Parkinson's in prime time: What it means for disease research, awareness

Zoltan Mari, interim director of School of Medicine's Movement Disorder Center, discusses state of Parkinson's research, Michael J. Fox's new show

This fall, network television welcomes back Michael J. Fox—every involuntary twitch and tremor of him. The well-known star of Family Ties, Spin City, and the Back to the Future franchise has jumped back into the sitcom biz to play Mike Henry, a beloved local news anchor and family man who returns to work after being diagnosed with Parkinson's disease.

The Michael J. Fox Show, which airs Thursday nights on NBC, has the somewhat daunting task of finding humor in the everyday struggles of someone with the disease, a progressive disorder of the nervous system that affects a person's movement (tremors, stiffness, overall slowing) and can lead to other nonmotor symptoms such as depression and cognitive impairment.

In one scene, Fox attempts, with shaking hand, to spoon some food to an eager family member across the dinner table. His wife intervenes. "Can you not have a personal victory right now?" she says, taking the spoon from him. "We're starving."

Of course, this is no act. Fox was diagnosed with young-onset Parkinson's in 1991. He disclosed his condition in 1998 and two years later semi-retired from television to launch the Michael J. Fox Foundation for Parkinson's Research, which has raised more than $350 million.

Fox once declared to Barbara Walters that he would be cured by age 50. Now 52, no cure looms on the immediate horizon. However, medications can markedly improve quality of life. Symptoms can also be improved through deep brain stimulation, a surgery to deactivate parts of the brain associated with symptoms.

On the eve of the show's debut, we spoke with Zoltan Mari, an assistant professor of neurology at the Johns Hopkins School of Medicine, interim director of the school's Movement Disorder Center and director of the National Parkinson's Foundation Center of Excellence. Mari talked about the latest in Parkinson's research and the potential impact of Fox's new show.

What is the focus of Parkinson's research today?

The current momentum is toward biomarker research. In fact, the Michael J. Fox Foundation is extremely invested in biomarker research. One very relevant undertaking is called the Parkinson's Progression Markers Initiative. We need to trace certain biological characteristics that can tell us better how well a patient is doing and how far ahead they are in their disease. That will help us come up with better treatments to delay, slow, or prevent the disease.

Right now, the only way I can determine how severe someone's Parkinson's disease is is to perform a motor exam. I ask them to do certain standard motor tasks, and I rate their speed and performance. Of course, this is a very subjective and noisy measure, and not an ideal way to tell how far a person has progressed.

What do we know about Parkinson's and how it is contracted?

There is no question it's a combination of genetics and environmental factors. We learn more and more about the genetic components each year. We have already described a number of genes that are associated with certain forms of Parkinson's. Some of them you can commercially test for.

The limitation of the genetics side of Parkinson's is that there is no such genetic abnormality, mutation, or bad gene that will predict Parkinson's with certainty. Even if you have the LRRK2 gene, one of the most common genes associated with Parkinson's, you may live 100 years and never have the disease. Loss of a sense of smell is also a common marker. We want to understand what is happening with these prodromal conditions and try to develop better biomarkers that will predict if you will come down with Parkinson's later on.

We know that there are certain pesticides and other chemicals that have been associated with increased risk of Parkinson's disease. One is Agent Orange. The VA recently acknowledged the association. Exposure to Rotenone, a pesticide, is also clearly connected with a higher risk.

What is the holy grail of Parkinson's research?

It's prevention or neuro-protection. We have plenty of good drugs that can symptomatically treat Parkinson's disease, where we can mask the tremor, the slowness, the rigidity, or other advanced problems. We also have some nonpharmacological therapies, like speech and occupational therapy, and surgical therapies. These are well-tried and effective, but they are only masking the symptoms. They don't do anything to the underlying pathology of the disease. Your cells in the brain are continuing to die at the same rate. It's a progressive disease. Eventually you will end up in a very disabled state.

So the holy grail is finding something that will prevent all that before it starts or just as soon as it manifests. That goes back to what I was saying about better identifying the prodromal states. If you can tell with more certainty that you are on the path toward Parkinson's, that is when we can intervene and do something and you never have it.

What is the challenge of developing a cure and even better treatments?

It's a multigenic disease, not just one. Probably dozens of genes play some role in your predisposition. And predisposing is not enough, as I said before; there has to be something environmental on top of that. And the disease doesn't just impact dopamine neurons, but ultimately the whole brain will be affected.

How this all breaks down in any individual is difficult to measure. So that is the next big thing in Parkinson's research, how we can stratify and identify the different types of Parkinson's disease and what causes it in each individual. Once we can identify subgroups of patients than we can try to develop different prevention strategies aimed at those groups. That will help a lot.

Are you hopeful that The Michael J. Fox Show will have some positive benefits?

Definitely. Michael J. Fox has already done a lot of work in increasing public awareness and having people support research. Of course, we also have to thank others, like the NIH and the National Parkinson's Foundation.

We see a glimmer of light at the end of the tunnel, but more importantly right now we see the limitations, and we will be addressing those.

What about the significance of a leading character on a show with Parkinson's disease, showing how he leads his daily life?

I think the way this is beneficial is that it brings the disease to light and perhaps conversations on it to the dinner table. I assume he will be portraying real challenges in everyday families who live with Parkinson's. So if it humanizes the disease more, or tells the public something they have not heard before, or exposes a myth, then it will be beneficial.