Recent advances in treating Parkinson's disease.

Wolfgang H Oertel

doi:10.12688/f1000research.10100.1

Abstract

This article summarizes (1) the recent achievements to further improve symptomatic therapy of motor Parkinson’s disease (PD) symptoms, (2) the still-few attempts to systematically search for symptomatic therapy of non-motor symptoms in PD, and (3) the advances in the development and clinical testing of compounds which promise to offer disease modification in already-manifest PD. However, prevention (that is, slowing or stopping PD in a prodromal stage) is still a dream and one reason for this is that we have no consensus on primary endpoints for clinical trials which reflect the progression in prodromal stages of PD, such as in rapid eye movement sleep behavior disorder (RBD) —a methodological challenge to be met in the future.

Highlights

The decades of focus on the nigrostriatal system and dopamine replacement therapy Parkinson’s disease (PD) is a devastating disorder of the human nervous system and the second most common progressive chronic neurodegenerative disease
2) The publication of the Braak staging of PD8 combined with the “dual hit theory”[9] proposing that the manifestation of motor PD symptoms is a late-stage phenotype preceded for years, if not decades, by three prodromal stages (Figure 2)
Prevention is still a dream and one reason for this is that we have no consensus on primary endpoints for clinical trials, which reflect the progression in prodromal stages of PD, such as in rapid eye movement (REM) sleep behavior disorder (RBD), the most specific prodromal stage of PD - a methodological challenge to be met in the future

Summary

Introduction

The decades of focus on the nigrostriatal system and dopamine replacement therapy Parkinson’s disease (PD) is a devastating disorder of the human nervous system and the second most common progressive chronic neurodegenerative disease. Given the major impact of NMS and therapy-related nonmotor complications on the quality of life for PD patients and their partners, this field clearly needs priority in future clinical trials These compounds and techniques allow fine tuning of the available symptomatic therapy of motor and in part of NMSs in PD. At least 28 genetic risk (susceptibility) factors have been identified, and it is likely that this number will further increase (reviewed in 59) These discoveries have already had a major impact on the development of new therapies, especially in regard to potentially disease-modifying compounds—as will be discussed in relation to the alpha-synuclein “spreading hypothesis” below. Major efforts are placed into different imaging techniques with sophisticated magnetic resonance methods, nuclear medical ligands for the dopamine transporter single-positron emission computed tomography (SPECT) or fluorodesoxyglucose positron emission tomography[84]

Conclusions

Tretiakoff C

44. Pinna A

Findings

99. Parkinson Study Group