Pubdate: Wed, 24 Oct 2012
Source: Colorado Springs Independent (CO)
Copyright: 2012 Colorado Springs Independent
Contact:  http://www.csindy.com
Details: http://www.mapinc.org/media/1536
Author: J. Adrian Stanley

HIGH HOPES FOR COCAINE

Local Parkinson's patients start to benefit from a new test using the
party drug

If you hear "cocaine" and think of junkies smoking crack in squalid
apartments, or of downward-spiraling rock stars, this may come as a
shocker.

A cocaine-based drug is being used in doctors' offices around the
world, including one large Pikes Peak area practice. And it's helping
a lot of sick people.

The drug's medical re-emergence has been a cautious one. (And it is a
re-emergence, as cocaine was used as a painkiller and treatment option
for everything from toothaches to wound-healing until around the turn
of the 20th century.) This is no medical marijuana. Nor does the
situation resemble that of the club drug ketamine, now seen as a
promising treatment for depression.

Instead, doctors are using extremely small doses of radioactive
cocaine analogue to "light up" dopamine receptors in patients' brains,
allowing for easier diagnosis of Parkinson's disease.

At Colorado Springs Health Partners, the only city practice using the
newly approved DaTscan test, doctors like radiologist Pio Hocate and
neurologist Brian Grabert say they're helping patients get treatment
faster, and prolonging their lives. The test is also helping them rule
out the serious neurodegenerative disease for others. But, because of
modern drug laws, the DaTscan has met with challenges with the U.S.
Drug Enforcement Agency.

"We've had to go through a lot of hoops," Hocate notes.

Motor trends

Hocate and Grabert bend over a computer screen, where orange-and-black
images of brains look like a Halloweenish Andy Warhol work.

"That's abnormal; that's normal," Grabert says, pointing at two scans,
one more lit-up than the other.

Grabert, who's been in practice since 1980, explains that when people
develop Parkinson's - probably most widely known for affecting actor
Michael J. Fox - they stop producing a normal level of the
neurotransmitter dopamine. Most of us know dopamine as something that
makes us feel good, and wards off depression. But dopamine is also the
main chemical that charges our motor system.

A new Parkinson's patient produces about 70 percent less dopamine than
the average person, leading to motor problems and, at times, dementia.
People often live for 20 years with the disease before dying of a
complication, like a fall or infection.

Early on, the National Parkinson's Foundation notes, patients show as
many as four telltale symptoms: a tremor, slowness of movement,
stiffness and trouble with balance.

Doctors once had to diagnose Parkinson's based on these symptoms
alone, a tricky business since other diseases and abnormalities like
harmless "essential tremor" or the beginnings of dementia often mimic
Parkinson's. Usually, doctors who suspect Parkinson's put patients on
treatment with drugs that mimic dopamine in their bodies. If symptoms
subside, the patient is assumed to have Parkinson's.

The method usually works, but not always. Some Parkinson's patients
don't respond well to medication; others who don't have Parkinson's
may seem to improve with the drugs.

"The diagnosis of Parkinson's is not always 100 percent accurate on a
clinical basis," Grabert says. "In fact, much less than that."

The DaTscan was meant to help people who stump neurologists, Hocate
says, by ruling out many conditions that present like Parkinson's.
"It's really a problem-solving tool," he explains.

For the DaTscan, a patient is injected with iodine and the radioactive
cocaine analogue mixture, then scanned. The cocaine lights up the
caudate and putamen, parts of the brain that contain the
neurotransmitters for dopamine. In a normal scan, these two parts look
like twin commas; in a person with Parkinson's, they often look more
like periods.

Change agents

In January 2011, GE Healthcare's DaTscan (generically called Ioflupane
I 123 Injection) became the first U.S. Food and Drug
Administration-approved diagnostic imaging agent to help doctors
evaluate neurodegenerative movement disorders like
Parkinson's.

It was a breakthrough, and pioneering practices began seeking approval
from the DEA to use it. Since roughly 1 percent of people over 65 will
get Parkinson's (plus a small number of younger people), it looked
likely that large offices in large-to mid-sized cities could make use
of the technology.

CSHP, which with 10 locations is the largest physician-owned,
multi-specialty practice in the state, applied to carry the drug early
in 2012. But it took five months to get approval, despite the DaTscan
using so little cocaine that it can't get a person high.

Over those five months, Grabert estimates, he had as many as 12
patients on whom he would have liked to use the test. Since being
approved to carry the DaTscan in September, CSHP has tested five
patients. All but one had Parkinson's, and it's notable that the odd
man out was about to go into surgery for Parkinson's, during which he
would have had deep brain stimulation. That involves hooking a "brain
pacemaker" onto the brain, and shooting it with electrical signals.

"If you don't need that..." Hocate says with a laugh.

So far, the doctors note that their patients' various insurance
companies have covered the $2,500 test for patients. But even if
underinsured or uninsured, Parkinson's patients referred by a
neurologist may want to take the test. Parkinson's medications can
cost a bundle - Grabert knows one of the drugs is $900 out-of-pocket a
month - and, of course, they won't work for a non-Parkinson's patient.
Plus, a patient may have a different condition that could be helped
with early treatment.

Says Hocate, who's been in practice since 2001: "You don't want to be
treated for something you don't have."
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MAP posted-by: Matt