Abstract
Parkinson’s Disease was first introduced by James Parkinson in 1817. Since then, major strides have been made in the development of its treatment. Early treatments were dominated by traditional and complementary therapies, which were largely serendipitous and observation-based. Especially, the use of anticholinergics by Jean-Martin Charcot and his student Ordenstein prevailed in the late 20th century. Current drug-based therapies manifest in the form of levodopa accompanied by dopamine agonist, COMT inhibitor, or MAO-B inhibitor, for the purpose of reducing the levodopa-induced symptom fluctuation. In terms of surgical treatment, while ablative surgeries in the brain have been abandoned due to high mortality rate in the late 1900s, Deep Brain Stimulation in the subthalamic nucleus or internal globus pallidus has mostly replaced ablative surgeries since its introduction in 1987. Current research topics include non-dopaminergic agents for motor fluctuation reduction, transplantation of dopaminergic neurons, gene therapies using viral vectors, reduction of alpha-synuclein neurotoxicity, and neuroprotective therapies. Especially, due to the fact that the etiology of the disease is yet to be elucidated, neuroprotective therapies aimed at slowing or stopping disease progression are of particular interest. It is suggested that future research should aim towards clarifying the cause of the disease, for the development of a treatment that can permanently halt or reverse Parkinson’s Disease-related neurodegeneration.
Highlights
Parkinson’s Disease (PD) is a neurodegenerative disease characterized by distinct triad cardinal motor symptoms of bradykinesia, rigidity, and resting tremor
It is caused by dopamine deficiency following the loss of dopaminergic neurons primarily in the substantia nigra pars compacta (SNc), but the reason for the neuronal death is unknown to date
It is reported that levodopa-carbidopa intestinal gel infusion (LCIG) results in a significant reduction of daily mean ‘off’ time and an increase of mean ‘on’ time without dyskinesia in advanced PD patients [16]; it is commonly accompanied by complications such as abdominal pain, skin infection, peritonitis, gastric reflux, and aspiration [17]
Summary
Parkinson’s Disease (PD) is a neurodegenerative disease characterized by distinct triad cardinal motor symptoms of bradykinesia, rigidity, and resting tremor. It is caused by dopamine deficiency following the loss of dopaminergic neurons primarily in the substantia nigra pars compacta (SNc), but the reason for the neuronal death is unknown to date. It is strongly suggested that, in cases of idiopathic PD, the combination of genetic factors and environmental factors leads to various mechanisms that trigger neuronal death [1]. It is often accompanied by the pathological hallmark of Lewy Bodies aggregated alpha-synuclein proteins - in the nigrostriatal pathway. This article is a narrative of the major advances in the treatment for Parkinson’s Disease since its first description, as well as its future prospects
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