As Michael J. Fox launches documentary, specialist talks Parkinson's treatment, research

May 11, 2023
Man with brown hair, blue eyes and a goatee is wearing a black shirt and smiling in front of a white and yellow background.
Michael J. Fox arrives at "A Country Thing Happened On The Way To Cure Parkinson's" at The Fisher Center in Nashville, Tenn. (AP Photo/George Walker IV)

The 61-year-old actor Michael J. Fox has become the charming, self-deprecating face of Parkinson’s disease for a lot of people. He’s been discussing his condition lately while promoting a documentary about his life called “Still.”

Fox, who also starred in “Back to the Future,” “Doc Hollywood,” “Spin City” and “Family Ties,” spoke frankly in an interview with CBS. "I recognize how hard this is for people, and I recognize how hard it is for me, but I have a certain set of skills that allow me to deal with this stuff," Fox said. "And I realize, with gratitude, optimism is sustainable."

Gonzalo Revuelta, D.O., directs the Murray Center for Research in Parkinson's Disease and Related Disorders at the Medical University of South Carolina. “Michael J. Fox has been amazing as far as establishing his foundation and raising funds. He's been inspirational,” Revuelta said.

But not everyone with Parkinson’s has the platform – or the knowledge – that Fox has. So Revuelta recently sat down to discuss:

  • How the disease works.
  • Highly effective treatments for its symptoms.
  • Research focusing on a condition that affects almost 1 million Americans from all walks of life.

Cause of Parkinson’s disease

Revuelta said the cause of Parkinson’s comes down to the loss of nerve cells in an area of the brain called the substantia nigra. They’re supposed to make a chemical the brain uses to tell the body how to move. When neurons get damaged or die, the survivors can’t keep up with the body’s demands. “At a basic level in Parkinson’s, there's a lack of dopamine,” Revuelta said.

Scientists aren’t sure what causes Parkinson’s. They think genetics and the environment may be the culprits. 

However, scientists are sure that Parkinson’s has a wide range of effects. “I had a patient tell me once that if you've met one patient with Parkinson's, you've met one patient with Parkinson's. So it is pretty clear once you go to one of our Parkinson's clinics that every patient is very different,” Revuelta said. “They have similar symptoms, but they affect their lives very differently. They manifest very differently.”

Revuelta said people tend to think of Parkinson’s as causing tremors. “But many patients with Parkinson's don't have tremors at all.”

Other symptoms of Parkinson’s include:

  • Stiffness.
  • Slow movement.
  • Problems with balance.

Some people with Parkinson’s have memory and attention problems along with anxiety and depression. The disease can also cause dementia.

The age of diagnosis is usually between the ages of 55 and 65. “But we have many young onset patients in their thirties and forties and even juvenile patients who are children when they’re diagnosed.”

Highly effective treatments

Michael J. Fox was diagnosed with Parkinson’s when he was 29 years old, more than 30 years ago. Revuelta said while that’s an early age to develop the condition, it’s not unusual for Parkinson’s patients to live long, productive lives. “It's not just your grandpa's Parkinson's disease. It's a very treatable condition.”

That’s thanks in great part to the medication levodopa. Revuelta called it a miracle drug. “I wouldn't be here if it wasn't for the discovery of levodopa because that's what led to this field of therapeutics for patients with Parkinson's disease.”

Levodopa serves as way to replace lost dopamine. 

Other medications include: 

  • Dopamine agonists that make the brain think it’s getting dopamine.
  • Amantadine, which can help reduce tremors.
  • Adenosine A2A antagonists that block a receptor in the brain.
  • COMT inhibitors, which prolong levodopa’s effects.
  • Anticholinergic medications that block a brain chemical that affects movement.
  • MAO-B inhibitors that keep an enzyme from reducing the amount of dopamine in the brain.

Source: Parkinson’s Foundation

Revuelta also described another way to treat Parkinson’s. It focuses on a brain circuit that’s malfunctioning. “We place an electrode deep in the brain within that circuit, fixing the way it works.”

That’s called deep brain stimulation. It energizes areas that affect movement, which can help people with tremors, rigidity and other symptoms.

Revuelta specializes in using deep brain stimulation to help Parkinson’s patients who have trouble walking. That’s also known as freezing of gait. People with this symptom may involuntarily pause before walking or feel stuck and unable to walk. They may also shuffle and/or walk in a stooped position.

Gonzalo J. Revuelta, DO 
Dr. Gonzalo Revuelta

Exercise is another way for people with Parkinson’s to ease symptoms. MUSC has a program called Rock Steady Boxing at the Wellness Center for Parkinson’s patients. It’s known for energizing participants and improving flexibility and balance through no-contact boxing, stretching, balance and strength training and more.

Whatever treatment approach patients and doctors take, Revuelta said it’s important to get diagnosed as early as possible. “You need to treat it aggressively and to stay really active with Parkinson's. If you don't know what it is and it's not addressed, patients don't do well.”

Revuelta said there’s plenty of help out there. MUSC alone has multiple movement disorder neurologists to work with Parkinson’s patients. “Last I checked, we were following about 3,200 patients of Parkinson's in a year.”

Those patients can see dramatic changes in their conditions. “The symptoms of Parkinson's are treated extremely well. There's tons of medical options, surgeries, therapies. In many other neurological diseases that is not at all the case.”

Parkinson’s research

MUSC has the only Parkinson’s research center in South Carolina. It’s a Center of Excellence for the Parkinson’s Foundation. “We're trying to find something that slows down progression of Parkinson's,” Revuelta said. “By the time we can diagnose Parkinson's clinically, a lot of the damage has been done. So we're trying to find a test that identifies Parkinson's before you get symptoms.”

The Michael J. Fox Foundation for Parkinson’s Research recently announced a test that it said can find “Parkinson’s protein” in cells in the brain and body. Revuelta said that protein has been under intense scrutiny. 

“One of the theories is that [the protein] alpha synuclein has a lot to do with Parkinson's disease, and if you identify it at a higher level that means that you are going to develop Parkinson's disease or you have Parkinson's disease. So to me, it, the research area, is interesting.”

But it’s far from the end of Parkinson’s research. MUSC has five labs focused on the disease and has multiple clinical trials underway. “The big categories of research are basically neuroprotection, which is slowing disease progression. Another angle on a neuroprotection is to understand the subtypes of Parkinson's better. We're getting down to the nitty gritty where we have a lot more genetic diagnoses of Parkinson's,” Revuelta said.

“We have over a half dozen different clinical trials ongoing right now aiming to develop new symptomatic therapies for Parkinson’s disease. We are very proud of the research that is started here at MUSC, studies funded by the NIH. I hope that patients out there recognize that we're here for them clinically and the importance of participating in research.”

Revuelta hopes Michael J. Fox’s public comments about Parkinson’s and his new documentary will help them recognize that as well. His team used to give patients books that Fox wrote about living with Parkinson’s. Now, it may add “Still” to its list of suggested educational materials.

“We all want to cure for Parkinson's, of course. But there are many important options already available.”

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