Objective: Parkinson's disease, the second most common neurodegenerative disorder afflicting 10 million people worldwide and the fourteenth leading cause of death in the United States, is caused by the death of dopaminergic neurons that regulate movement in the substantia nigra pars compacta. Mechanisms contributing to the development of Parkinson’s disease in vulnerable individuals include protein misfolding, protein aggregation, and mitochondrial dysfunction. In order to develop guidelines for clinicians to utilize precision medicine to develop treatment plans to address the specific needs of individuals with Parkinson’s disease and related conditions, we have developed algorithms for diagnosis and treatment based on their view of available knowledge. We reviewed the key literature on the pathogenesis of Parkinson’s disease on PubMed and google scholar in order to propose guidelines for the development of diagnostic and therapeutic interventions for people with Parkinson’s disease and related conditions. In about 25 percent of patients, clinicians incorrectly diagnose Parkinson’s disease. Causes of misdiagnosis include a lack of algorithms and inadequate use of diagnostic modalities. Four main mechanisms that may contribute to the development of Parkinson's disease (misfolding of alpha-synuclein, mitochondrial dysfunction, dysfunctional ubiquitin proteasomal pathways, and abnormal autophagy) and different diagnostic modalities (structured interview and examination, laboratory assessments, neuropathology, genetic testing, neuroimaging) will form the basis for our algorithm for the diagnosis and treatment of Parkinson’s disease and related conditions. Clinicians, administrators, policy planners, advocates, and other concerned individuals will benefit from the adoption of our guidelines for the diagnosis and treatment of Parkinson’s disease and related conditions.
Introduction: Clinicians are trained to elicit symptoms and signs to formulate a differential diagnosis. Ruling out treatable diseases is crucial. Movement disorders specialists interpret observable behaviors as indicators of potential pathological processes. Movement disorders specialists must be able to identify symptoms and signs of organic disorders as well as actions that represent normal behaviors in healthy members of specific ethnic and cultural groups. The goal of this presentation is to describe zaghrouta, a manifestation of joy in the Middle East and other cultures, and to differentiate this normal expression of feelings from movement disorders, exaggerated startle responses, and functional disorders. Case Presentation: A 29-year-old Egyptian woman observed the performance of zaghrouta frequently for happy events in her family, neighborhood, and community since early childhood as long as she can remember. Ten years ago she herself first performed zaghrouta at the engagement party of her friend. Since then she has performed zaghrouta five or six times a year to express happiness for cheerful events. Conclusions: Zaghrouta may resemble pathological behaviors seen in movement disorders as tardive dyskinesia, focal seizures, psychiatric manifestations as catatonia in schizophrenia, tics in the syndrome of Gilles de la Tourette syndrome, and functional disorders. Therefore, clinicians around the world must be able to differentiate this normal behavior to express emotions from abnormal behaviors indicating pathology.
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