Health Life

Finding right drug balance for Parkinson’s patients

A representation of how finger tapping frequency is used to determine the appropriate levodopa dose in treating Parkinson’s disease. Credit: Florence Véronneau-Veilleux

Parkinson’s disease is most commonly treated with levodopa, a drug which alleviates the slowing of bodily movements, called bradykinesia, found in Parkinson’s disease patients.

But the benefits of levodopa wear off as the disease progresses. The relationship between its dosage and its effectiveness becomes fuzzy, and high doses can result in dyskinesia, which are involuntary and uncontrollable movements.

To better understand the underlying reasons behind these effects, researchers from the Université de Montréal, University of Bologna, and University of Ottawa created a model of the interactions between levodopa, dopamine, and the , an area of the brain that plays a crucial role in Parkinson’s disease. They discuss their findings in the journal Chaos.

“In Parkinson’s disease, the dopaminergic neurons of the basal ganglia are dying, which results in a lower concentration of dopamine. Levodopa is effective at the beginning of the disease, because it can be transformed into dopamine by the remaining dopaminergic neurons,” said Florence Véronneau-Veilleux, one of the authors. “However, at advanced stages of disease, there are not enough remaining for levodopa to prevent symptoms.”

Once they confirmed the accuracy of their model by using it to predict behavior like modification of dopamine dynamics with neuron degeneration, the group used it to simulate a patient tapping their finger a few hours after taking levodopa, a clinical assessment of bradykinesia.

What they found verified suspicions about the progression of Parkinson’s disease. Eventually, as the brain loses more and more of its , its dopamine concentration falls, and no amount of levodopa can compensate for this. This leads to a competition of effects, in which maintaining low levels of levodopa is not

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Is a clinical trial right for you?

Do you take a statin for high cholesterol? Does ibuprofen help you with aches and pains? These medicines were once studied in a clinical trial. Now, millions of people take them every day.

Clinical trials or studies happen when medicines or tools that have been tested for safety in a lab are ready to test in people. Some people participate in clinical trials because none of the standard (approved) treatment options have worked, or they are unable to tolerate certain side effects. For others, it’s an opportunity to help researchers find new ways to prevent, detect, or treat diseases.

A number of clinical trials take place right at the National Institutes of Health (NIH) through the NIH Clinical Center, the nation’s largest research hospital.  

Clinical trials evaluate:

  • New ways to find a disease early, sometimes before there are symptoms
  • How to safely use a treatment or different ways to use current treatment more effectively
  • New approaches to surgery and new medical devices
  • Vaccines and lifestyle changes that can help prevent a disease
  • Improvements to the comfort and quality of life for people with short- or long-term illnesses

How do clinical trials work?

The idea for a clinical trial often starts in a lab, where scientists identify a promising potential treatment for development and conduct experiments to gather information to find out if it could cause serious harm. Following this research and testing, the Food and Drug Administration (FDA) may then give approval for testing in humans in a clinical trial.

Clinical trials happen in a series of four steps called “phases.” Each has a different purpose and helps researchers answer different questions about treatments, risks, and side effects.

  • Phase I: Researchers study a new treatment in a small group of people (20 to 80) to identify the correct dose and
Health Life

The geographic bias in medical AI tools

Credit: Pixabay/CC0 Public Domain

Just a few decades ago, scientists didn’t think much about diversity when studying new medications. Most clinical trials enrolled mainly white men living near urban research institutes, with the assumption that any findings would apply equally to the rest of the country. Later research demonstrated that assumption to be false; examples accumulated of medications that were later determined to be less effective or caused more side effects in populations that were underrepresented in the initial study.

To address these inequities, federal requirements for participation in were broadened in the 1990s, and now attempt to enroll diverse populations from the onset of the study.

But we are now at risk of repeating these same mistakes as we develop new technologies, such as AI. Researchers from Stanford University examined clinical applications of machine learning to find that most algorithms are trained on datasets from patients in only three , and that the majority of states have no represented patients whatsoever.

“AI algorithms should mirror the community,” says Amit Kaushal, an attending physician at VA Palo Alto Hospital and Stanford adjunct professor of bioengineering. “If we’re building AI-based tools for patients across the United States, as a field, we can’t have the data to train these tools all coming from the same handful of places.”

Kaushal, along with Russ Altman, a Stanford professor of bioengineering, genetics, medicine, and , and Curt Langlotz, a professor of radiology and biomedical informatics research, examined five years of peer-reviewed articles that trained a deep-learning algorithm for a diagnostic task intended to assist with patient care. Among U.S. studies where geographic origin could be characterized, they found the majority (71%) used patient data from California, Massachusetts, or New York to train the algorithms. Some 60%

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Confronting alcohol use disorder and misconceptions as a woman

Forty-one-year-old Christine* started experimenting with alcohol in her early teens.

The first time she tried it, she blacked out and became physically ill. While she instantly regretted that decision, she continued drinking for years, often taking it to the extreme.

“Things fell in place when I started listening and following directions. I didn’t feel like I was a victim anymore.”

“I completely went off the deep end,” she says. “I couldn’t imagine being in a social situation without alcohol. I wanted to feel included, interesting, funny, liked, and loved. Alcohol gave me all those things.”

In her early 20s, Christine started seeing a therapist. She talked about her feelings of guilt and regret over her behavior after a night of drinking. The therapist encouraged her to talk more about it, but she denied she had a problem.

“He told me that people who don’t have a problem with drinking don’t feel the way I always did after drinking,” she says. “That was the start of me realizing that maybe I did have a problem with alcohol.”

Alcohol use disorder (AUD) affects an estimated 15 million Americans. It is a medical condition that can cause you to be unable to control how much you drink. And when you’re not drinking, you may feel anxious, irritable, or stressed.

Seeking help

At the suggestion of her therapist, Christine joined a 12-step program. But she struggled early on to accept why she was there. She felt sorry for herself and regularly cried during meetings. When she was finally able to admit that she had a problem with alcohol, she began to take steps toward recovery.

“Things fell in place when I started listening and following directions,” she says. “I got a sponsor and learned how to cope physically, mentally, and spiritually. This helped me