Did you know that one of the most effective treatments for Parkinson's disease, levodopa, may also be obtained from a plant? In this video, I discuss an important challenge facing the Parkinson's community: millions of people around the world lack reliable access to this essential medication. We explore the potential of plant-based sources of levodopa, including Mucuna pruriens, and how researchers are investigating ways to make treatment more accessible and affordable. The challenge is not simply growing a plant. It is finding safe, reliable ways to deliver consistent doses of levodopa to people who need it. Plant-based preparations are not yet a standardized replacement for prescription levodopa. I believe that where you live or how much money you have should never determine whether you can receive effective Parkinson's treatment. Levodopa for all should be a global priority. youtube.com/shorts/9N_La16hj…

What resonates most with me about the exciting new Parkinson’s drug solengepras (CVN424) is that it represents a genuinely novel mechanism of action and a potential new addition to our treatment armamentarium. Rather than acting directly on dopamine, this once-daily medication blocks the GPR6 receptor in the brain’s indirect motor pathway, essentially easing the foot off the brain’s brake on movement. In the Phase 3 ARISE trial involving 341 people with Parkinson’s disease, the 150 mg dose reduced daily OFF time by 1.56 hours compared with 0.95 hours on placebo, a net benefit of approximately ~30-40 minutes per day, while also increasing good ON time without troublesome dyskinesia. These are modest but meaningful improvements, particularly for patients struggling with unpredictable motor fluctuations. The study also reported improvements in daily functioning, daytime sleepiness, and quality of life, although insomnia was more common (6.2% versus 0.9% with placebo). What excites me is not that this drug is a game changer for everyone, but that we are finally expanding beyond traditional dopamine-based approaches. Every additional treatment option matters, and even 30–40 minutes of better movement each day can make a difference for some people living with Parkinson’s. One important clarification: solengepras has not yet received FDA approval. These positive Phase 3 results are an encouraging step toward a potential regulatory submission, and we should celebrate the progress while awaiting full data and FDA review.

What resonates with me about this excellent review of gastroparesis is how relevant it is to Parkinson’s disease and parkinsonism, where impaired gastric motility can become much more than a gastrointestinal symptom: delayed emptying can contribute to nausea, bloating and early satiety, but it can also make absorption of critical Parkinson’s medications, particularly levodopa, delayed and unpredictable. The review specifically recognizes Parkinson’s as a neurological risk factor for gastroparesis and reminds us how remarkably limited our therapeutic toolbox remains. Metoclopramide is the only FDA-approved drug for gastroparesis, yet because it blocks dopamine D2 receptors and carries a risk of parkinsonian symptoms and tardive dyskinesia, it is generally a particularly poor choice for people with Parkinson’s and other parkinsonian disorders. This is where I think we should all be making more noise: domperidone (Motilium), a peripheral dopamine antagonist commonly used in many countries, does not readily cross the blood-brain barrier and can be useful in Parkinson’s, yet it remains unavailable as a routinely FDA-approved prescription in the United States because of cardiac safety concerns. We need safer treatments, better trials and a workable regulatory pathway because for people with Parkinson’s, the stomach can determine whether the medication that works beautifully on paper actually reaches the brain when it is needed. You will find domperidone sold all over the world, and here are some of the names it goes by in different countries: Motilium, Motilium Rapid, Peridon, Peridys, Cilroton, Cinet, Costi, Domstal, Domperitop, Nauzelin, Neoperidys, Oroperidys, Permotil, Remotil, Riges, Tametil, Touristil, and Zilium. jamanetwork.com/journals/jam…

Focused ultrasound and pallidotomy: what can lesions teach us that DBS cannot? A lesion means creating a permanent interruption in a brain circuit. Deep brain stimulation (DBS) uses electricity to modulate and reshape abnormal circuits without destroying tissue and importantly it can be adjusted, optimized and reversed if needed. Adam Zaidel and colleagues described in a fascinating paper (2008) in the European Journal of Neuroscience how prior pallidotomy lesions altered the physiology of the subthalamic nucleus (STN) years later in folks living w/ Parkinson's disease. As focused ultrasound lesioning rapidly expands across the globe, this older work may provide important clues into how lesion therapies and DBS differ in their effects on brain circuits. Thanks to my friend Hagai for reminding me about this one. Key points: - Prior pallidotomy reduced abnormal activity and oscillations in the STN, suggesting that lesioning one node in a network can reshape activity in distant connected regions. - The effects were durable and measurable years later, supporting the idea that lesion therapies may permanently reset portions of dysfunctional brain circuitry. - Despite these changes, STN DBS remained effective in many individuals, highlighting that lesioning and stimulation may improve symptoms through overlapping but distinct mechanisms. My take: The recent enthusiasm surrounding focused ultrasound is exciting and appropriate. For carefully selected folks, lesion therapies can be transformative. However, focused ultrasound and DBS are fundamentally different interventions and should not be viewed as interchangeable. DBS is more like installing a dimmer switch in a room. You can turn it up, turn it down, move the settings around and adapt as the disease evolves. Focused ultrasound is more like removing a wire from the circuit entirely. Sometimes that may be exactly the right strategy, however, once the wire is cut there is no putting it back. Here are 5 points that resonated w/ me: 1- Lesions teach us important aspects of neuroscience because they reveal what happens when a node in a brain network is permanently removed. 2- DBS teaches us something different because it allows us to observe and manipulate brain networks in real time. 3- Parkinson's disease and tremor are network disorders and not simply diseases of one structure or one target. 4- The reversibility and programmability of DBS remain major advantages, especially for younger folks and for diseases that evolve over decades. 5- Focused ultrasound and DBS should not compete against one another. The future is matching the right therapy to the right person at the right time in their disease journey. The next decade will likely teach us that lesioning and stimulation are complementary tools. Understanding when to use each may be every bit as important as understanding how they work. onlinelibrary.wiley.com/doi/… #parkinson #tremor

Join the revolution in interdisciplinary neurological care at the Norman Fixel Institute for Neurological Diseases at the University of Florida. We believe the person living w/ disease is the sun, and every member of the care team orbits around helping them live their best possible life. If you are a social worker who believes care should be coordinated, compassionate and deeply human, this is your opportunity to help redefine what Parkinson’s disease, dystonia, Alzheimer's, ALS and movement disorders care can look like. Work side-by-side w/ neurologists, therapists, neuropsychologists, nurses, researchers and families in one truly integrated environment. If you believe the person w/ disease is the sun, then apply for this job: explore.jobs.ufl.edu/en-us/j…

The people have spoken and the company is listening. We have reached a public health milestone. “For decades we have warned that certain pesticides increase the risk of Parkinson’s and other serious diseases. This moment proves that advocacy, data and courage can change the trajectory of disease.” "Fewer people are going to develop Parkinson’s disease in the future.” "The voices of the Parkinson’s community, the voices of those who’ve been highlighting the toxic effects of this weed killer … are being heard and they’re having an impact.” Folks w/ Parkinson's, "tell your story," as that is the best way to create impact and contribute to the PLAN. pdplan.org theguardian.com/environment/…