Contents

• Parkinson's - questions and answers
• Parkinson's and the pharmaceutical industry
  
  • A short history of medicines discovery and
    development for Parkinson's
  • How medicines for Parkinson’s work
  • Some possible future developments
• Conclusions
• Summary table
• Some useful addresses

Introduction

In 1817, Dr James Parkinson described for the first time the essential characteristics of the condition we now call Parkinson’s. The reason that it had not been described before is undoubtedly because it mainly affects the older age group and was less frequently encountered in earlier centuries, when life-span was shorter. However, historical documents show that the disorder had been recognised long before: Leonardo da Vinci’s anatomical manuscripts describe a similar set of symptoms, and a disorder resembling Parkinson’s was described in the ancient Indian medical system called Ayurveda.

Treatment options for Parkinson’s were poor until the past 50 years, but nowadays a wider range of medicines is available. Brain surgery, common in the mid 1930s and 40s, went out of fashion, but improved techniques and brain mapping have led to a recognition of its value for a few people with serious disability. Physiotherapy, occupational therapy and speech and language therapy also play important roles in improving the quality of life of people with Parkinson’s. In the longer term, developments in the biotechnology arena, such as the use of nerve growth factors, transplantation and gene therapy, hold the potential for a cure, but are clearly still many years away.

The financial cost of Parkinson’s to the NHS and social services is considerable and estimates published in 1995 gave a total figure of £382 million for 1992. Of this, £179 million was for residential care and £95 million were costs to the NHS, of which £49 million was for hospital in-patient treatment. Only £27 million (7 per cent) was accounted for by medicines costs. In individual patient terms, the cost varies from about £500 per year at diagnosis to over £11,000 for those in the advanced stages of Parkinson’s. The lifetime cost of care for someone with Parkinson’s is about £100,000. Despite recent improvements, Parkinson’s remains somewhat sidelined in terms of care provisions, with significant regional variations in services and support within the UK. It is hoped that this booklet will help improve public awareness and education, as well as generate understanding about the illness and show that improved therapies and other forms of treatment are becoming available now that progress is being made on the condition’s underlying nature.

Acknowledgements

The ABPI thanks member companies for their generous co-operation in the preparation of this booklet. Illustrations are reproduced with the kind permission of the Bibliothèque J.M. Charcot, Salpêtrière Hospital, Paris (historical sketches), Professor U K Rinne and Dr H Ruottinen of the University of Turku, Finland, Adis International, and Orion Pharmaceuticals (PET brain scan showing the effect of COMT inhibitors), Eli Lilly & Company (diagram of a neurone), Dr S E Daniel at the Institute of Neurology, London, (brain sections and Lewy bodies), Professor D J Brooks, Hammersmith Hospital, London and the MRC Cyclotron Unit (PET scans showing 18F-dopamine accumulation), New Scientist (handwriting), and to Oxford BioMedica (gene therapy methodology). Other illustrations are from the Science Photo Library, Zeneca and the Parkinson’s Disease Society. The booklet was researched and written by Dr Mike Hall, who would like to acknowledge the valuable help and co-operation of the Parkinson’s Disease Society in its preparation.