing motor symptoms, but also a range of non-motor symptoms that can hugely impact quality of life. Current treatments for Parkinson’s do not help control all of these symptoms. And in the search for better management of the condition, some researchers are now turning to therapies that don’t involve drugs.

Non-drug therapies may hold the key to targeting individual symptoms as well as Parkinson’s more broadly. Exercise, for instance has been shown to reduce stiffness, improve balance and alleviate pain, but researchers also think the chemicals released by our brains when we do exercise could have protective effects, potentially slowing the progression of Parkinson’s.

But it’s not just these more traditional non-drug therapies that researchers are interested in. Some pioneering studies are now looking at how devices might change the way the brain works to overcome symptoms.

Nerve stimulation and Parkinson’s

Therapies that are currently under investigation for Parkinson’s involve various methods of nerve stimulation that aim to help improve the way brain cells communicate. In some instances this may involve surgery but in others non-invasive devices are now being explored. So what is nerve stimulation?

Our nervous system spans the whole body and is made up of an intricate network of nerves connecting different parts of our body to the brain. Nerve stimulation involves brain cells either directly or indirectly being energised using electrical currents to help boost their activity. This has potential in Parkinson’s as electrical circuits within the brain are disrupted, affecting how the brain communicates to control things such as movement.

This idea is not new and is changing the way people treat several conditions, including pain. For instance, sticky electrode patches, attached to a battery pack, can be used to send electrical impulses through the body. These impulses can help relax muscles or boost brain chemicals that act as natural pain relief.

Surgical nerve stimulation

Nerve stimulation is also already used in Parkinson’s in deep brain stimulation (DBS), the most common type of surgery for the condition. In DBS, very fine wires are carefully inserted into the brain to electrically stimulate particular groups of brain cells involved in controlling movement to adjust their activity. Read more about the history of brain surgery in Parkinson's.

There is another surgical method that involves nerve stimulation, which is under investigation for Parkinson’s. Researchers are exploring the potential of a spinal implant to improve walking and freezing. The therapy involves implanting a device at the base of the spinal cord. This delivers low voltage electrical currents to stimulate cells involved in controlling movement and pain responses. This research has been shown to be successful in mouse models of Parkinson’s and the device is now being investigated in small clinical trials in Canada and the UK.

Surgical techniques continue to improve, but perhaps what is even more exciting is that researchers now believe nerve stimulation could be achieved through the skin. This opens the door to possible non-invasive ways to change the activity of brain cells via devices that are portable, easy to use and can be self-administered at home.

Non-invasive nerve stimulation

Headset to help with motor and non-motor symptoms of Parkinson’s

One example of a non-invasive method of nerve stimulation under investigation for Parkinson’s is a device that works by gently stimulating a nerve in the ear, using earpieces in a headset. The technique, called vestibular stimulation, has previously been shown to improve neurological symptoms associated with stroke and traumatic brain injury.

Back in the summer of 2019, results were published from a double-blind clinical trial of vestibular stimulation in people with Parkinson’s carried out by researchers at the University of Kent. The 33 participants self-administered the active treatment or a placebo twice a day over 2 months.

Participants were assessed up to 6 months after using the device and significant improvements were seen in a variety of symptoms, including mobility and decision making, and in quality of life ratings in those receiving the active treatment.

These results highlight the potential of a new painless and non-invasive electrical stimulation device that could be used at home to improve Parkinson’s symptoms. A larger clinical trial is now needed to assess these potential benefits and to see if they are long lasting. We hope there will be news of further trials starting in 2021. We will be keeping people up to date on this through our Parkinson’s UK Research Support Network emails.

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Device to help improve bladder control

Bladder problems are reasonably common in Parkinson’s, in fact, they are in the top 10 priority areas for research to address, but this is one symptom that can be hard to manage.

The bladder is responsible for holding and then expelling urine from the body. Signals from the brain are responsible for controlling these functions, and in Parkinson’s these signals can get interrupted.

Previous studies have shown that using mild electrical stimulation to a nerve in the lower ankle can improve bladder problems in some people, improving their quality of life. Now, research funded by Parkinson’s UK is underway to see if this non-invasive nerve stimulation can offer a way to boost the signals needed to improve bladder control in Parkinson’s.

Professor Doreen McClurg and her team at Glasgow Caledonian University are carrying out a clinical trial in 200 people with Parkinson’s. The device under investigation will deliver electrical stimulation through patches placed near the ankle, where half the participants will be receiving the active stimulation and half the placebo. Participants will use the device twice a day for 6 weeks with careful monitoring of bladder symptoms.

The hope is that the study will show benefit to people with Parkinson’s and open the door to a new treatment option in the future.

We hope to share results for this study in the second half of 2021.

Could a handheld device improve walking?

So we’ve seen the possibilities of stimulating the nerves in the ear and in the ankle. Another part of the body that researchers are currently stimulating is the neck.

Parkinson’s UK are part funding research investigating a small handheld device that stimulates a nerve in the neck to see if it has potential to improve walking in people with Parkinson’s, and in turn reduce falls. The team at the University of Newcastle are in the process of setting up this research. Find out more in our blog: Could a handheld device help reduce falls?

Funding more research into non-drug therapies

More research is needed to find innovative ways to help find better treatments and a cure for Parkinson’s. Technology holds potential for monitoring and providing ways to help better manage symptoms of the condition. Parkinson’s UK is now funding more research into non-drug therapies to help accelerate these breakthroughs. Read more about our research grants.