Closer To A Cure––

Newtown Neurologist On Forefront Of Parkinson’s Disease Research

By Dottie Evans

In 1817, London physician James Parkinson used the words “shaking palsy” to describe symptoms of muscle tremor, weakness, and rigidity that he was observing in many of his older patients, leading to his name being forever linked to the malady.

Today, Parkinson’s Disease (also known as PD) is familiar to many, especially since public figures such as Michael J. Fox, Janet Reno, Mohammed Ali, and the late Pope Paul II have been forthcoming about their own experiences with the chronic, neurodegenerative disease.

Newtown resident John Murphy, MD, of Associated Neurologists, P.C., in Danbury said during a July 1 interview that Parkinson’s patients make up more than 50 percent of his practice, and that more than one million Americans are currently being treated.

He said “no definitive PD test exists,” yet doctors are able to make a clinical diagnosis based on symptoms that Dr Parkinson observed 200 years ago. Also noted are a host of other symptoms including slowness of speech, a halting gait, postural instability, certain distinctive facial movements and expressions, and what Dr Murphy calls “an abnormal resistance –– a ratcheting movement –– that you can feel in the muscle.”

The primary, though not the only symptom used in making the PD diagnosis, is that a patient’s automatic movement is simply gone.

“After you’ve seen as many patients as I have –– do a careful exam and get a good history –– you just know what it is,” Dr Murphy said, speaking from his office at 69 Sand Pit Road where he has been on staff since 1989.

Also working since 1989 as attending neurologist at Danbury Hospital, Dr Murphy has seen more than 800 patients in his practice and is now conducting research studies on new medications and new diagnostic methods that he hopes may someday slow or even reverse the progression of the disease.

As a summa cum laude graduate of Fordham University in the Bronx and a graduate of Rutgers Medical School with a residency in neurology at University Hospital, New Jersey Medical School in Newark, Dr Murphy is licensed to practice in Connecticut and New Jersey. Among his honors and awards are listings in Connecticut Magazine’s “Best Doctors in New York Metropolitan Area” for 2005 and “Best Doctors in America” for 2005–06. The list of research papers and published articles with Dr Murphy’s name listed among the authors is long and impressive.

Causes, Treatment, And Research

When asked what are the prospects for treating or even curing Parkinson’s Disease in the future, Dr Murphy spoke with enthusiasm about the possibilities.

“We can talk about what is going on right now, about what is just around the corner, or what is the dream for the future. We’ve got one of the busier PD research sites in the United States right here in the Danbury area,” he noted.

Field trials of several new medications are being conducted today at Associated Neurologists under Dr Murphy’s guidance with the help of Nurse Practitioner Joan Ellen Gereg (APRN) and Margaret Mukwaya, RN, both Newtown residents who are helping gather data.

“I am extremely grateful for the help of my Parkinson’s patients who are participating in this research and are helping us move ahead,” Dr Murphy said.

Most Parkinson’s patients are diagnosed in their 60s, and for unknown reasons the ratio of males to females is approximately 3:1. Researchers believe the disorder is due to a loss of nerve cells in an area deep within the brain called the substantia nigra. This area produces the chemical dopamine that sends signals within the brain responsible for automatic muscle response.

Lack of dopamine eventually means impaired movement. But this symptom may not be present for years due to built-in redundancy within the system. By the time a patient is diagnosed, more than 70 percent of his or her dopamine neurons may be gone. At this point, the disease is progressive and there is no known cure.

As for what causes dopamine levels to fall, Dr Murphy postulated that a combination of factors including environment and heredity may come into play.

“In rural areas where they spray pesticides like rotenone, if the quantity reaches a certain threshold and if this is added to a genetic propensity, the [cell] reparation system is destablilized. Five to ten percent [of PD patients] have a familiar history of the disease,” he said.

 “We’re beginning to see why certain people are getting it and others not.”

Dr Murphy said researchers are finding a new PD gene every month that is capable of producing Parkinson’s –– and they have identified 12 such genes already.

“Brain cells are always recycling. When a cell is damaged, it’s targeted for removal and the trash hauler cells come by to take it away. It seems there are certain patients that have a defective removal system that doesn’t allow for the cell to be properly tagged, identified, and removed,” Dr Murphy said.

 Visions For 2010 And Beyond

 Among the medical options that neurologists most frequently use for their PD patients is the dopamine agonist called Levodopa. (An agonist is a drug that mimics the body’s own regulatory functions).

When treating patients to lessen or manage their PD symptoms, Dr Murphy and his research staff want to learn how to improve the delivery of the dopamine agonist into the patient’s system. One method is by trans-dermal skin patch. Another is by pill, but then the problem becomes how to ensure that the stomach delivers enough of the drug directly into the small intestine where it can be absorbed into the nervous system without it being shunted around the rest of the body and causing harmful side effects.

An exciting breakthrough leading to earlier diagnosis of Parkinson’s disease is the use of new imaging tools that study the neuro-chemical rather than anatomical features of the brain.

The PET (Positron Emission Tomography) scan, which is currently very expensive and not widely available, involves the injection of a tracer isotope and focuses on the mid-brain area where dopamine is produced. A pattern of biochemical abnormalities typical of dopamine deficiency in the substantia nigra, can be clearly seen in PET scans and may be “predictive of stage one Parkinson’s Disease,” Dr Murphy said.

“At present, we can say that if 70 percent of the cells are out of position, this person is headed in the wrong direction. At that point, we would offer a neuro-protective agent, do genetic screening, and hope to reduce that person’s risk,” he added.

Asked about stem cell research and the possibility of implanting fetal neural cells, Dr Murphy said that technique “is fraught with ethical issues and practical problems.”

“It seems the cells don’t know where they should grow or what they are supposed to grow into. They just don’t fit into the network. You can’t simply drop cells in and expect them to know the neighborhood,” he said.

“Our breakthroughs will be in other areas,” he predicted, mentioning a drug developed in Europe known as Rasagaline that will be available later this year.

“It slows the progress of the disease and can bring cells back to health. Where there has been unacceptable toxicity, it causes them to regrow or to grow other cells.”

Anyone interested in contacting the support group Connecticut Parkinson‘s Working Group that meets in Middletown is welcome to call Dave Curtin at 203-264-5536.