However, a clinical trial, set to begin this fall at 14 research sites in the United States and four overseas, may change that. Researchers, including one from El Camino Hospital, hope to figure out a way to objectively determine if someone is suffering from Parkinson's with simple tests. Currently, it takes a battery of exams to diagnose the devastating disease.
Scientists and doctors at El Camino Hospital and The Parkinson's Institute in Sunnyvale will be teaming up to collect data and specimens from 20 patients with Parkinson's and 10 control subjects, all of whom will be from the Bay Area. Worldwide, the Parkinson's Progression Markers Initiative will collect data from 400 early-stage Parkinson's patients and 200 healthy control subjects.
The five-year, $40-million initiative is being funded by the Michael J. Fox Foundation, and is employing some of the most cutting-edge medical technology available.
The Bay Area site was chosen, in large part, because of El Camino Hospital's department of nuclear medicine. While researchers at The Parkinson's Institute will run the initiative's subjects through a gamut of clinical examinations and collect tissue samples, El Camino will image the patient's brains, using sophisticated machines like the multi-head gamma camera.
Parkinson's sufferers slowly lose control over all voluntary muscle function, said Dr. J. William Langston, the founder and executive director of The Parkinson's Institute.
Langston said that the disease is caused by the gradual depletion of dopamine — a chemical that allows the brain to transmit signals and is essential in the coordination of muscles.
"Once you lose your dopamine the whole motor system gradually begins to shut down," Langston explained. "Patients have a harder and harder time doing the simple things in life."
Search for markers
The goal of the initiative is to identify a "biological marker" for Parkinson's disease, or PD.
Currently, the lack of a biological marker is perhaps the single most glaring obstacle facing PD researchers working for a cure. Without it, doctors have no way of knowing whether their treatments are effective. If a biological marker were known, tests could be developed for early diagnosis of the disease.
While doctors and researchers are familiar with the symptoms of PD — rigidity, slowness, tremors, a flux posture and a shuffling gait — they have yet to be able to pin down objective biological measurements of the disease's progression.
Dr. Ramesh Gopi, vice chief of radiology and imaging services at El Camino, will be a site investigator for the Parkinson's Progression Markers Initiative at the hospital. He said he hopes that the initiative will uncover concrete biological markers that doctors could use to definitively diagnose the disease in one or a few steps. Right now, the only way PD can be diagnosed is by putting patients through a myriad of tests and procedures in a clinical exam, Gopi said.
"The clinical exam is pretty inexact," said Dr. J. William Langston, founder and executive director of the Parkinson's Institute. "It's good but not great in Parkinson's disease."
Langston said an accurate biological marker would be a "game changer" for the field of PD research.
"An earlier diagnosis leads to a better response to treatment," Gopi said.
A critical tool
"We're really excited," said Fox Foundation co-founder, Deborah W. Brooks. "Michael is excited when he sees how we are tackling some of these challenges. This is an essential critical tool in developing new treatments."
Gopi and Langston hope to begin collecting data from subjects as soon as possible.
Langston's Parkinson's Institute will study the subjects in a clinical setting, collecting specimens, like blood and spinal fluid, and taking notes on the progression of symptoms.
Meanwhile, at El Camino Hospital, patients will see Gopi or one of his colleagues and have their brains imaged using the multi-head gamma camera.
Gopi will use the camera in conjunction with a radio isotope agent called DATscan, which is injected into a patient's blood stream. DATscan mimics a kind of dopamine molecule that is drawn to two areas of the brain that control movement and are often impacted by Parkinson's — the basal ganglia and brain stem.
"The agent goes in like a Nike missile and labels the cells that you want to look at, so that you can see them on the scanner," Langston said.
The result is a detailed, three-dimensional image of the basal ganglia and brain stem used to measure the extent of the damage caused by the disease.
"With imaging, you have an objective way to quantify the extent of the disease and its progression as well as the response to any potential treatments and therapies," Gopi said.
Ultimately all the data yielded by the researchers at El Camino, The Parkinson's Institute and all the other sites around the world will be made available to the scientific community at large, giving researchers a chance to parse the research and make discoveries of their own.
Brooks, of the Fox Foundation, said Bay Area residents who have recently been diagnosed with PD and are interested in participating in the study should contact the Parkinson's Institute in Sunnyvale at 800-655-2273.