The Current Clinical Picture Of Parkinson’S Disease

  • Stewart A. Factor
  • William J. Weiner


The following chapters in this book are very specifically directed at individual research topics which relate to Parkinson’s disease (PD). Often in our quest for answers to specific questions we lose sight of the patient and their disease. It is our intent to provide a clinical description of PD and to discuss the current symptomatic treatment. We will also review new evidence related to the etiology of PD and briefly discuss new directions in attempting to treat this debilitating disease.


Substantia Nigra Dopamine Agonist Essential Tremor Motor Fluctuation Neuroscience Letter 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. Ballard PA, Tetrud JW, Langston JW., 1985, Permanent human parkinsonism due to 1-methyl-4-phenyl-1, 2, 3, 6- tetrahydropyridine (MPTP): seveij cases. Neurology 35:949–956PubMedGoogle Scholar
  2. Barbeau A., 1973, Aging and the extrapyramidal system. J AM Geriatrics Soc 21:145–149Google Scholar
  3. Barbeau A, Roy M, Cloutier T, Plasse L, Paris S., 1986, Environmental and genetic factors in the etiology of Parkinson’s disease. Adv Neurol 45:299–306Google Scholar
  4. Barbeau A, Roy M, Paris S, Cloutier T, Plasse L, Poirier J., 1985, Ecogenetics of Parkinson’s disease: 4 hydro- xylation of debrisoquin. Lancet 2:1213–1216PubMedCrossRefGoogle Scholar
  5. Barbeau A and Roy M., 1984, Familial subsets in idiopathic Parkinson’s disease. Can J Neurol Sci 11:144–150.PubMedGoogle Scholar
  6. Bharucha NE, Stokes L, Schoenberg BS, Ward C, Ince S, Nutt JG, Eldridge R, Calne DB, Mantel N, Duvoisin RC., 1986, A case control study of twin pairs discordant for Parkinson’s disease: a search for environmental risk factors. Neurology 36:284–288PubMedGoogle Scholar
  7. Bradbury AJ, Kelly ME, Costall B, Naylor RJ, Jenner P, Marsden CD., 1985, Benztropine inhibits toxicity of MPTP in mice. Lancet 1:1444–1445PubMedCrossRefGoogle Scholar
  8. Brown RG and Marsden CD., 1984, How common is dementia in Parkinson’s disease? Lancet 2:1262–1265PubMedCrossRefGoogle Scholar
  9. Burns RS, Lewitt PA, Ebert MH, Pakkenberg H, Kopin IJ., 1985, The clinical syndrome of striatal dopamine deficiency: Parkinsonism induced by 1-methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine (MPTP). N Engl J Med 312:1418–1421PubMedCrossRefGoogle Scholar
  10. Burns RS, Chiueh CC, Markey SP, Ebert MH, Jacobowitz DM, Kopin JJ., 1983, A primate model of parkinsonism: selective destruction of dopaminergic neurons in the pars compacta of the substantia nigra by N-methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine. Proc Natl Acad Sci USA 80:4546–4550.PubMedCrossRefGoogle Scholar
  11. Calne DB and Langston JW., 1983, Aetiology of Parkinson’s disease. Lancet 2:1457–1459PubMedCrossRefGoogle Scholar
  12. Cohen G., 1983, The pathobiology of Parkinson’s disease: biochemical aspects of dopamine neuron senescence. J Neural Trans 19(suppl):89–103Google Scholar
  13. Cotzias GC, Papavasiliou PS, Gellene R., 1969, Modification of parkinsonism: chronic treatment with l-dopa. N Engl J Med 280:337–345PubMedCrossRefGoogle Scholar
  14. Davis GC, Williams AC, Markey SP, Ebert MH, Caine ED, Reichert CM, Kopin IJ., 1979, Chronic parkinsonism secondary to intravenous injection of meperidine analogs. Psychiatry Res 1:249–254PubMedCrossRefGoogle Scholar
  15. Duvoisin RC., 1986, On heredity, twins and Parkinson’s disease. Ann Neurol 19:409–411PubMedCrossRefGoogle Scholar
  16. Factor SA, Sanchez-Ramos JR, Weiner WJ., 1988, Parkinson’s disease: an open label trial of pergolide in patients failing bromocriptine therapy. J Neurol Neurosurg Psychiatry 51:529–33PubMedCrossRefGoogle Scholar
  17. Factor SA, Sanchez-Ramos JR, Ingenito AM, Weiner WJ., 1988a, Efficacy of Sinemet CR4 in subgroups of patients with Parkinson’s disease. J. Neurol Neurosurg Psychiarty submittedGoogle Scholar
  18. Fahn S., 1982, Fluctuations of disability in Parkinson’s disease: pathophysiologic aspects (Chap 8). In: Marsden CD and Fahn S, eds. Movement disorders. London: Butterworth Scientific pp 123–145Google Scholar
  19. Forno LS, Langston JW, DeLanney LE, Irwin I, Ricaurte GA., 1986, Locus ceruleus lesions and eosinophilic inclusions in MPTP-treated monkeys. Ann Neurol 20:449–455PubMedCrossRefGoogle Scholar
  20. Freeman BA and Crapo JD., 1982, Biology of disease: free radicals and tissue injury. Lab invest 47:412PubMedGoogle Scholar
  21. Geraghty JJ, Jankovic J, Zetusky WJ., 1985, Association between essential tremor and Parkinson’s disease. Ann Neurol 17:329–333PubMedCrossRefGoogle Scholar
  22. Glover V, Gibb C, Sandler M., 1986, Monoamine oxidase B (MAO-B) is the major catalylst for l-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) oxidation in human brain and other tissues. Neurosci let 64:216–220CrossRefGoogle Scholar
  23. Goetz CG, Lütge W, Tanner CM., 1986, Autonomic dysfunction in Parkinson’s disease. Neurology 36:73–75PubMedGoogle Scholar
  24. Goetz CG, Tanner CM, Levy M, Wilson RS, Garron DC., 1986a, Pain in Parkinson’s disease. Movement Disorders 1:45–49PubMedCrossRefGoogle Scholar
  25. Halliwell B and Gutteridge JMC., 1985, Oxygen radicals and the nervous system. Trends In Neuroscience 8:22–26CrossRefGoogle Scholar
  26. Hoehn MD and Yahr MM., 1967, Parkinsonism: onset, progression and mortality. Neurology 17:427–442PubMedGoogle Scholar
  27. Jankovic J and Reches A., 1986, Parkinson’s disease in monozygotic twins. Ann Neurol 19:405–408PubMedCrossRefGoogle Scholar
  28. Joynt RJ and Gash DM., 1987, Neural tranplants: are we ready? Ann Neurol 22:455–456PubMedCrossRefGoogle Scholar
  29. Kidron D and Melamed E., 1987, Forms of dystonia in patients with Parkinson’s disease. Neurology 37:1009–1011PubMedGoogle Scholar
  30. Kish SJ, Morito C, Hornykiewicz O, 1985, Glutathione peroxidase activity in Parkinson’s disease brain. Neuros- cience letters 58:343–346PubMedCrossRefGoogle Scholar
  31. Koller W, O’Hara R, Nutt J, Young J, Rubino E, 1986, Monozygotic twins with Parkinson’s disease. Ann Neurol 19:402–405PubMedCrossRefGoogle Scholar
  32. Koller W, O’Hara R, Weiner W, Lang A, Nutt J, Agid Y, Bunnet AM, Jankovic J., 1986, Relationship of aging to Parkinson’s disease. Adv Neurol 45:317–321Google Scholar
  33. Koller WC., 1984, Sensory symptoms in Parkinson’s disease. Neurology 34:957–959PubMedGoogle Scholar
  34. Kopin IJ., 1986, Toxins and Parkinson’s disease: MPTP parkinsonism in humans and animals. Adv Neurol 45:137–144Google Scholar
  35. Kurlan R, Rubin AJ, Miller C, Rivera-Calimlim L, Clarke A, Shoulson I., 1986, Duodenal delivery of levodopa for on-off fluctuations in parkinsonism: preliminary observations. Ann Neurol 20:262–265PubMedCrossRefGoogle Scholar
  36. Lang AE and Johnson K., 1987, Akathesia in idiopathic Parkinson’s disease. Neurology 37:477–481PubMedGoogle Scholar
  37. Langston JW, Ballard P, Tetrud JW, Irwin I., 1983, Chronic parkinsonism in humans due to a product of meperidine synthesis, Science 219:979–980PubMedCrossRefGoogle Scholar
  38. Langston JW and Ballard PA., 1983a, Parkinson’s disease in a chemist working with l-methyl-4-phenyl-1,2,3,6-tetrahydropyridine. N Engl J Med 309:310PubMedGoogle Scholar
  39. Leiberman AN and Goldstein M., 1985, Bromocriptine in Parkinson’s disease. Pharmacologic Rev 37:217–227Google Scholar
  40. Madrazo I, Drucker-Colin R, Diaz V, Martinez-Mata J, Torres C, Becerril JJ., 1987, Open microsurgical autograft of adrenal medulla to right caudate nucleas in two patients with intactable Parkinson’s disease. N Engl J Med 316:831–834PubMedCrossRefGoogle Scholar
  41. Markham CH, Treciokas LJ, Diamond SG., 1974, Parkinson’s disease and levodopa — a five year followup. West J Med 121:188–206PubMedGoogle Scholar
  42. Martilla RJ and Rinne UK., 1986, Clues from epidemiology of Parkinson’s disease. Adv Neurol 45:285–288Google Scholar
  43. Mitchell IJ, Cross AJ, Sambrook MA, Crossman AR., 1985, Sites of neurotoxic action of l-methyl-4-phenyl-1,2,3,6-tetrahydropyridine in the macque monkey include the ventral tegmental area and the locus coeruleus. Neuroscience letters 61:195–200PubMedCrossRefGoogle Scholar
  44. Mjones H., 1949, Paralysis agitans: a clinical and genetical study. Acta Psychiatrica Scand Supplementum 54:1Google Scholar
  45. Nausieda PA, Weiner WJ, Klawans HL., 1980, Dystonic foot response of parkinsonism. Arch Neurol 37:132–136PubMedCrossRefGoogle Scholar
  46. Nutt JG, Woodward WR, Hammerstad JP, Carter JT, Anderson JL., 1984, The “on-off” phenomenon in Parkinson’s disease: relation to levodopa absorption and transport. N Engl J Med 310:483–488PubMedCrossRefGoogle Scholar
  47. Nutt JG., 1987, On-off phenomenon: relationship to levodopa pharmacokinetics and pharmacodynamics. Ann Neurol 22:535–540PubMedCrossRefGoogle Scholar
  48. Obeso JA, Luguin MR, Martinez Lage JM., 1986, Intravenous lisuride corrects oscillations of motor performance. Ann Neurol 19:31–35PubMedCrossRefGoogle Scholar
  49. Parkinson J., 1817, Essay on the shaking palsy. London: Whittingham and Rowland, for Sherwood, Neely and JonesGoogle Scholar
  50. Perry TL and Yong VW., 1986, Idiopathic Parkinson’s disease, progressive supranuclear palsy and glutathione metabolism in substantia nigra of patients. Neuroscience letters 67:269–274PubMedCrossRefGoogle Scholar
  51. Perry TL, Godin DV, Hansen S., 1982, Parkinson’s disease: a disorder due to nigral glutathione deficiency ? Neuroscience letters 33:305–310PubMedCrossRefGoogle Scholar
  52. Pincus JH and Barry KB., 1987, Influence of dietary protein on motor fluctuations in Parkinson’s disease. Arch Neurol 44:270–272PubMedCrossRefGoogle Scholar
  53. Quinn NP, Lang AE, Koller WC, Marsden CD., 1986, Painful Parkinson’s disease. Lancet 1:1366–1369PubMedCrossRefGoogle Scholar
  54. Rajput AH., 1984, Etiology of Parkinson’s disease: environmental factor (s). Neurology 34(suppl 1):207Google Scholar
  55. Rajput AH, Uitti RJ, Stern W, Laverty W., 1986, Early onset Parkinson’s disease and childhood environment. Adv Neurol 45:295–297Google Scholar
  56. Reznikoff G, Manaker S, Parsons B, Rhodes CH, Rainbow TC., 1985, Similar distribution of monoamine oxidase (MAO) and parkinsonian toxin (MPTP) binding sites in human brain. Neurology 35:1415–1419PubMedGoogle Scholar
  57. Rinne UK., 1985, Combined bromocriptine — levodopa therapy early in Parkinson’s disease. Neurology 35:1196–1198PubMedGoogle Scholar
  58. Sanchez-Ramos JR, Michel P, Weiner WJ, Hefti E, 1988, Selective destruction of cultured dopaminergic neurons from embryonic rat mesencephalon: cytochemical and morphological evidence. J Neurochem in pressGoogle Scholar
  59. Sanchez-Ramos JR, Hollinden CE, Sick TJ, Rosenthal M., 1988a, 1-methyl-4-phenylpyridinium (MPP +) increases oxidation of cytochrome b in rat striatal slices. Brain Res 443:183–189PubMedCrossRefGoogle Scholar
  60. Sanchez-Ramos J, Barret JN, Goldstein M, Weiner WJ, Hefti E, 1986, 1-methyl-4-phenylpyridinium (MPP +) but not 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) selectively destroys dopaminergic neurons in cultures of dissociated rat mesencephalic neurons. Neuroscience letters 72:215–220PubMedCrossRefGoogle Scholar
  61. Santamaria J, Tolosa E, Valles A., 1986, Parkinson’s disease with depression: a possible subgroup of idiopathic parkinsonism. Neurology 36:1130–1133PubMedGoogle Scholar
  62. Schwab RS., 1960, Progression and prognosis of Parkinson’s disease. J nervous & Mental Disease 130:556–566CrossRefGoogle Scholar
  63. Schwarcz R and Meldrum B., 1985, Excitatory aminoacid antagonists provide a therapeutic approach to neurological disorders. Lancet 2:140–143PubMedCrossRefGoogle Scholar
  64. Snyder SH and D’Amato RJ., 1986, MPTP: a neurotoxin relevant to the pathophysiology of Parkinsin’s disease. Neurology 36:250–258PubMedGoogle Scholar
  65. Spencer PS, Nunn PB, Hugon J, Ludolph AC, Ross SM, Roy DN, Robertson RC., 1987, Guam amyotrophic lateral sclerosis-parkinsonism-dementia linked to plant excitant neurotoxin. Science 237:517–522PubMedCrossRefGoogle Scholar
  66. Stern G., 1987, Prognosis in Parkinson’s disease (Chap 7). In: Marsden CD and Fahn S eds. Movement disorders 2. Butterworth. London: pp 91–98Google Scholar
  67. Stoessl AJ, Mak E, Calne BD., 1985, (+)-4-propy 1–9-hydroxynaphthoxazine (PHNO). a new dopaminemimetic, in treatment of parkinsonism. Lancet 2:1330–1331PubMedCrossRefGoogle Scholar
  68. Sweet RD and McDowell FH., 1975, Five years treatment of Parkinson’s disease with levodopa. Ann lnt Med 83:456–463Google Scholar
  69. Uhl GR, Javitch JA, Snyder SH., 1985, Normal MPTP binding in parkinsonian substantia nigra: evidence for ex- traneuronal toxin conversion in human brain. Lancet 1:956–957PubMedCrossRefGoogle Scholar
  70. Vyas I, Heikkila RE, Nicklas WJ., 1986, Studies on the neurotoxicity of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine: inhibition of NAD-linked substrate oxidation by its metabolite, 1-methyl-4-phenylpyridinium. J Neurochem 46:1501–1507PubMedCrossRefGoogle Scholar
  71. Ward CD, Duvoisin RC, Ince SE, Nutt JD, Eldridge R, Calne DB., 1983, Parkinson’s disease in 65 pairs of twins and in a set of quadruplets. Neurology 33 815–824PubMedGoogle Scholar
  72. Ward CD, Hess WA, Calne DB., 1983a, Olfactory impairment in Parkinson’s disease. Neurology 33:943–946PubMedGoogle Scholar
  73. Weiner WJ, Factor SA, Sanchez-Ramos JR., 1988, A comparison of bromocriptine and levodopa/carbidopa both alone and in combination in de novo patients with Parkinson’s disease. Arch Neurol 45:207Google Scholar
  74. Weiner WJ, Factor SA, Sanchez-Ramos JR., 1987, The efficacy of (+)-4-propy 1–9-hydroxynaphthoxazine (PHNO) as adjunctive therapy in Parkinson’s disease. Neurology 37 (Suppl 1):276,1987Google Scholar
  75. Weiner WJ, Factor SA, Sanchez-Ramos JR, Berger J., 1987, A double blind evaluation of Ciladopa in Parkinson’s disease. Movement Disorders 2 211–217PubMedCrossRefGoogle Scholar
  76. Weiner WJ and Nausieda PA., 1982, Meiges syndrome during long term dopaminergic therapy in Parkinson’s disease. Arch Neurol 39:451–452PubMedCrossRefGoogle Scholar
  77. Yahr MD., 1975, Levodopa. Ann lnt Med 83:677–682Google Scholar
  78. Zetusky WJ, Jankovic J, Pirozzolo FJ., 1985, The heterogeneity of Parkinson’s disease: clinical and prognostic implications. Neurology 35:522–526PubMedGoogle Scholar

Copyright information

© Plenum Press, New York 1988

Authors and Affiliations

  • Stewart A. Factor
    • 1
  • William J. Weiner
    • 2
  1. 1.Dept of Neurolog AlbanyAlbany Medical CollegeNew YorkUSA
  2. 2.Dept of Neurology MiamiUniversity of MiamiFloridaUSA

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