Japan's Best Hospital for Parkinson's Disease

Join us as we explore Medical Frontiers！ Parkinson's disease can cause tremors, stiffness, difficulty with balance and coordination,

and many other seemingly unrelated symptoms.

And currently, there is no cure for Parkinson's.

The diagnosis can be life altering, both for the patient and also the whole family.

But with the right treatment, the progression can be slowed.

Parkinson's disease is a progressive neurological disorder that affects commands for movement control from the brain.

Ishiyama Teruchika was diagnosed with Parkinson's disease 13 years ago.

He is unable to get out of bed by himself.

Symptoms vary from patient to patient.

When I'm in bed, my body doesn't move.
I try to move my muscles, but I can't.

My body stiffens and won't move on bad days.
I can't get up once I lie down.

I also suffer leg cramps at night.
It's tough.

When Parkinson's progresses, it puts a heavy burden not just on patients but also on their families.

He can't go to the bathroom on his own
during the night, so I have to help him up.

I woke up and helped him a few times last night.

I go to bed around 9:30 p.m. every night.
Otherwise, I wouldn't get enough sleep.

The couple used to travel every year.

Ishiyama was diagnosed with Parkinson's at the age of 58, two years after these pictures were taken.

I was devastated. I thought, "Why me?
I've worked hard and lived an honest life."

For a while, he continued working and enjoyed hobbies such as fishing.

But tremors in his limbs and stiffness in his body gradually worsened.

Daily activities became increasingly difficult.

He becomes very depressed.
I would turn a blind eye if I could.

But there's no escape from
Parkinson's once you get it.

All you can do is stay positive.

Ishiyama is receiving treatment at a hospital that ranked 10th globally in the field of neurology in Newsweek's list of "World's Best Specialized Hospitals 2021."

Today, we will take a close look at how this hospital is treating Parkinson's disease.

Good morning.

How are you feeling today?

Not so bad.

You look good today.

Nobutaka Hattori, a neurology professor, leads the Parkinson's disease treatment and research team.

He always talks encouragingly to his patients.

No need to worry.

We're very honored to have you on the program.

And I know you're incredibly busy, Professor, so thank you so much for your time.

So busy.

Crazily busy. Too busy.

So, Professor Hattori, what actually causes Parkinson's disease?

Aging is a risk factor. But nobody knows
the true mechanism of Parkinson's disease.

Most of the patients have declining numbers
of dopaminergic neurons.

This footage shows neurons releasing dopamine.

The yellower the color, the greater the number of neurons.

People with Parkinson's disease have fewer neurons than healthy people.

This means they also have lower levels of dopamine.

Dopamine is a neurotransmitter in the brain.

When it reaches the neurons responsible for movement, they transmit signals that can move the body.

Lower levels of dopamine disrupt the brain's signals to the body, which control movement.

The limbs tremble and become stiff, preventing patients from moving the way they want.

Parkinson's is often treated with Levodopa, a dopamine replacement drug.

And Ishiyama is taking it.

In the early stages, the drug's effects are long-lasting.

However, as the disorder progresses, its effects begin to wear off, and symptoms become much more noticeable.

Therefore, larger doses are required.

At first, Ishiyama was taking three pills of Levodopa spread out over the day.

Now, he takes a daily total of about 20 pills of Levodopa and other drugs, spread out over six doses.

And Professor Hattori, how have the treatments improved?

Have the medication has it improved over the last few decades?

The only important treatment is
Levodopa replacement therapy.

We discovered this treatment in 1961.
Even now, it is considered a gold standard.

But most of the patients show
progression of the disease.

Surgery is an option for patients whose symptoms have become difficult to control with medications.

It aims to ease symptoms by running electric currents deep inside the brain.

Thin needles that serve as electrodes are implanted in the brain, and a small device that generates electrical stimulation is placed in the chest.

The treatment can improve symptoms, but it is not a cure.

The stage now, you can say this no cure for Parkinson's.

It doesn't shorten the life, does it?

Life expectancy is almost the same.
We have to care for their lives for a long time.

Regular checkups are necessary to control Parkinson's disease, which progresses gradually.

But there are only a limited number of medical institutions and doctors specializing in it.

Hospital visits also put a heavy burden on patients, who have difficulty moving.

Hattori's hospital is trying to solve the problem using the latest internet technologies.

Genko Oyama is developing a new diagnostic technology that uses smartglasses.

He ran an experiment from Tokyo connecting himself to a patient at a care facility for Parkinson's sufferers some 300 kilometers away.

Senda Yutaka, who is in his 70s, has stiffness in his right arm.

He puts on the smartglasses.

Senda appears in front of Oyama.

And Oyama appears in front of Senda.

How is the weather in Ishikawa?

It's cloudy, but it will be sunny later.

No rain?

No.

How are you feeling today?
Is there anything I can do for you?

I feel terrific.

Their movements are captured by sensors in front of them.

The technology enables doctors to examine patients in distant places as if they were in the same room.

Images appear in 3D.

In the near future, doctors will be able to see patients' movements from various angles.

So, can you tell me why did you decide to carry out remote diagnosis by 3D?

Patients living in rural areas don't have access to
specialists, because specialists mostly live in the city.

We can use the 3D telemedicine to
see patients, even those living far away.

Put your hands out in front of you
and spread your fingers.

Good. Lower your hands.

Raise your right hand.

Touch your thumb with your index finger,
then spread them wide apart.

Now, do the other side.
Spread them wide.

Good!

The resolution needs improvement, but the technology allows doctors to collect three-dimensional data on movements unique to Parkinson's patients.

Oyama plans to build a diagnostic support system based on the data.

We can gather 3D motion data
and analyze this big data using AI.

AI can make models such as ones that can
distinguish between patients and healthy people.

So not only specialists but also, for example, general practitioners can
see the patient with the AI assist.

I see no major changes in your condition.
Your movements were smooth, too.

We'll keep your drug dosage
and exercise program unchanged.

Can't you reduce the dosage?

You need the current amounts to move your body
and maintain your good condition.

That's all for today. Take care.

Thank you.

I usually go to a national hospital, but
this is just like seeing a doctor in person.

The examination is exactly the same,
so I think it's good.

In Parkinson's disease, early detection and treatment can increase the chances of finding the medicine suited to each patient.

This can keep the symptoms under control, and enable them to continue living normal lives.

However, diagnosing Parkinson's is difficult, and it takes time and effort.

It requires detailed interviews by specialists, image diagnoses involving radiation exposure, and assessments of the patient's reactions to dopamine replacement therapy drugs.

This woman in her 30's waited a long time to receive a Parkinson's diagnosis.

In 2015, she felt stiffness in her left foot and visited a local clinic.

The doctor told her that work-related stress could be the cause.

I was told that given my stress level,
I might be suffering from depression.

I started seeing a psychotherapist, but
I didn't improve even after a year of treatment.

I was 32, and told I was too young
to develop Parkinson's disease.

Convinced that it was not depression, she visited the hospital where Hattori worked.

She was diagnosed with Parkinson's two-and-a-half years after she first noticed the symptoms.

I couldn't figure out how to find a hospital
specializing in Parkinson's disease.

Shinji Saiki, a physician, is tackling this problem.

He has developed a new way to diagnose Parkinson's disease without the numerous tests.

Professor Saiki, such a great pleasure to meet you.

Nice to meet you too.

The method uses oil-blotting sheets that are used to remove excess oil from the face.

Saiki says sebum absorbed by the sheets contains information that can be used in the diagnosis of Parkinson's.

So, Professor, why did you decide to just to develop this and create the system?

We knew autonomic nerves undergo major changes
from the early stages of Parkinson's.

Dysfunction in the autonomic nervous system
leads to changes in sebum.

We thought we could use blotting paper
to capture the sebum and diagnose Parkinson's.

It has been known that the autonomic nervous system, which control whole-body's metabolism, become dysfunctional in Parkinson's patients.

This causes frequent urination, constipation, faintness, hypersalivation and other symptoms.

Autonomic dysfunction is also known to cause an excessive secretion of sebum.

This is why many Parkinson's patients develop dermatitis.

Sebum contains cells from sebaceous glands, where lipids are secreted.

Saiki's team collected sebum from Parkinson's patients.

They analyzed the genetic information carried by RNA in the cells contained in the sebum, then compared it with that of healthy people.

The team found that RNA from patients contains unique information, which they used to establish a method that could diagnose Parkinson's disease with high accuracy.

They published the study results in an international scientific journal in 2021.

This test can be done anywhere,
and it's inexpensive and speedy.

It gives confirmed and suspected
Parkinson's patients easier access to testing.

In other words, it could enable early detection.

Does it matter on whether it be, you know, a different ethnic background?

How about in terms of sex with a male, female?

The components of sebum may differ
according to race.

Gender also has a major impact on sebum.

In addition, we know the year's seasons
affect the components of sebum too.

We need to clarify these differences and
reflect them in the system.

In terms of treatments in for Parkinson's patients.

How do you think the RNA sebum test will improve treatments for Parkinson's patients?

We've found that changes in sebum RNA
reflect changes in Parkinson's patients' brains.

We can check the brain by examining the sebum.
This could give us clues on the progress of Parkinson's.

This diagnostic test yields results in three days.

Saiki aims to analyze more sebum RNA and put the test into practical use in three years.

Experts on the front lines of Parkinson's disease research have been making discoveries that could overturn conventional theories.

Just 10-20 years ago, I believed
Parkinson's disease may be a brain disorder.

But recently, so much scientific data
shows us it's not just a brain disorder, but a systemic disorder.

Many scientific developments provide us
good hints for Parkinson's disease causes.

Research published in recent years shows the intestines are related to Parkinson's.

So recently, there are 2 theories.

The brain is attacked first,
or the body is attacked first.

The gut to the brain, or the brain to the gut.

I believe gut microbiota is
the next target for a new treatment.

So therefore, we have to look at everything,
including the microbiota and of course, mitochondria.

Recently, many neurologists call
Parkinson's disease "Parkinson's diseases."

Hattori believes it's important to observe patients outside of the hospital.

He has been going on bus trips with them for about last 10 years.

But it was also a good chance for you to observe them out of, you know, the clinical time together and see them 24 hours a day.

We usually share 5-10 minutes with each patient.
But on a bus trip, we share 24 hours.

For example, in the bathroom,
patients washed my back.

Patients encouraged me.
This experience is very important for me.

And what's the most important thing that you keep in mind with treating patients?

Encouragement. This is very important.

Many patients said, "Parkinson's disease,
it's impossible to halt this disease."

Actually, that's true. But every time,
I say, "It's okay. Don't worry."

"We will develop new medication for you."

"Many approaches are ongoing, so don't give up."

This is my message for patients
with Parkinson's disease.

I wish you all the success going forward with all your amazing research.

I really enjoyed this. Thank you so much.

Thank you for having me.

Today, we will learn three exercises from a physical therapist.

They can benefit not just Parkinson's patients, but also people with stiff shoulders and lower back pain.

I'm joined by lovely physical therapist, Mr. Sato.

The first exercise is a seated stretch for the upper body and the shoulders.

Hold the side of a chair with one hand and swing your other hand outward as if to draw a big circle.

This loosens the muscles that tend to stiffen in Parkinson's patients.

Try it on both sides.

Put your hand on the side of the chair.

Extend your arm as far as you can when you swing it inward to stretch out the muscles on the back of your shoulder.

Try to open your chest when moving your arm outward.

Make sure the palm of your hand
is open and facing up.

Like this?

Perfect.

So palms down when you do the opposite and then palms up.

The muscles stretch more
when your palm is facing down.

The second exercise stretches your sides.

Place your hand on a chair and raise your other hand as you shift your weight from your heel to your toes.

This eases difficulty with walking.

Hold onto a chair so you won't fall, and
step forward with the foot that's beside the chair.

Make sure you step heel first,
while putting all your weight on it.

Next, shift your weight to your back foot
while raising the toes on your front foot.

Shift your weight back and forth rhythmically.

It's really focusing on heel, toe, heel, toe.

Once you get used to the movements, raise your hand above your head when you put your weight on the foot in the front.

Bring your arm down when you shift your weight to the other foot.

Switch sides and repeat.

Patients perhaps who are not so stable with this exercise, are there any other things you could suggest doing instead of this one?

They might want to hold onto something
more stable, such as a table or a wall.

The last exercise is done lying down.

Lie on your back with your knees bent and lower them from one side to the other.

Do this after you get up in the morning or before you go to bed at night.

It helps your body to relax.

Some people may not be able to lower
their knees all the way. But that's okay.

Take a deep breath, relax, and do the other side.
This will gradually loosen the muscles.

Erica, are you ready to give it a try?

OK, great. So, I lie down on my back.

My knees, is it a 45-degree angle?

Yes. If you have shoulder pain,
you can lower your arms a little.

Try to keep your shoulders on the mattress.

Take a deep breath when you lower your knees.

This helps to stretch the muscles.

If you don't have any shoulder pain, try raising your arms.

The more your raise them, the more your sides will stretch.

If your lower back hurts, you can
lower your legs a little to ease the discomfort.

How did you like the exercises?

I'm often, you know, so tight and I think tense that it was felt great to do those exercises.

I felt especially sort of the stretching of the arm felt really good.

They are also great for people with
stiff shoulders or lower back pain.

I highly recommend them.

Great. Thank you so much.