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    Brain Cell Protection

    Growing List of Positive Effects of Nicotine Seen in Neurodegenerative Disorders Neurology Today 19 January 2012; Volume 12(2); Pp 37,38 Dyskinesia and impulsivity in Parkinson disease, cognitive defects in attention deficit-hyperactivity disorder (ADHD), and now attention and memory in mild cognitive impairment (MCI): the list of reported neurological benefits just keeps growing in animal and human studies of nicotine. Dr. Okun, how close is nicotine to being a credible candidate for neuro-protection ?
  2. Dr. Okun, as a scientist actively engaged in research to develop treatments for Parkinson disease, do you believe that the massive funding earmarked for basic research in the BRAIN initiative might divert money away from more treatment-oriented research? It would be easier for me to support the BRAIN initiative if I could be sure that it would not slow down research in areas which might deliver treatments sooner. More basic research is great if it does not starve out translational research.

    Brain Cell Protection

    Thank you for your prompt reply, Dr. Okun. Based on your recommendation, and the adverse effects such as nausea I have experienced, I will stop the nicotine lozenges for now, and only restart them if they are proven beneficial at some time in the future. You are right, the known risks outweigh the unproven benefit (if any) in the case of nicotine. And thank you for reminding me about creatine, a relatively benign substance which has lab evidence of neuro-protection and has at least passed a non-futility study. I actually took it for a while, but I stopped when the manufacturer Neotine had problems supplying the "sachets" which were used in the study. It sounds like creatine, in your estimation, holds little possibility for harm, and may someday be proven beneficial. I plan to add it back to my regimen until the evidence is in. I understand and accept the risk that it may not be beneficial and may (like minocycline) actually surprise us and be proven harmful in some way. For now, I am leaving uric acid on my "watch list", because I have seen so much suffering in patients with gout and kidney stones. There is going to have to be some very impressive neuro-protection evidence obtained for uric acid before I consider taking anything to raise my own level. As for exercise, I am aware that it is the single best medicine for me, but like so many patients, I find it easier to pop another supplement than to get out there and go for a walk every day. I will try harder to do so!

    Brain Cell Protection

    I am a primary care physician (Internist) with early-onset PD formally diagnosed at age 49. My prescription medications are Azilect, Requip XL 8 mg a day and Sinemet CR 25/100 mg three times a day, which allow me to practice full-time. In addition, I take the following substances in the hope that they might be neuro-protective (slow down the loss of further brain cells): Coenzyme Q10 400 mg twice a day, ibuprofen 200 mg per day, and I am attempting to slowly add nicotine in the form of the lowest dose of Commit nicotine lozenges. I can only tolerate less than half a milligram of nicotine per day. I have never been a smoker or tobacco user, and I have no cardiac risk factors other than being a 53 year old male. In fact, like many people with PD, my blood pressure is low and my LDL is naturally very low (under 70). I tried isradapine (Dynacirc), a potentially neuro-protective calcium channel blocker, but it made my constipation and orthostatic hypotension intolerable. I took low-dose minocycline until it was proven to be not neuro-protective (actually, harmful) in ALS. I accept this risk, but I want to take every potentially neuro-protective substance which does not cause significant harm until it is proven or disproven. When I try to ask neuro-scientists about this, they tell me to sign up for clinical neuro-protection trials. I would do so, but I do not qualify because of the prescriptions I take. My questions for the neurologists are these: if you had Parkinson's, wouldn't you do as I am doing (be honest now)? If so, are there any other potentially neuro-protective substances you would consider "taking a chance on" until they are proven or disproven?

    HPV causing YOPD?

    Correction: shingles and chicken pox are not caused by HPV, they are caused by Herpes Zoster virus, which is totally unrelated to HPV. All strains of Human Papilloma Viruses cause wart-like infections of the skin and mucus membranes, they do not invade the bloodstream or go to the brain. HPV causes cervical cancer by a local effect on the DNA of the cervical mucus membrane cells, which causes dysplasia, a condition which can lead to localized squamous cell carcinoma, which can in turn invade and spread if not detected in time by a Pap smear.
  6. I have been taking Azilect for a couple of years. It was my first prescription medication. I was already taking Coenzyme Co-Q10 400 mg twice a day, which I continue in the hope that it will prove to be neuro-protective. I have since added Requip XL 8 mg per day (the maximum dose I can tolerate due to side effects) and Sinemet CR 25/100 mg three times a day. Only with the help of these medicines am I able to work full time. And, honestly, I have not been at all careful about limiting my intake of foods which might interact with Azilect, and I have never had a "tyramine crisis" or any other problem. This is not to advise you to do the same, everyone is different, talk to your neurologist. I think the warnings on Azilect are based on experiences with the earlier non-selective MAO inhibitors, such as Nardine, which are basically obsolete anti-depressants, and with which you had better darn well avoid ingesting tyramine. I have heard that the warnings on Azilect might be relaxed. Talk to your neurologist. But again, my experience with Azilect has been very positive. The Adagio and Tempo studies also give us strong hope that it might be neuro-protective, too.