Neurodegenerative Diseases

Parkinson's

Understand Parkinson’s, Lewy Body, And Alzheimer’s

The Parkinson’s Solution Summit 2.0

https://drive.google.com/file/d/1RSxG70BaRN8PBnGH_nEOAqSuFhropZKh/view?usp=drive_link

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<h6><b>David Hagedorn, PhD, BCN</b></h6>
<span style="font-weight: 400;">Thanks, Dr. Sharlin; it's a privilege to be here, and it's a privilege to be part of, your contribution to the science and education for not only your peers, professional neurologists, primary care, and your patients and people at large, because we want people to understand and be advocates for their care. I'll give you a little, just brief history. We started the company because we needed a simpler solution to record objective data from the brain, the electrophysiology of the brain, and EEG, the central nervous system. But we needed data about the heart because that's connected to the brain. We're looking at EEG, something called evoked potentials, which comes from the EEG. We use that to calculate processing speed and how the brain handles new information coming in. That's very important for Parkinson's. The heart is affected. The autonomic nervous system with Parkinson's. </span>

<span style="font-weight: 400;">This one, that one test is an FDA-approved process for EEG and ERP, and we use it to help in the differential diagnosis tracking treatment, and helping people target some interventions. When we think about Parkinson's and I'm at this age point myself, it's a little scary; 1% of those my age 60 and above have that's the prevalence of Parkinson's today. It's a big number. It's the second leading neurodegenerative disease to Alzheimer's. Very important. We're seeing an increase, an uptick. That's a problem. It could be from all the inflammatory processes that happen from toxins. There are a lot of reasons why. But we want to measure things early, and we want to be definitive. Interestingly, EEG is now being found to be about 99% accurate in diagnosing Parkinson's. It's a shock to this recent research in the last couple of years. That's why we're talking about this test today. It's non-invasive.  It's office-based. You don't need a radioactive isotope in your veins to do it. It just makes this inexpensive. From a medical prudence standpoint, it just makes a lot of sense. Yes. Go ahead, Dr. Sharlin.</span>

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<h6><b>Kenneth Sharlin, MD, MPH, IFMCP</b></h6>
<span style="font-weight: 400;">Recently in the news, of course, when we talk about Parkinson's, the focus tends to be on the motor symptoms: the tremor, the rigidity, the shuffling gait, etc. But there's a huge dimension to Parkinson's that it's non-motor. Of that, we talked about the cognitive dimension. There was recently an article that came out. We'll see if the data ultimately is supported in the long run, suggesting that perhaps we've been overestimating the dementia component of Parkinson's, meaning how much of a percentage of people will develop dementia and at what point? Maybe the dementia comes on much later than we were thinking. Certainly, not everybody develops dementia, but the vast majority will develop. This is my point. Some degree of cognitive impairment. What I love about this test is that it takes a microscope to the brain in terms of function and allows us to pick up some subtle changes in cognitive decline very early, which gives us opportunities for intervention.</span>

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<h6><b>David Hagedorn, PhD, BCN</b></h6>
<span style="font-weight: 400;">Yes, well said Dr. Sharlin. We always think about the motor, and it could be bradykinesia, rigidity, static tremors, postural problems, and gait disorders as being the signature symptoms. Indeed, those are, I mean, early on, you definitely can see that. But there are cognitive symptoms and pain. We don't want to ignore the pain component, and we don't have time to talk about the pain networks in the brain. But there are the medial and lateral pathways involved. There's a relationship to pain processing too. </span>

<span style="font-weight: 400;">I'll just touch on EMG first. How does that apply? EEG is just recording the electrical activity of the cortex of the pyramidal neurons that are directed toward the top of the head. We record that EEG. We then compare that EEG to a normal reference group to see what the difference is between you to someone like you, and age and gender with no symptoms. What's nice about EEG, unlike MRI, is you get great temporal resolution. The difference there is a fancy word, but it means it's a more rapid measure of function versus a, like a snapshot that will look at 4 or 5 seconds of activity time in your brain. If you had a lesion or a bleed, other devices like CT, MRI, or superior. But when you're looking at function, how does the brain do stuff every day at the millisecond level? There is no better way than looking at it with EEG. That's why we use EEG. </span>

<span style="font-weight: 400;">One of the other advantages is that we can then see the type of electrical activity that's coming off your brain. There are a couple of different. But signatures, biomarkers, or endophenotypes are another term. One of them is a frequency called beta. It's a very fast frequency. It's over the motor strip through here. If you have that activity, that vocal overactivity, it will cause motor muscle activity or cause motor tremors. Then you can see it very clearly. There are other signatures to what's called an alpha-theta measure. It's a measure of how slowly your brain is going. Some parts of the brain, say frontally or parietal, will be slowing down compared to what a normal person would be, what we would like. One of the reasons for this is that Parkinson's disease causes dysfunction in the thalamus. That's the limit of processing in that part of the brain.</span>

<span style="font-weight: 400;">When we have Lamarck dysregulation, or we call it the oscillation effect in the cortex, that oscillatory or rhythmic activity in the thalamus that's damaged with the decline in dopamine, which is one of the things we see with Parkinson's, is that dopamine decline. That affects the brain quite significantly. With EEG, we have some very good mathematics, like independent component analysis, which allows us to mathematically, very cleanly look at what's going on electrically in a person's brain and find the location and the frequency where there's a problem. Now this is helpful beyond diagnosis. This helps plan treatment strategies. Or if you're taking levodopa and carbidopa, which is a standard treatment for many people. We can see the effects of that. Like, is the dose working? Do we need to change the dose? We can see an immediate response in the brain to the treatment and modulate or titrate the dose accordingly to minimize symptoms—abnormal symptoms. So it's another reason why to use it. Then, if you add another therapy, let's take a look at the brain. How does the brain handle that? Those are some advantages of what's called quantitative or digital analysis of EEG. Doctor Sean.</span>

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<h6><b>Kenneth Sharlin, MD, MPH, IFMCP</b></h6>
<span style="font-weight: 400;">That's what I want folks watching this interview to understand: we use the term EEG frequently, and I do routine EEGs in my office. If I'm evaluating somebody, say for epilepsy. This takes the EEG data a step higher. Dr. Hagedorn, you use the term quantified as a quantitative or, and, analytical,  where they can take the raw data and then extract out of that specific type of information.</span>

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<h6><b>David Hagedorn, PhD, BCN</b></h6>
<span style="font-weight: 400;">Exactly. That's a great segue way to another thing we do extract from the EEG. If you imagine, you're recording the electrical activity in the brain, and then you present a stimulus to the body like a flash of light or a checkerboard. We can then extract how the brain deals with that new information. We call those event-related potentials or evoked potentials. That's one of the very interesting things that's unique to Parkinson’s is how your brain takes in new data, what does it do with it? Can it handle it quickly or not? Even visual processing-evoked potentials are very sensitive to people with Parkinson's. Where they don't respond well to the input is just tremendous delay or lag time, and how the brain processes data coming in. You can't get that with just EEG. You need the evoked potential data. </span>

<span style="font-weight: 400;">We talk about evoked potentials like P300 and P300 A, which is the front P300 B, which is higher-order processing. They're both part of the same measure of how the brain processes. We know that those numbers change with the severity of Parkinson's. Starting to do the regression of the condition. We can track those numbers. But they respond to treatment, and they're very sensitive in responding to treatment. So a P300 B is, for example, a delay. It takes longer for you to process higher-order information, which is one of the reasons memories are impaired with Parkinson's. As I mentioned, visual processing, which is a sensory measure, is impaired. We look at these ERPs, if you will, as another view or angle view of the mountain. You're looking up from the north side of the mountain with two EEGs. We're looking at the west side with those earlier potentials. Then we still have more measures. We can use the autonomic. ERPs are not very helpful, Dr. Sharlin, to the package. I would say up until recently, neurologists typically used ERPs just for peripheral conduction measures. What we're looking for is how this information for pain is processed in the brain through the spinal cord and the nervous system. That's a type of evoked potential that neurologists commonly use in practice when they're doing peripheral nerve conduction studies.</span>

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<h6><b>Kenneth Sharlin, MD, MPH, IFMCP</b></h6>
<span style="font-weight: 400;">You've alluded to the autonomic, and that's a big component of Parkinson's. There is a test I've never ordered the tests. I don't even know if it's being performed. But if you look at the diagnostic criteria of the Movement Disorders Society for Parkinson's as adjunctive early, you can support that diagnosis. In other words, this isn't by itself a test for Parkinson's. But if it's abnormal, it's supporting the suspicion that the person has Parkinson's. That's the middle and topography of the heart. Essentially, for folks watching this, what's that? What that does. It's a nuclear medicine test that is in which the individual gets this medicine through their vein. I've and normally if the heart was healthy, it would essentially light up what's called the sympathetic nervous system component of the heart. But because we know in Parkinson's, those nerve fibers have often deteriorated. Essentially, you would have a negative test instead of a positive test, or a positive test would be normal. You'd have a negative test reflecting a loss of those essentially fight or flight fibers that folks understand. </span>

<span style="font-weight: 400;">This is interesting to me because a big component I find of using the Evoke test is a measure of what's called heart rate variability. I'm sure doctors hate to explain it more, but the point I want to get to here is that, oftentimes, when we see abnormal HRV in general in our clinic, it's much more dominated toward the sympathetic side that the brain is in fight or flight. Yet at this and that wouldn't be expected in Parkinson's, and we've done some independent confirmation of that in our clinic. What is interesting, though, is that hand in hand with this loss of sympathetic nervous system innovation is that people with Parkinson's often feel very anxious, which I think is interesting because it says there's a disconnect between the brain and the heart. I wonder if you had any thought of that.</span>

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<h6><b>David Hagedorn, PhD, BCN</b></h6>
<span style="font-weight: 400;">Yes, that's a fantastic point. The poor man's version of the nuclear test is a three-lead EKG, you see, and where you simply can get it is a little zap for you. You look at the R to RP differently. That's where the big spike is. Whenever your heart beats too large, the bottom of your heart contracts electrically, forcing blood through the arteries. That's called an R wave. We measure the time sequence from one to the next. It gives us a measure called the time domain of heart rate variability. We know that that number is low, abnormally low in those with Parkinson's. But there's another side of heart rate variability besides that time measure of R to R differences. It has to do with frequency. There's fancy math called fast four transform that can dissect the frequency of your heartbeat and tell you how much sympathetic and parasympathetic you have going on in your body. This is your autonomic nervous system's tug-and-pull pull given-give-and-take nervous system. </span>

<span style="font-weight: 400;">When people have a high sympathetic tone that comes with pain and anxiety, and if they have a high parasympathetic tone that causes a lot of fatigue, it's very difficult. Even sometimes it's an adrenal-level problem, they definitely will feel it. Now with Parkinson's, we certainly have impairment in the parasympathetic regulation of the autonomic nervous system, which is clear, especially as it's more advanced. But we can see it early, and what we see there is this high-frequency tone, which is quite correlated with parasympathetic activity, which is quite clear. They have an impairment in their hearts. If you have impaired parasympathetic sympathetic regulation, you will by default have feelings of anxiety because the parasympathetic job is to balance and put things into perspective in your autonomic system and keep it well balanced. If you have dysfunction in the parasympathetic regulation, you will have anxiety symptoms that affect sleep, irritability, and things like that clinically. </span>

<span style="font-weight: 400;">But the good news is, if you can measure it, there are some easy ways to try to modulate it with therapy like heart rate variability and biofeedback, which would be an adjunct therapy that doesn't have side effects. Looking at the heart variability is a must with Parkinson's, not only for diagnostics but also to guide treatment. Biofeedback, by its definition and by its mechanism, is training to reregulate the power of sympathetic tone. You have a very targeted therapy for the impairment that's common to Parkinson's. It's simple to do at home. It's a must, in my opinion, for every person with Parkinson's.</span>

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<h6><b>Kenneth Sharlin, MD, MPH, IFMCP</b></h6>
<span style="font-weight: 400;">Just to summarize, because I know, unfortunately, of a shorter interview today, we have a tool called EVOX. It is a test of brain physiology, focusing on brainwaves, and it's computerized in such a way that the computer can analyze the software, can analyze the data that's collected, and then present in a very different way than just look at the routine EEGs that most every neurologist performs, either in their office or in a hospital. </span>

<span style="font-weight: 400;">This test can be helpful both diagnostically and alternatively, tracking therapy, tracking outcomes, or if we make a change, do we want to know, Hey, what is the result of that change? Are we moving in the right direction? Ultimately, what I'm hearing, too, is that we're tapping into the brain's neuroplasticity because we're giving people opportunities to get a hard measure of what's going on. Then, because this is the Solution Summit, I want folks to understand that the solution, once you have the data, is then to take action steps and remeasure because tracking is critical here. Remeasure. Then we can see the results of the effort.</span>

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<h6><b>David Hagedorn, PhD, BCN</b></h6>
<span style="font-weight: 400;">That's right. The nice part about re-measuring is you're not exposing yourself to more radiation with other types of imaging tools. It's non-invasive and interesting. One of the therapies that are neuromodulatory is transcranial magnetic stimulation. Changing the neuron firing pattern with a coil magnetic coil TMS is a very effective tool. There are different reasons why we don't have time to go into them. But the mechanisms make perfect sense. It's why they dovetail well with EEG measures. Even transcranial direct current stimulation, which is a very tiny, two-milliamp intervention, is very effective. </span>

<span style="font-weight: 400;">Now, some of the most recent research just this year even says DCS is a reasonable therapy for the motor symptoms associated with Parkinson's. It's non-invasive. Again, super easy, very inexpensive, and safe. There's a paper that talks about safety, and even neurofeedback from 2003. This year, as well as shown studies that fMRI, neurofeedback, and other neurofeedback can modulate the motor system in the brain. This is secondary to the benefits of depression and pain as well. Some adjunct therapies like TMS, DCS, neurofeedback, heart rate variability, biofeedback, plus the medications involved. If you combine all these, there's a lot that can be done for Parkinson's. This is even before talking about deep brain stimulation and lesioning, which is very invasive, we can do a lot of noninvasive things.</span>

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<h6><b>Kenneth Sharlin, MD, MPH, IFMCP</b></h6>
<span style="font-weight: 400;">First, it summarizes well what we're trying to accomplish in the Parkinson's Summit: to let people know that we're certainly a bit. I prescribe the dope all the time. I do have patients with DBS, but how often do we have conversations like we're having now and show people that there are solutions out there that are FDA-approved, that are science-backed, that are peer-reviewed? All the things that we like to talk about, we say it works. I was telling Dr. Hagedorn before we pressed the go button on the interview, that this test that I've used in my office, probably since about 2017 or so, was just a game changer. It is a game changer. We continue to use EVOX as a reasonable therapy testing here in Ozark.</span>

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<h6><b>David Hagedorn, PhD, BCN</b></h6>
<span style="font-weight: 400;">I appreciate you, Dr. Sharlin, for all you're doing for your patients and the academic community as well because a lot of our peers are still in the dark ages. On the use of technology.</span>

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<h6><b>Kenneth Sharlin, MD, MPH, IFMCP</b></h6>
<span style="font-weight: 400;">Sadly, I know we have a hard stop in a minute. I do want to thank you very much, Dr. David Hagedorn, CEO and Chief Scientific Officer for Evoke Neuroscience. If you would like to learn more about this technology, they have a wonderful website, and they have a lot of folks who are involved in education who work with the company, I'm sure they would be more than willing to set some time aside. That folks can learn more about what EVOX has to offer. I know about 20% of people involved in watching this summit are practitioners. I would encourage you to consider investing in this technology to help patients.</span>

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<h6><b>David Hagedorn, PhD, BCN</b></h6>
<span style="font-weight: 400;">Thank you.</span>

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<h6><b>Kenneth Sharlin, MD, MPH, IFMCP</b></h6>
<span style="font-weight: 400;">Thank you very much. Thank you again for your time, Dr. Hagedorn.</span>

<h6><b>Kenneth Sharlin, MD, MPH, IFMCP</b></h6>
<span style="font-weight: 400;">Welcome to the Parkinson's Solutions Summit. I'm your host, Dr. Ken Sharlin. Today's interview is with Dr. David Hagedorn. We go back several years when I became introduced to or was introduced to an indispensable piece of technology that I use in my clinic all the time. His company is called Evoke Neuroscience. The technology is called an Evoke Test. The way that I explain this to my patients is, look, when you get an MRI, we're looking at the structure of the brain, but there's a whole other dimension to how we as human beings work, and that is function or physiology. His test gives me tremendous insight into the physiology or the workings or how it's not working right because we call our program Brain Tune-up, how it's not working right. When it comes to the brain and, to an extent, the heart, which I'm sure he'll touch on. </span>

<span style="font-weight: 400;">Dr. David Hagedorn is the Chief Science Officer and CEO at Evoke Neuroscience. He has a practice in North Carolina, where he. I'm sure he's probably visiting with me now. But without further ado, we're going to talk about this fantastic tool and how it helps people with Parkinson's. Dr. Hagedorn, welcome to the Parkinson's Solution Summit.</span>

https://drtalks-media.b-cdn.net/Summit%20Audio%20Files/2024%20Summits/2024%20-%20The%20Parkinson's%20Solutions%20Summit%202.0/Transcripts%20Folder/2024_TPSS2_David%2BHagedorn%2C%2BPhD%2C%2BBCN%2BTranscript%2BFile.pdf

<p>Dr. David Hagedorn served as a U.S. Army Medic and then went on to work in various clinical and private practice settings for over 20 years. He is experienced in clinical health psychology and neuropsychology and serves as an international neuroscience and biofeedback expert consultant to several organizations. Dr. Hagedorn is the CEO and CSO of Evoke Neuroscience, Inc. He previously served as a teaching faculty and clinical staff member at Naval Hospital Camp Lejeune and Assistant Professor of Military and Emergency Medicine and Family Medicine at Uniformed Services University of the Health Sciences &#8211; School of Medicine.</p>
<p>He is an international speaker and instructor for advanced psycho-neuro electrophysiology assessment and interventions with particular skill in the traumatic brain injury, posttraumatic stress disorder, and neurodegenerative conditions. He has authored several patents in the areas of brain computer interface and neuromodulation and lectures on neurofeedback, transcranial magnetic stimulation (rTMS) and direct current stimulation (tDCS/tACS).</p>
<p>Dr. Hagedorn is licensed in several states and is board certified as an electroencephalography biofeedback practitioner with particular skill in the applications of EEG and ERP, QEEG, and brain computer interface (BCI) and portable peripheral biofeedback methods.</p>


David Hagedorn, PhD, BCN

<p>Kenneth Sharlin, MD, MPH, IFMCP, is a board-certified neurologist, consultant, functional medicine practitioner, Assistant Clinical Professor, researcher, author, and speaker. His medical degrees are from Emory University, The University of Virginia, and Vanderbilt University. His functional medicine certification is through The Institute for Functional Medicine. He is author of the #1 best-seller The Healthy Brain Toolbox: Neurologist-Proven Strategies to Improve Memory Loss and Protect Your Aging Brain and co-author of Neurishment: The Brain Tune Up Food Guide. Dr. Sharlin is also a major contributor to Reversal of Cognitive Decline: 100 Patients, that can be found in the peer-reviewed Journal of Alzheimer’s &amp; Parkinsonism, and he has been the primary investigator in several pharma-sponsored clinical trials that have helped bring new therapeutics to market. Dr. Sharlin practices general neurology, and directs his functional medicine program, Brain Tune Up!, in Ozark, MO.</p>


Understand Parkinson’s, Lewy Body, And Alzheimer’s

Kenneth Sharlin, MD, MPH, IFMCP

David Hagedorn, PhD, BCN

Summary

Content Provided By

Kenneth Sharlin, MD, MPH, IFMCP

Guest Experts

David Hagedorn, PhD, BCN