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Parkinson Disease

Roberta Balestrino, Anthony H V Schapira
European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies 2019 October 20
31631455
Parkinson disease (PD) is the most common neurodegenerative movement disorder [1]. Its cardinal motor symptoms are tremor, rigidity, bradykinesia/akinesia and postural instability, but the clinical picture includes other motor and non-motor symptoms (NMS). The diagnosis is principally clinical, although specific investigations can help the differential diagnosis from other forms of Parkinsonism. The pathological hallmarks of PD are loss of dopaminergic neurons in the substantia nigra (SN) pars compacta (SNpc) and accumulation of misfolded alpha-synuclein, which is found in intra-cytoplasmic inclusions called Lewy bodies (LBs). When patients are first diagnosed, a substantial proportion of dopaminergic neurons in the SNpc has already been lost, and neurodegeneration has spread to other central nervous system (CNS) regions. The aetiology of the disease in most patients is unknown, but different genetic causes have been identified in approximately 5-10% of cases. Current treatment of PD is based on the replacement of dopamine, although alternative approaches such as deep brain stimulation (DBS) are suitable for later stage disease. Currently available treatments offer good control of motor symptoms, but do not halt the progression of neurodegeneration, the evolution of the disease and the increasing disability. This article is intended to provide a comprehensive, general and practical review of PD for the general neurologist.

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