Struggling with Parkinson's: Overcoming the Trauma of Freezing Episodes


If you or somebody you know has Parkinson's disease (PD), you have surely experienced the sense of helplessness this condition can trigger. PD patients face a wide array of challenges both physical and psychological; although less obvious to the eye, the latter can be just as daunting to overcome, and just as potentially damaging, as the former.

Take one of the worst sources of stress for PD patients: Freezing or "off" episodes—periods of immobility that last from one to several hours. First-line PD therapy involves drugs that keep these episodes at bay, but after a few years these treatments work less well. Subsequent treatments help, but their effects can be limited and slow to kick in. When they are too slow, the patient enters an "off" episode.

If you have experienced an "off" episode firsthand—or have observed a family member or loved one experience one—you know how traumatic they can be. They are potent sources of psychological trauma for three reasons:

  1. No advance warning. Imagine if you woke up in the morning knowing that paralysis could strike you at any moment during the day. Well, this is exactly what some PD patients go through—every single day. Not only does this compromise their ability to work and play; it affects their sense of being in control of their lives. No wonder they are prone to feelings of helplessness.
  2. Painful treatment. As you may know, there is a rescue therapy to treat these "off" periods: apomorphine, the only drug approved to treat this symptom (under the name APOKYN® in the U.S. and Japan and APO-go® in Europe). Unfortunately, it is only available in an inconvenient and painful injectable form. Not only do the injections need to be given several times a day, but they can produce negative reactions—including irritation and nodules—at the injection site.
  3. Dependence on a caregiver. Lastly, the reliance of PD patients on caregivers or loved ones during "off" episodes—because patients are either unable or unwilling to inject themselves with apomorphine—may trigger despondency. Who wants to inconvenience somebody they care about in this way?

Working in tandem, the lack of advance warning, painful treatment, and continual dependence on a caregiver is almost guaranteed to trigger psychological trauma in the PD patient who experiences "off" episodes. Thus the demand for better treatments is rooted in two needs: First, PD patients need more effective and less cumbersome treatment options. Second, just as importantly, they need to feel they are in control of their lives. The psychological costs will continue to be excessive until this happens.

Cynapsus Therapeutics, a small Toronto company, is trying a novel approach to overcome the limitations of the injectable form of apomorphine. Cynapsus has developed APL-130277, a dual-layer, sublingual thin-film strip, similar to Listerine® Breath Strips. Placed under the tongue, the strip dissolves in about 1.5 minutes, delivering apomorphine to the bloodstream in a similar time frame and concentration as the injectable dose.

If APL-130277 is cleared for use by the FDA, it holds the potential to open a new chapter in PD treatment, ensuring "off" episodes are rescued quickly, providing the patient the ability to move freely, thanks to a much more convenient and tolerable delivery method.

And that physical freedom could potentially be accompanied by an escape from the psychological trauma that has dogged some PD patients for too long.

Anthony Giovinazzo is President and CEO of Cynapsus Therapeutics, Inc., which is developing the only non-injectable (sublingual) delivery of the only approved drug (apomorphine) to be used as a rescue therapy for "off" motor symptoms of Parkinson's disease.


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