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Drugs & Aging

, Volume 36, Issue 2, pp 103–113 | Cite as

Parkinson’s Disease in the Era of Personalised Medicine: One Size Does Not Fit All

  • Lauren E. Ryden
  • Simon J. G. LewisEmail author
Leading Article

Abstract

The concept of personalised medicine in Parkinson’s disease has arrived where the implications of findings made in research are certain to have an increasing impact upon clinical practice. Disease heterogeneity in Parkinson’s disease has been well described and lends itself to the construct of personalised medicine where it is hypothesised that a greater understanding of genetic and pathophysiological contributions may underpin the sub-groups described. This in turn has driven the development of potentially individualised disease-modifying therapies where, for example, we are beginning to see treatments that target patients with Parkinson’s disease with specific genetic mutations. Furthermore, clinicians are increasingly recognising the need to tailor their management approach to patients depending on their age of presentation, acknowledging differential side-effect profiles and responses especially when considering the use of device-assisted technologies such as infusion or surgery. Clearly, individualising the treatment of both motor and non-motor symptoms will remain imperative but, in the future, personalised medicine may provide clearer insights into various aspects of a patient’s symptomatology, disease course and thus the best therapeutic approaches.

Notes

Compliance with Ethical Standards

Funding

Lauren E. Ryden receives a salary from the University of Sydney, ForeFront group and is currently completing a Neurodegenerative Disease Fellowship at the Brain and Mind Centre, Sydney, NSW, Australia. Simon J.G. Lewis is supported by an NHMRC-ARC Dementia Fellowship (#1110414) and funding to ForeFront, a collaborative research group at the Brain and Mind Centre, University of Sydney, from the NHMRC programme (#1132524), Dementia Research Team (#1095127), NeuroSleep Centre of Research Excellence (#1060992) grants and a Sydney Research Excellence Initiative 2020 grant. No sources of funding were received for the preparation of this article.

Conflict of interest

Lauren E. Ryden and Simon J. G. Lewis have no conflicts of interest that are directly relevant to the contents of this article.

References

  1. 1.
    Ginsburg GS, Willard HF. Genomic and personalized medicine: foundations and applications. Transl Res. 2009;154(6):277–87.CrossRefGoogle Scholar
  2. 2.
    Obeso JA, Stamelou M, Goetz CG, et al. Past, present, and future of Parkinson’s disease: a special essay on the 200th anniversary of the shaking palsy. Mov Disord. 2017;32(9):1264–310.CrossRefGoogle Scholar
  3. 3.
    Titova N, Padmakumar C, Lewis SJ, et al. Parkinson’s: a syndrome rather than a disease? J Neural Transm (Vienna). 2017;124(8):907–14.CrossRefGoogle Scholar
  4. 4.
    Ehgoetz Martens KA, Shine JM, Walton CC, et al. Evidence for subtypes of freezing of gait in Parkinson’s disease. Mov Disord. 2018;33(7):1174–8.CrossRefGoogle Scholar
  5. 5.
    Mu J, Chaudhuri KR, Bielza C, et al. Parkinson’s disease subtypes identified from cluster analysis of motor and non-motor symptoms. Front Aging Neurosci. 2017;9:301.CrossRefGoogle Scholar
  6. 6.
    Lawton M, Baig F, Rolinski M, et al. Parkinson’s disease subtypes in the Oxford Parkinson Disease Centre (OPDC) discovery cohort. J Parkinsons Dis. 2015;5(2):269–79.CrossRefGoogle Scholar
  7. 7.
    Lewis SJ, Foltynie T, Blackwell AD, et al. Heterogeneity of Parkinson’s disease in the early clinical stages using a data driven approach. J Neurol Neurosurg Psychiatry. 2005;76(3):343–8.CrossRefGoogle Scholar
  8. 8.
    Erro R, Vitale C, Amboni M, et al. The heterogeneity of early Parkinson’s disease: a cluster analysis on newly diagnosed untreated patients. PLoS One. 2013;8(8):e70244.CrossRefGoogle Scholar
  9. 9.
    Szeto JY, O’Callaghan C, Shine JM, et al. The relationships between mild cognitive impairment and phenotype in Parkinson’s disease. NPJ Parkinsons Dis. 2015;1:15015.CrossRefGoogle Scholar
  10. 10.
    Mestre TA, Eberly S, Tanner C, et al. Reproducibility of data-driven Parkinson’s disease subtypes for clinical research. Parkinsonism Relat Disord. 2018.  https://doi.org/10.1016/j.parkreldis.2018.07.009 (Epub ahead of print).Google Scholar
  11. 11.
    Selikhova M, Williams DR, Kempster PA, et al. A clinico-pathological study of subtypes in Parkinson’s disease. Brain. 2009;132(Pt 11):2947–57.CrossRefGoogle Scholar
  12. 12.
    Fahn S, Jankovic J, Hallett M. Principles and practice of movement disorders. 2nd ed. Edinburgh: Elsevier/Saunders; 2011. p. 548 (vii).Google Scholar
  13. 13.
    Sulzer D, Alcalay RN, Garretti F, et al. T cells from patients with Parkinson’s disease recognize alpha-synuclein peptides. Nature. 2017;546(7660):656–61.CrossRefGoogle Scholar
  14. 14.
    Dzamko N, Geczy CL, Halliday GM. Inflammation is genetically implicated in Parkinson’s disease. Neuroscience. 2015;302:89–102.CrossRefGoogle Scholar
  15. 15.
    Alessi DR, Sammler E. LRRK2 kinase in Parkinson’s disease. Science. 2018;360(6384):36–7.CrossRefGoogle Scholar
  16. 16.
    O’Donnell PH, Ratain MJ. Germline pharmacogenomics in oncology: decoding the patient for targeting therapy. Mol Oncol. 2012;6(2):251–9.CrossRefGoogle Scholar
  17. 17.
    Atashrazm F, Hammond D, Perera G, et al. Reduced glucocerebrosidase activity in monocytes from patients with Parkinson’s disease. Sci Rep. 2018;8(1):15446.CrossRefGoogle Scholar
  18. 18.
    Titova N, Chaudhuri KR. Personalized medicine and nonmotor symptoms in Parkinson’s disease. Int Rev Neurobiol. 2017;134:1257–81.CrossRefGoogle Scholar
  19. 19.
    Nandipati S, Litvan I. Environmental exposures and Parkinson’s disease. Int J Environ Res Public Health. 2016;13(9):881.  https://doi.org/10.3390/ijerph13090881.CrossRefGoogle Scholar
  20. 20.
    Antonini A, Moro E, Godeiro C, et al. Medical and surgical management of advanced Parkinson’s disease. Mov Disord. 2018;33(6):900–8.CrossRefGoogle Scholar
  21. 21.
    Giugni JC, Okun MS. Treatment of advanced Parkinson’s disease. Curr Opin Neurol. 2014;27(4):450–60.CrossRefGoogle Scholar
  22. 22.
    Silberstein P, Bittar RG, Boyle R, et al. Deep brain stimulation for Parkinson’s disease: Australian referral guidelines. J Clin Neurosci. 2009;16(8):1001–8.CrossRefGoogle Scholar
  23. 23.
    Trenkwalder C, Chaudhuri KR, Garcia Ruiz PJ, et al. Expert Consensus Group report on the use of apomorphine in the treatment of Parkinson’s disease: clinical practice recommendations. Parkinsonism Relat Disord. 2015;21(9):1023–30.CrossRefGoogle Scholar
  24. 24.
    Fung VS. New and emerging treatments for Parkinson disease. Med J Aust. 2015;202(6):283–4.CrossRefGoogle Scholar
  25. 25.
    Thenganatt MA, Jankovic J. Parkinson disease subtypes. JAMA Neurol. 2014;71(4):499–504.CrossRefGoogle Scholar
  26. 26.
    Schrag A, Hovris A, Morley D, et al. Young- versus older-onset Parkinson’s disease: impact of disease and psychosocial consequences. Mov Disord. 2003;18(11):1250–6.CrossRefGoogle Scholar
  27. 27.
    Calne SM, Kumar A. Young onset Parkinson’s disease: practical management of medical issues. Parkinsonism Relat Disord. 2008;14(2):133–42.CrossRefGoogle Scholar
  28. 28.
    Seier M, Hiller A. Parkinson’s disease and pregnancy: an updated review. Parkinsonism Relat Disord. 2017;40:11–7.CrossRefGoogle Scholar
  29. 29.
    Chen JJ, Swope DM, Dashtipour K. Comprehensive review of rasagiline, a second-generation monoamine oxidase inhibitor, for the treatment of Parkinson’s disease. Clin Ther. 2007;29(9):1825–49.CrossRefGoogle Scholar
  30. 30.
    Weintraub D, David AS, Evans AH, et al. Clinical spectrum of impulse control disorders in Parkinson’s disease. Mov Disord. 2015;30(2):121–7.CrossRefGoogle Scholar
  31. 31.
    Lenka A, Padmakumar C, Pal PK. Treatment of older Parkinson’s disease. Int Rev Neurobiol. 2017;132:381–405.CrossRefGoogle Scholar
  32. 32.
    Lewis SJ, Gangadharan S, Padmakumar CP. Parkinson’s disease in the older patient. Clin Med (Lond). 2016;16(4):376–8.CrossRefGoogle Scholar
  33. 33.
    Meng Y, Voisin MR, Suppiah S, et al. Is there a role for MR-guided focused ultrasound in Parkinson’s disease? Mov Disord. 2018;33(4):575–9.CrossRefGoogle Scholar
  34. 34.
    Williams DR, Evans AH, Fung VS, et al. Practical approaches to commencing device-assisted therapies for Parkinson disease in Australia. Intern Med J. 2017;47(10):1107–13.CrossRefGoogle Scholar
  35. 35.
    Lee JY, Lee EK, Park SS, et al. Association of DRD3 and GRIN2B with impulse control and related behaviors in Parkinson’s disease. Mov Disord. 2009;24(12):1803–10.CrossRefGoogle Scholar
  36. 36.
    Lewis SJ. Disease-modifying approaches for Parkinson disease. Med J Aust. 2018;208(9):377–8.CrossRefGoogle Scholar
  37. 37.
    Stebbins GT, Goetz CG, Burn DJ, et al. How to identify tremor dominant and postural instability/gait difficulty groups with the movement disorder society unified Parkinson’s disease rating scale: comparison with the unified Parkinson’s disease rating scale. Mov Disord. 2013;28(5):668–70.CrossRefGoogle Scholar
  38. 38.
    Klein C, Westenberger A. Genetics of Parkinson’s disease. Cold Spring Harb Perspect Med. 2012;2(1):a008888.CrossRefGoogle Scholar
  39. 39.
    Pagano G, Ferrara F, Brooks DJ, et al. Age at onset and Parkinson disease phenotype. Neurology. 2016;86(15):1400–7.CrossRefGoogle Scholar
  40. 40.
    Thaler A, Bregman N, Gurevich T, et al. Parkinson’s disease phenotype is influenced by the severity of the mutations in the GBA gene. Parkinsonism Relat Disord. 2018;55:45–9.CrossRefGoogle Scholar
  41. 41.
    Ferreira M, Massano J. An updated review of Parkinson’s disease genetics and clinicopathological correlations. Acta Neurol Scand. 2017;135(3):273–84.CrossRefGoogle Scholar
  42. 42.
    O’Regan G, deSouza RM, Balestrino R, et al. Glucocerebrosidase mutations in Parkinson disease. J Parkinsons Dis. 2017;7(3):411–22.CrossRefGoogle Scholar
  43. 43.
    Nyholm D. Duodopa® treatment for advanced Parkinson’s disease: a review of efficacy and safety. Parkinsonism Relat Disord. 2012;18(8):916–29.CrossRefGoogle Scholar
  44. 44.
    Katzenschlager R, Poewe W, Rascol O, et al. Apomorphine subcutaneous infusion in patients with Parkinson’s disease with persistent motor fluctuations (TOLEDO): a multicentre, double-blind, randomised, placebo-controlled trial. Lancet Neurol. 2018;17(9):749–59.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Parkinson’s Disease Research Clinic, Brain and Mind CentreUniversity of SydneyCamperdownAustralia

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