Treatments for both of these brain diseases have evolved over time with research. Now, experts explain how lifestyle factors can have a major impact on managing Parkinson’s disease and multiple sclerosis symptoms.
The American Brain Foundation is committed to sharing valuable resources and increasing public awareness of brain disease. As part of our ongoing efforts to highlight the latest advancements in brain disease research, our recent webinar connected attendees with two renowned experts to discuss managing Parkinson’s disease and multiple sclerosis (MS).
Lisa Shulman, MD, director of the University of Maryland Movement Disorders Center, is a neurologist specializing in Parkinson’s disease. Her research focuses on the impact of chronic neurological diseases on daily function and quality of life.
Dr. Shulman was joined by Ellen Mowry, MD, director of the Multiple Sclerosis Experimental Therapeutics Program and a professor of neurology at Johns Hopkins Medicine. Dr. Mowry’s research interests include the role of environmental risk factors in multiple sclerosis.
Dr. Shulman and Dr. Mowry’s conversation outlined how treatment options for MS and Parkinson’s disease have changed over time. They also discussed how to improve outcomes for both diseases, including everyday actions people with these diseases can take to improve their quality of life and reduce disability.
The Evolution of Treatment Options for MS
When Dr. Mowry began working with people with MS in the mid 1990s, there was one FDA-approved treatment for the disease. Today there are almost 25 FDA-approved medications for MS that can help people manage symptoms and reduce the degree of long-term disability.
“The early phases of MS are caused, we think, by the immune system [attacking and] causing injuries in the brain and the spinal cord,” says Dr. Mowry. These injuries cause neurologic symptoms, such as vision loss and trouble with coordination, in addition to damaging nerves in the brain. The latter can be visible on MRI scans.
In the early stages of MS, medications can help reduce the number of these attacks and minimize damage to multiple areas of the brain. This type of early treatment is especially important in preventing severe disability that becomes more likely as the disease progresses. As damage to the nerves in the brain accumulates over time, it can lead to progressive MS—an advanced stage of MS without any currently approved treatments.
Even as research continues, it’s important to recognize that there has been progress in treatment outcomes. “We have a lot of accumulating data that follow groups of people over time to suggest that a person diagnosed with MS today is at lower risk of developing disability than a person who is diagnosed prior to the [current] disease-modifying therapy era,” says Dr. Mowry. “We used to quote a risk of people becoming disabled at around 50%, say 15 years or so into the illness. Now we’re down in the 5-10% range in terms of being disabled enough to need a cane to walk.”
The Evolution of Treatment for Parkinson’s Disease
Researchers have found that people with Parkinson’s have low levels of dopamine, a neurotransmitter that sends signals between nerve cells and helps control body movements. Levodopa is currently the main drug-based treatment of choice for Parkinson’s disease. It works by replacing missing dopamine and reducing motor symptoms, such as muscle stiffness.
While this medication has been around for more than half a century, during that time research has made significant strides in improving diagnosis and delaying disability for people with Parkinson’s. “When I started in the field, we would think in terms of people having considerable problems 5 to 10 years after diagnosis,” says Dr. Shulman. “Today it’s quite common to see people who are 15 or more years after diagnosis who live active lives—not to say asymptomatic, but they’re able to maintain a good lifestyle in many cases.”
Part of this progress has been due to an expansion of medications and surgical treatment options, allowing doctors to fine-tune a person’s treatment plan to their specific symptoms and needs. Surgical treatments—including deep brain stimulation (DBS) and focused ultrasound—can improve symptoms and reduce involuntary movements. While they were previously thought to be a “last resort,” doctors have learned that surgical interventions can have a positive impact on disability and quality of life when used in earlier stages of Parkinson’s disease.
Lifestyle Changes to Improve Outcomes
Dr. Shulman and Dr. Mowry also shared how making certain lifestyle changes—including regular exercise, a healthy diet, and plenty of quality sleep—can help people with Parkinson’s and MS.
Research shows that a combination of aerobic exercise, muscle strengthening, and stretching has the power to improve outcomes, symptoms, and mobility for people living with Parkinson’s and MS.
“Right now, if you were to ask what intervention has the most evidence [showing it can] delay the progression of Parkinson’s disease, that is exercise,” Dr. Shulman says. “What you find [in animal research trials] is that there is a huge difference in the number of connections in the motor pathways—a huge difference in the survival of the neurons, the nerve cells in those pathways—and I think that’s what we’re seeing in our patients.”
Based on smaller studies, exercise also appears to be beneficial for managing some MS symptoms that don’t typically respond well to medication. These symptoms include fatigue, which is one of the major symptoms of MS, as well as depression and anxiety. Exercise also reduces insulin resistance (a condition that leads to increased blood sugar), which in turn lowers the risk of health issues like diabetes and high blood pressure—both of which have been shown to accelerate damage to the brain.
Dr. Mowry often recommends physical therapy for people who have difficulty with mobility and balance. Engaging in daily activities—simply moving one’s body throughout the day—is especially important and beneficial for people with MS. “I’ve stopped worrying about whether people are doing 150 minutes of high-intensity interval training and started encouraging people to just move. That’s a great starting point,” she says.
Smaller studies on nutrition and MS suggest that a healthy diet benefits quality of life, reduces fatigue, and may help minimize neurologic symptoms. “We have looked at obesity as a marker of cardiometabolic syndrome, and we know that people who are obese and living with MS have accelerated damage and loss of brain tissue,” says Dr. Mowry. Cardiometabolic syndrome includes a group of health factors like high blood pressure and high cholesterol that increase the risk of diabetes, heart disease, and stroke—all of which can contribute to damage in the brain.
While overall research is inconclusive, one study suggests that people who eat a Mediterranean-style diet—including fruits, vegetables, and fish and avoiding red meat and fatty foods—may have a lower risk for developing MS.
While there is not as much evidence linking diet to Parkinson’s symptoms or risk factors, dietary changes have shown to be beneficial in managing certain health complications that often arise with the disease. “When it comes to diet in Parkinson’s disease, there isn’t one particular thing that you tell everybody,” Dr. Shulman says. “It has to do with the specific problems that the person is having. You would target those problems with certain kinds of changes.”
- Timing of medication with meals: If it’s possible to take medication on an empty stomach, the body absorbs the medicine more quickly. However, people who have gastrointestinal issues or nausea may need to take their medication with food.
- Constipation: Making changes like eating more high-fiber foods and drinking more water can help relieve these symptoms.
- Blood pressure instability: This is a relatively common problem among people with more advanced Parkinson’s. To help stabilize blood pressure, it’s important to maintain good hydration and can sometimes be beneficial to include more salt in a person’s diet.
Not getting enough sleep can affect long-term brain health. For people with MS and Parkinson’s, improving the quality and amount of sleep they get can be helpful in managing symptoms.
People with Parkinson’s and MS often experience mood disorders like anxiety and depression—both of which can result in poor sleep quality. “Sometimes it can be hard, at least for my patients, to accept treatment of those mood disorders,” says Dr. Mowry. “But I always argue that screening for them and treating them when appropriate could have massive benefits for the health of their sleep, their quality of life, and in the long term, brain health as well.”
People with MS and Parkinson’s who are experiencing trouble sleeping may use small doses of melatonin, a supplement to help shift your internal body clock and promote better sleep. Melatonin can also have some benefit for people with Parkinson’s who experience visual hallucinations.
Finding Connections Between Neurodegenerative Diseases
The American Brain Foundation funds research across the entire spectrum of brain diseases because we know that all parts of the brain are interconnected. When we make treatment advances and develop cures for one disease, it will lead to cures for other diseases as well.
Dr. Shulman echoes this idea. “These chronic conditions have a lot more in common than they are different, and that’s particularly true when it comes to lifestyle issues,” she says. “The area that comes to mind—and the area that I’ve studied and I’m very passionate about—is the issue of patient empowerment.”
She points out that people with Parkinson’s and MS have the power to take action in their daily lives to improve their outcomes. By being engaged and knowledgeable about their disease, medications, and bodies, they can develop confidence in their own abilities to make lifestyle changes and manage their condition.
“You can design and individualize your lifestyle in the best possible way,” says Dr. Shulman. “Whether you’re dealing with the fatigue of MS or the motor fluctuations of Parkinson’s disease, you can begin to customize your life in a way that works for you.”
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