Dubai: An innovative treatment for the management of Parkinson’s disease (PD) that was introduced recently at a Dubai hospital is in the spotlight after patients reported a significant improvement in their conditions.
The King’s College Hospital (KCH) of London’s Dubai branch started its Parkinson’ Clinic and initiated the Levodopa Infusion Therapy. This new therapy — approved by the Food and Drug Administration in the United States and which was in practise in the United Kingdom for more than ten years — is now providing dramatic results in Dubai as well, the clinic claims. the Levodopa Infusion Therapy is now providing dramatic results in Dubai
What is PD?
Parkinson’ Disease (PD) is a progressively deteriorating neuro-degenerative disease caused by the breaking down of the cells in the nervous system. A patient of PD goes through five progressively deteriorating phases, which begins with slight motor tremors and moves to muscle rigidity, difficulty in walking to a stage where the patient is finally confined to a wheelchair. Patients also experience slurring of speech, loss of control of the muscles in the jaw leading to drooling, severe constipation and depression. Drugs such as Levodopa are used in the management of PD, which has so far defied a cure. However, the oral consumption of such drugs slows down their absorption into the brain with time and the condition of the patient deteriorates. In the next three decades, PD is projected to reach epidemic proportions and one in eight people over the next 80 years is expected to suffer from it.
How many people are affected by PD?
Globally, about ten million people are living with PD. In the UAE, more than 10,000 people suffer from the disease. Neurologists say age is the biggest risk factor in PD. It is considered the second most common nerve degeneration disease after Alzheimer’s disease. Worldwide, it affects about one per cent of the population above 60 years of age and it impacts about five per cent of the population.
Use of gel, instead of oral medication
KCH’s international Levodopa Infusion programme is led by Professor Dr Ray Chaudhari, consultant neurologist and director of the Parkinson’s Centre for Excellence, KCH, London, along with Dr Vinod Metta, consultant interventional neurologist and movement disorder specialist at KCH, Dubai. Dr Metta handles the clinical aspect of the therapy at KCH, Dubai.
Dr Guy Chung-Fay, consultant gastroenterologist, works as an expert in placing the external pump for the infusion therapy in KCH, Dubai.
Speaking to Gulf News, Dr Metta who is currently treating more than 160 PD patients at KCH, Dubai, said: “The infusion therapy uses Levodopa, the gold standard treatment of PD in a gel form, instead of oral ingestion. The gel is infused through a small cassette into the body through an external pump at a very precise calibration into the stomach and directly to the small bowel. The gel is then absorbed by the brain. This direct infusion of the gel into the brain helps patients overcome motor and neurological symptoms of PD.”
How the infusion works
The medicine is used in combination with Carbidopa. This is a decarboxylase inhibitor and prevents the levodopa from being broken down before it reaches the brain. From the small bowel, the levodopa is directly absorbed into the blood stream and into the brain where it is converted into dopamine.
Dopamine is a type of a neurotransmitter that enables the body to exchange messages with the nervous system, something that gets impaired in PD patients. So when the levodopa is directly converted into dopamine in the brain and it bypasses the entire system, much smaller amounts are required than in case of oral ingestion.
Dr Metta added: “I have patients who were taking about 1,800mg of the medication in oral form. Now, in the gel form, they require only one or two mg of the medicine with far more effective impact. In oral ingestion, after five to six years, despite increasing the dosage, the drug gets progressively ineffective and the patient suffers from degeneration of his symptoms.”
With the infusion treatment, patients with advance PD, who suffer from motor weakness, tremors and were confined to wheelchair, were able to stand up, walk without help, have a long period without tremors and were able to go about life without much help. The infusion pump works like the insulin pump in diabetics, providing a carefully calibrated amount of medicine directly into their intestine.
The first two patients to receive the Levodopa Infusion — Diksha Raja and Felerman Villanueva — said they were doing remarkably well, much to the relief of their respective families.
Take the case of Raja, 65, a British national who had come in December 2019 to pay a visit to her daughter in Dubai. Raja, a patient of PD for 15 years and on oral medication, was unable to return to the UK due to the subsequent lockdown. As her condition deteriorated, her daughter Reena Oates, a Dubai resident, looked up the internet for some new treatment.
“I came across this therapy offered at KCH, Dubai, and since my mother was from UK and under treatment there with neurosurgeons, we decided to seek a second opinion at KCH, Dubai. Within four weeks of getting the Levodopa infusion, my mother, who could not even stand up without a wheelchair, could actually walk on her own, go to the supermarket, hug her grandchildren and do many things without assistance. She still gets tremors etc., but there has been a remarkable improvement as she is able to use her limbs, get exercise and has been in general, doing better. She is all set to fly back to the UK,” said Oates with obvious relief and happiness.
A similar case was that of Filipino national Villanueva, 56, who has been suffering from the debilitating neuro degenerative disorder for 13 years. He had contracted COVID-19 and had to be admitted to KCH, Dubai, for treatment, where doctors taking down his history told him about the infusion therapy. Within four weeks of the therapy, Villanueva was able to not only walk but also do push-ups — unaided — and found himself reclaiming a part of who he was prior to his PD diagnosis.
Feliza Lynne ‘ZsaZsa’ Villanueva, his daughter, told Gulf News: “We were fortunate that my father was able to get a residence visa sponsored by my mother’s company. However, he contracted COVID-19 last year and was admitted to KCH, Dubai. However, the illness proved to be a boon in disguise for my father because he was able to meet Dr Metta and take this treatment. My father, who was a fun-loving person prior to PD, had, over the last decade, become very shy, timid and depressed. In fact, the oral medications were no longer working effectively and as a family we thought he would not survive for too long as he had grown progressively frail over the last few years. It is remarkable how he has bounced back within four months of the infusion pump procedure. This treatment has enabled him to do things we could not even imagine he would be able to do unassisted. Only four months ago, he needed help to get out of the wheelchair, to change his clothes, to brush. Now he is able to stand up on his own, walk, jog, exercise, talk, smile and I am so glad he seems like the person he was, 13 years ago.”
Such has been the remarkable impact of this procedure that Dr Metta, who treated Raja and Villanueva as his first two patients in Dubai last year, said he was now regularly visiting Dubai as a consultant at KCH and had about 160 patients seeking the same treatment at the Parkinson’s Clinic.
Cost of Procedure
So far, while, patients can afford the small surgery to fix the pump, the cost of the cassettes of Levodopa is high. ZsaZsa, the daughter of Villanueva, said that it was costing the family about Dh24,000 per month to provide the medication to her father and hoped this cost would come down. Few health insurances cover such expensive pre-existing chronic disease and families of patients hope that the cost of the drug will be slashed to make it affordable.
What Friends of Parkinson’s Association says
In a touching gesture of solidarity towards patients receiving the Levodopa Infusion Therapy treatment at KCH, Dubai, members of the Friends of Parkinson’s Association UAE felicitated Raja, the first patient to avail this treatment in Dubai. This was part of a community outreach programme organised by the association last month.
The felication ceremony had a delegation led by Shaikha Fatima Bint Hasher bin Dalmouk Al Maktoum, accompanied by Huzaifa Ibrahim, founder and president of Friends of Parkinson’s UAE, who visited Raja to congratulate her on her progress following the treatment. Raja had come to Dubai from London to visit her daughter and was able to undergo this therapy when her condition deteriorated. Thanks to the treatemnt, Raja was able to fly back home with remarkable improvement.
* Slow movement (bradykinesia).
* Rigid muscles.
* Impaired posture and balance.
* Loss of automatic movements.
* Changes in speech.
* Changes in writing.
* Dance therapy for people in earlier stages of PD is recommended.
The delegation included important dignitaries such as Ahmed Bin Hasher Al Robban, Khaled Nawab, chairman of the board of directors at Nabdh Al Emarat Volunteering Team, Ali Abbas Nasser Alhawai, community engagement programmes coordinator for Friends of Parkinson’s, UAE.
This visit highlighted the special care that Shaikha Fatima bint Hasher bin Dalmouk Al Maktoum takes of patients in general and Parkinson’s patients in particular.
Other treatments for PD
There is no cure for PD, but with medicines, exercise and certain interventional therapies it is possible for PD patients to enjoy a fairly good quality of life, However, they require tremendous support from their friends, family and the community.
Apart from the Levodopa Infusion Therapy, which has just been introdcued in the UAE at KCH, Dubai, other hospitals offer Deep Brain Stimulation Therapy (DBS).
DBS is a treatment to alleviate some symptoms of PD like tremors, stiffness and difficulty in walking. DBS Therapy involves implanting electrodes within certain areas of the brain of a PD patient. These electrodes produce electrical impulses that regulate abnormal impulses. This method is greatly effective in PD patients, but is also used to treat tremors in other disease like epilepsy. In PD, one sees patients suffer from tremors, stiffness, rigidity, extreme tics and so on. DBS does not cure the disease, but is able to help counter most of these symptoms, halve the medications and provide a good quality of life for the patient. The amount of stimulation in DBS is controlled by a pacemaker-like device that is like a battery. It is placed under the skin in the upper portion of the chest. A wire under the skin connects this device to the electrodes in the brain. However, neuroligsts say this theapy is used in very extreme cases when patients are largely unresponsive to medication and experience extreme rididity or ‘freezing’ of limbs.