Today I’m going to talk on two new developments in the management of Parkinson’s disease. Both of them have a significant influence on the way we will look at Parkinson’s disease, the first topic being about the new guidelines recently published in the Canadian Medical Journal and the other is about a unique ability to diagnose PD by smell.

Guidelines published in the Canadian Medical Journal: The guidelines have been divided into five sections as below:

1. Communication: People should be encouraged to make their own choices, the communication should be verbal and in written form, prognosis and expectations should be realistic and should also be on the phone to the family and caretakers.

2. Diagnosis: Parkinson’s disease should be suspected in any person suffering from slowness, tremors, gait and balance problems or stiffness. CT and MRI scans are usually not necessary for the diagnosis of Parkinson’s disease. No therapies are effective for slowing or stopping brain degeneration in Parkinson disease.

3. Treatment: Regular exercise regimen is of proven benefit. Dopamine replacement therapy is the first line of treatment. DBS and intestinal levodopa (DUODOPA) infusion are now routinely used to manage motor symptoms. Rehabilitation specialist may be of help in guiding the care of PD patients.

4. Nonmotor symptoms: Botulinum toxin A helps for drooling. Depression should be appropriately treated. Presence of Dementia does not exclude the diagnosis of PD. REM sleep disorder can predate the diagnosis of PD.

5. Palliative care: They may need support during all phases of PD.

The guideline also underscores the need for expanding the number of Healthcare workers, Parkinson disease nurses, occupational and physical therapist interested in the care of Parkinson’s disease, etc.

These guidelines have been drawn based on recommendations from UK, USA Scotland and Ireland. Dr. Veronica Bruno, department of clinical neurosciences, movement disorders program from Calgary adds that this guideline represents a great effort to streamline the management of Parkinson disease across Canada.

Super Smeller Diagnosis Parkinson’s Disease by Sniffing

Recently an article was published in recent research in ACS Central Science. 

describing a unique diagnostic method to detect Parkinson’s disease. Joy Milne a super smeller, has been credited with an ability to diagnose patients suffering from Parkinson’s disease by just smelling the body odor. Physicians in ancient time have used odor to diagnose diseases. They have been some studies to test various body Fluids of Parkinson’s disease patient for establishing diagnosis comma this include cerebrospinal fluid, blood sputum, etc.

It all started one day when it Tito kunath was giving a talk to a group of Parkinson’s disease patient, and Joy stood up in the audience and said that “that is all well but what are you doing about the fact that people with Parkinson’s smell”.

Initially, it felt like a rude comment on the personal hygiene of Parkinson’s disease patient however when Tito communicated with Dr. Peterborough the professor of mass spectrometry at the University of Manchester, that they felt that there must be some something else in the comment made by the lady and decided to seek her out.

It all started in 1986 when Joy’s husband was detected to be suffering from Parkinson’s disease. Joy had noted that her husband had started emitting a peculiar odor which was different and later on it turned out that he developed Parkinson’s disease.

Address for the photo: (https://www.telegraph.co.uk/health-fitness/body/meet-woman-can-smell-parkinsons-disease/)

Milne is what’s known as a “super smeller,” a person with an exceptional sense of smell. And they’re more common than you might think. Barran explains that many of them are professionals, called “noses,” working in the perfume or food and drink industries. As it turned out, to a super smeller like Milne, Parkinson’s disease has a distinct odor. More importantly, the odor is present long before physical symptoms appear.

Before embarking on scientific exploration, the team of Kunnath, Barran, and Milne decided to test the skills. They recruited a mix of normal and Parkinson’s disease patients and gave them an identical T-shirt to sleep in overnight. Next day Milne identified all the six patients suffering from PD and had a one false-positive result. However, a few months down the line, this ‘normal’ patient ended up developing PD!!.

It was time, that now some concrete scientific evidence is produced. The team embarked upon a scientific experiment. 64 participants (21 controls and 43 PD patients) were recruited for the study. The participants were recruited from 25 sites across the UK. Swabs were collected from the top back region of each participant. One of the 17 metabolites found is 3,4-dihydroxy mandelic acid, a metabolite of norepinephrine in humans. It was noted that the presence of endogenous 3,4 dihydroxy mandelic acid could be indicative of altered levels of neurotransmitters in PD. In a series of experiments that followed, the super smeller was clearly able to identify the PD smell unequivocally.

 The team is now working on taking this task further on a mass scale. One of the ways would be to train dogs to home in on the scents, others could be developing laboratory tools to detect and identify the compounds producing the smell, as described above.

Many others have also reported that they can smell an odor from patients suffering from PD. They describe it as: Musky, reminiscent of how a beaver smells, yet unlike anything else.

As mentioned earlier there are no diagnostic tests for PD. Any laboratory test that can be developed to diagnose PD would be a great gift to mankind. Also based on the preliminary observations, the odor test has the potential to spot PD before it actually clinically manifests. It would be nice to see what is there in store for the future.

Author: Dr. Paresh Doshi is a leading neurosurgeon and a pioneer of stereotactic and functional neurological surgery in India