Angelo Antonini, EAN 2023: Highlights in Parkinson’s disease
touchNEUROLOGY editorial board member Prof. Angelo Antonini (Padua University Hospital, Italy) provides an overview of his top three most important updates and hot topics from the annual European Academy of Neurology (EAN), July 1–4, 2023, in the field of Parkinson’s disease. He particularly focusses on new insights in early detection of the disease before motor symptoms occur. Looking to the future, he discusses some novel treatments that could tackle the disease from a biological perspective.
Disclosures: Angelo Antonini has no actual or potential conflicts of interest in relation to this video.
Support:Â Interview and filming was supported by Touch Medical Media. The interview was conducted by Sophie Nickelson.
Filmed as highlight of EAN 2023.
Transcript
I’m Professor Angela Antonini, professor Neurology at University of Padwa in Italy, and then the director at Moment Disorder and Parkinson Unit at Padway University Hospital. So there were a number of issues addressed this congress here at European Acadionurology this year, and many would deserve probably to be mentioned I think really what the it struck me the most was this some sessions address saying especially early detection of the disease even before motor symptom pathology could occur. This is applying not only, of course, to Parkinson some adults to genetic diseases.
But I think in Parkinson, we are now realized that there are changes at the cellular level that are occurring very early, many decades even before. We can see the modern manifestations we have classically attributed to the disease. Now, this changes have opened the way to the use of novel biomarkers approaches.
Some of them relate to the possibility to detect the abnormal protein, this misfolded synuclein, which is mechanistic cause of most of the Parkinson we see in the clinic. It can be detected in the blood or in tissues like the skin, and it could be analyzed using some relatively modern, but well established methodologists like real time quaking expansion. So whether it’s an approach that has been tested previously and has been partially useful during the COVID time, Now we can see this protein and this aggregates being opened up and we can actually make a diagnosis, potentially ensure that the patient has the pathology ongoing even before they rigidity the prediabetes or the tremor appear.
So this is relevant because there is another aspect that we have learned. A significant and proportion of people with Parkinson present genetic mutations.
Some of them are causative. Others are risk factors, but now that we have our us to sustain and allow to screen a large number of genes, it will be important to inform people if that specific mutation is the cause of the disease or it is a different mechanism ongoing. So the second, say, important take home message which is coming from the discovery of biomarkers is that we now have novel treatments that are under development that may tackle the disease from a biological perspective.
So instead of symptomatically replace the missing dopamine in the brain, we can now provide immunocytopies or small molecules that can block protein aggregation, and this will have an impact. Hopefully, on progression of the disease, and if effective, it could be applied even before the class c motor symptoms appear. To people who are manifesting biomarker changes, and this should be probably the future application of this advanced therapies.
I think there was another important aspect that was highlighted here which is the importance to recognize functional movement disorders and functional neurological disorder The wording functional has been often misinterpreted that people think that if you have a movement, which is involuntary, and which is a bit funny or nonhand consistent, people make it up or they have some underlying psychiatric conditions.
While we now understand that the dysfunction in specific areas of the brain, which are responsible of making us aware of the movement that we make are damaged in these people.
So these people suffer from a disorder in the posterior part of the brain, palliative Emperor cortex, which is responsible of giving us awareness of the movements that we make. So if I move my hand, I’m aware that I moved it But if I have a dysfunction of this area, my hand moves, I will never become aware that the hand has moved, and I think that something wrong is happening, and someone else is moving their hand for me. So these people don’t have psychiatric manifestations as we have consider them in the past, but they have a selective dysfunction in brain areas that are responsible for motor control.
