Diagnosis and Management of Parkinson's Disease

Abstract

Despite numerous efforts to identify specific and sensitive biomarkers, the diagnosis of Parkinson's disease (PD) is still based on clinical criteria that include the presence of a combination of cardinal motor features (tremor, rigidity, bradykinesia, and postural instability), other motor features (including freezing of gait and abnormal postures), and numerous nonmotor features. In addition, the presence of atypical features may suggest an alternative diagnosis. Levodopa therapy remains the gold standard in the management of motor features of PD. New formulations of levodopa and novel delivery systems are currently being evaluated and gradually introduced in clinical practice in an attempt to prevent or treat levodopa-related motor complications. Dopamine agonists also play an important role as monotherapy in mild or adjunctive therapy in moderately advanced disease. As the disease progresses and patients develop complications from levodopa therapy, specifically motor fluctuations and dyskinesias, deep brain stimulation becomes an alternative therapeutic option. Clinical trials of experimental therapeutics are currently fueling the PD therapeutic pipeline.

Essential Tremor and Parkinson’s Disease: Exploring the Relationship

“…However, the pathology-based definition of PD has been challenged and some have proposed that, similar to ET, PD should also be considered a syndrome as it can present in the setting of different motor and non-motor phenomenologies, heterogeneous pathological findings, and with increasingly recognized genetic etiologies. Clinically, PD is characterized by a wide variety of motor symptoms (bradykinesia, rigidity, tremor, gait disturbances, and dystonia among others), and non-motor symptoms (including mood disorders, anosmia, rapid eye movement sleep behavior disorder (RBD), and autonomic dysfunction) 19–21. Some of these non-motor features such as mood disorders and RBD may also occur at a higher frequency in ET patients than controls (as will be discussed later) 22,23.…”

Progress toward an integrated understanding of Parkinson’s disease

“…An integrated understanding of PD will also enable more effective multi- and inter-disciplinary collaboration among scientists and clinicians, driving next-generation therapeutic trials targeting disease mechanisms and fulfilling the promise of personalized medicine. Advances in understanding the cellular mechanism underlying PD-related neurodegeneration will undoubtedly lead to better symptomatic and novel pathogenesis-targeted, disease-modifying therapies 136 .…”

<p>Homing of Super Paramagnetic Iron Oxide Nanoparticles (SPIONs) Labeled Adipose-Derived Stem Cells by Magnetic Attraction in a Rat Model of Parkinson’s Disease</p>

“…5,6 The second treatment strategy consists of replacing damaged neurons via transplantation of dopamine neurons. 7,8 Several types of stem cell, including embryonic mesencephalic progenitors, 9 neural stem cells (NSCs), 10 embryonic stem cells (ESC), 11 mesenchymal stem cells (MSCs), 12 pluripotent stem cells (iPSCs), 13 and hematopoietic stem cells have been transplanted into the brain with the goal of promoting the improvement of PD. 14 Among these cellular sources, adipose-derived stem cells (ADSC) are an accessible and autologous source for neural lineage in cell therapy.…”