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! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align=center| {{fontcolor|#2B3B44|Parkinson Resident Survival Guide Microchapters}} | |||
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Parkinson resident survival guide#Overview|Overview]] | |||
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Parkinson resident survival guide#Causes|Causes]] | |||
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Parkinson resident survival guide#Diagnosis|Diagnosis]] | |||
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Parkinson resident survival guide#Treatment|Treatment]] | |||
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Parkinson resident survival guide#Do's|Do's]] | |||
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Parkinson resident survival guide#Don'ts|Don'ts]] | |||
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{{WikiDoc CMG}}; {{AE}}{{Fs}}, [[User:MoisesRomo|Moises Romo, M.D.]] | {{WikiDoc CMG}}; {{AE}}{{Fs}}, [[User:MoisesRomo|Moises Romo, M.D.]] | ||
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{{SK}}<nowiki/>''Parkinson's'' disease ''management, Parkinson's disease workup, Parkinson's disease approach, approach to Parkinson's disease, Parkinson's disease treatment'' | {{SK}}<nowiki/>''Parkinson's'' disease ''management, Parkinson's disease workup, Parkinson's disease approach, approach to Parkinson's disease, Parkinson's disease treatment'' | ||
==Overview== | ==Overview== | ||
'''Parkinson's disease''' is a degenerative movement disorder of the [https://www.wikidoc.org/index.php/Central_nervous_system central nervous system]. It is characterized by motor symptoms such as bradykinesia, rigidity, and tremor, but also cognitive and comunicative symptoms such as facial masking and dysarthria. These primary symptoms are the results of decreased stimulation of the motor cortex by the basal ganglia, normally caused by the insufficient formation and action of [https://www.wikidoc.org/index.php/Dopamine dopamine]. Diagnosis is mainly clinical. The mainstay of therapy for motor symptoms of Parkinson disease are: Levodopa, dopamine agonists, monoamine oxidase (MAO) B inhibitors, anticholinergic agents, amantadine, catechol-O-methyl transferase (COMT) inhibitors, estrogen and other drugs such as Exenatide, uric acid, isradipine, nilotinib and GDNF infusion. Other therapies will depend on comorbidities. | '''[[Parkinson's disease]]''' is a [[degenerative]] [[movement disorder]] of the [https://www.wikidoc.org/index.php/Central_nervous_system central nervous system]. It is characterized by [[Motor disorders|motor]] [[symptoms]] such as [[bradykinesia]], rigidity, and [[tremor]], but also [[cognitive]] and comunicative [[symptoms]] such as [[facial]] masking and [[dysarthria]]. These primary [[symptoms]] are the results of decreased stimulation of the [[motor cortex]] by the [[basal ganglia]], normally caused by the insufficient formation and action of [https://www.wikidoc.org/index.php/Dopamine dopamine]. [[Diagnosis]] is mainly clinical, it may be supported by [[MRI]] findings and dopamine transporter single-photon emission computed tomography (DaT SPECT), but definitive [[diagnosis]] is made by [[autopsy]]. The mainstay of [[therapy]] for [[Motor disorders|motor]] [[symptoms]] of [[Parkinson disease]] are: [[Levodopa]], [[dopamine agonists]], [[Monoamine oxidase B|monoamine oxidase (MAO) B]] inhibitors, [[Anticholinergic drug|anticholinergic agents]], [[amantadine]], [[Catechol-O-methyl transferase|catechol-O-methyl transferase (COMT)]] inhibitors, [[estrogen]] and other [[drugs]] such as [[Exenatide]], [[uric acid]], [[isradipine]], [[nilotinib]] and [[GDNF]] infusion. Other therapies will depend on [[comorbidities]]. | ||
==Causes== | ==Causes== | ||
===Life Threatening Causes=== | ===Life Threatening Causes=== | ||
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated. | Life-threatening causes include conditions that may result in death or permanent [[disability]] within 24 hours if left untreated. | ||
*[[ | *[[Parkinson's disease]] is not a life-threatening condition that may result in death or permanent [[disability]] within 24 hours if left untreated. | ||
===Common Causes=== | ===Common Causes=== | ||
*[[ | *The cause of [[Parkinson's disease]] is a [[dopamine]] depletion due to a [[necrosis]] of [[Dopaminergic neuron|dopaminergic neurons]] in the [[substantia nigra]]. | ||
*[[ | *Factors that may contribute to the development of [[Parkinson's disease]] are: | ||
*[[ | **Low [[norepinephrine]] levels | ||
*[[ | **The presence of [[Lewy bodies]] | ||
*[[ | **[[Autoimmunity|Autoimmune]] factors | ||
==Diagnosis== | ==Diagnosis== | ||
Shown below is an [[Algorithm (medical)|algorithm]] summarizing the [[diagnosis]] of [[Gait abnormality| | Shown below is an [[Algorithm (medical)|algorithm]] summarizing the [[diagnosis]] of [[Gait abnormality|Parkinson's disease]] according to the American Academy of Neurology guidelines:<ref name="Marinode Souza2020">{{cite journal|last1=Marino|first1=Bianca L.B.|last2=de Souza|first2=Lucilene R.|last3=Sousa|first3=Kessia P.A.|last4=Ferreira|first4=Jaderson V.|last5=Padilha|first5=Elias C.|last6=da Silva|first6=Carlos H.T.P.|last7=Taft|first7=Carlton A.|last8=Hage-Melim|first8=Lorane I.S.|title=Parkinson’s Disease: A Review from Pathophysiology to Treatment|journal=Mini-Reviews in Medicinal Chemistry|volume=20|issue=9|year=2020|pages=754–767|issn=13895575|doi=10.2174/1389557519666191104110908}}</ref> | ||
{{Family tree/start}} | {{Family tree/start}} | ||
{{ | {{familytree | | | | | | | | | | | A01 |A01=[[Prodromal symptoms|Prodromal period]] }} | ||
{{ | {{familytree | | | | | | |,|-|-|-|-|^|-|-|-|-|.| | | }} | ||
{{ | {{familytree | | | | | B01 | | | | | | | | | B02 | | |B01='''Possible early [[symptoms]] of [[Parkinson disease]]''' | ||
{{ | <br>• [[Rapid eye movement]] [[sleep]] [[behavior]] [[disorder]] | ||
{{ | <br>• [[Autonomic dysfunction|Autonomic symptoms]] (eg, [[constipation]], [[orthostatic hypotension]]) | ||
{{ | <br>• [[Hyposmia]] |B02='''Family history''' | ||
{{ | <br>• First-degree relative with [[Parkinson disease]] | ||
{{ | <br>• Known [[Parkinson disease]] [[gene mutation]] in family }} | ||
{{ | {{familytree | | | | | | |`|-|-|-|-|v|-|-|-|-|'| }} | ||
{{ | {{familytr | | | | | | | |,|-|-|-|-|+|-|-|-|-|-|.|}} | ||
{{ | {{familytree | | | | | | B01 | | | B02 | | | B03 | |B01='''Physical examination''' <br>Findings must include | ||
{{ | <br>• [[Bradykinesia]] | ||
{{ | <br>• Rigidity and/or [[tremor]] <br>Findings may include | ||
{{ | <br>• Hypophonia | ||
{{ | <br>• Micrographia | ||
{{ | <br>• Decreased arm swing | ||
{{ | <br>• Short step length|B02='''Patient medical history''' <br>Symptoms may include | ||
{{ | <br>• [[Slowness]] | ||
{{Family tree/end}}<br> | <br>• [[Tremor]] | ||
<br>• [[Gait abnormality|Gait changes]] | |||
<br>• Soft voice | |||
<br>• Decreased [[facial]] expression | |||
<br>• [[Depression]] and/or [[anxiety]] |B03='''Other factors''' <br>• [[Dopamine]] transporter single-proton emission [[computed tomography]] imaging findings | |||
<br>• [[Genetic]] data }} | |||
{{familytree | | | | | | |`|-|-|-|-|+|-|-|-|-|'| }} | |||
{{familytree | | | | | | | | | | | A01 |A01=Evaluation consistent with [[Parkinson disease]] }} | |||
{{familytree | | | | | | | | | | | |!| | | | }} | |||
{{familytree | | | | | | | | | | | A01 |A01='''Assessment of features potentially indicative of atypical parkinsonism''' | |||
<br>• Rapid progression | |||
<br>• Early and recurrent falls | |||
<br>• Severe early [[dysphonia]] or [[dysarthria]] | |||
<br>• Severe early [[Autonomic dysfunction|autonomic failure]] | |||
<br>• [[Cerebellar]] findings (eg, [[dysmetria]]) }} | |||
{{familytree | | | | | | | | | | | |!| | | | }} | |||
{{familytree | | | | | | | | | | | A01 |A01=All features present? }} | |||
{{familytree | | | | | | |,|-|-|-|-|^|-|-|-|-|.| }} | |||
{{familytree | | | | | | A01 | | | | | | | | A02 |A01=Yes |A02=No }} | |||
{{familytree | | | | | | |!| | | | | | | | | |!| | }} | |||
{{familytree | | | | | | A01 | | | | | | | | |!| |A01=Evaluate for patient response to [[levodopa]] }} | |||
{{familytree | | | | | | |!| | | | | | | | | |!| | }} | |||
{{familytree | | | | | | A01 | | | | | | | | |!| |A01=Response? }} | |||
{{familytree | | |,|-|-|-|^|-|-|-|.| | | | | |!| }} | |||
{{familytree | | A01 | | | | | | A02 |-|-|-| A03 |A01=Yes |A02=No |A03=Consider [[diagnosis]] of atypical [[parkinsonism]] }} | |||
{{familytree | | |!| | | | | | | | | }} | |||
{{familytree | | A01 | | | | | | |A01=Confirmation of [[Parkinson disease]] [[diagnosis]]}} | |||
{{Family tree/end}}(DO NOT MODIFY)<br> | |||
==Treatment== | ==Treatment== | ||
Shown below is an algorithm summarizing the treatment of | Shown below is an [[Algorithm (medical)|algorithm]] summarizing the [[treatment]] of [[Gait abnormality|Parkinson's disease]] according to the American Academy of Neurology guidelines:<ref name="Marinode Souza2020" /><br><br> | ||
{{familytree/start |summary=PE diagnosis Algorithm.}} | {{familytree/start |summary=PE diagnosis Algorithm.}} | ||
{{familytree | | | | | | | | A01 |A01= }} | {{familytree | | | | | | | | A01 |A01=[[Parkinson disease]] [[Motor disorders|motor symptoms]]<br>• [[Bradykinesia]] with or without rigidity<br>• [[Tremor]] }} | ||
{{familytree | | | | |,|-|-|-|^ | {{familytree | | | | | | | | |!| | | | | | | }} | ||
{{familytree | | | B01 | | | | | | | | B02 | | |B01= |B02= }} | {{familytree | | | | | | | | A01 |A01=Initial [[Therapy|medical therapy]] }} | ||
{{familytree | | | | | {{familytree | | | | |,|-|-|-|^|-|-|-|.| | | }} | ||
{{familytree | | | | {{familytree | | | B01 | | | | | | | | B02 | | |B01='''Tremor and/or bradykinesia options''' | ||
{{familytree | | | <br>• [[Levodopa]] | ||
{{familytree | | preparations | ||
{{familytree | |!| | | | | | | | | |,|-|^|.| }} | <br>• [[Dopamine agonists|Dopamine agonists]] | ||
{{familytree | | <br>• [[Monoamine oxidase B|Monoamine oxidase-B]] | ||
{{familytree | | | | | | | | | | |!| | | | | inhibitors |B02='''Tremor only''' | ||
{{familytree | | | | | | | | | | | <br>• [[Anticholinergic drug|Anticholinergic agents]] | ||
{{familytree/end}} | (eg, [[trihexyphenidyl]]) }} | ||
{{familytree | | | | |`|-|-|-|v|-|-|-|'| | }} | |||
{{familytree | | | | | | | | C01 | | | | | | | |C01=Subsequent [[Medical treatment|medical therapy]] }} | |||
{{familytree | | | | | | | | |!| | | | | | | | }} | |||
{{familytree | | | | | | | | C01 | | | | | | | |C01='''Increasing doses and add-on therapies for “wearing off”''' | |||
<br>• [[Levodopa]] | |||
preparations | |||
<br>• Istradefylline | |||
<br>• [[Dopamine agonists]] | |||
<br>• [[Monoamine oxidase B]] | |||
inhibitors | |||
<br>• [[Catechol-O-methyltransferase]] | |||
inhibitors | |||
<br>• [[Amantadine]] | |||
(primarily for [[dyskinesia]]) }} | |||
{{familytree | | | | | | | | |!| | | | | | | | }} | |||
{{familytree | | | | | | | | C01 | | | | | | |C01=Advanced [[therapy]] }} | |||
{{familytree | | | | |,|-|-|-|^|-|-|-|.| | | }} | |||
{{familytree | | | | C01 | | | | | | C02 |C01='''Tremor and/or bradykinesia options'''|C02='''Tremor only''' }} | |||
{{familytree | | | | |!| | | | | | | |!| | | | | }} | |||
{{familytree | | | | C01 | | | | | | C02 |C01=• [[Levodopa]] [[carbidopa]] | |||
enteral suspension infusion <br>• Unilateral or bilateral | |||
[[deep brain stimulation]]|C02=• Unilateral focused | |||
[[ultrasound]] [[thalamotomy]]<br>• Unilateral or bilateral | |||
[[deep brain stimulation]] | |||
([[thalamus]]) }} | |||
{{familytree/end}}(DO NOT MODIFY) | |||
==Do's== | ==Do's== | ||
* | *Use [[levodopa]] preparations, [[dopamine agonists]], and [[Monoamine oxidase B|monoamine oxidase-B (MAO-B)]] inhibitors initially for [[Motor disorders|motor symptoms]].<ref name="Marinode Souza2020" /> | ||
*Be aware of [[cognitive impairment]] and other [[side effects]] when using [[Anticholinergic drug|anticholinergic agents]] in young people.<ref name="FoxKatzenschlager2018">{{cite journal|last1=Fox|first1=Susan H.|last2=Katzenschlager|first2=Regina|last3=Lim|first3=Shen-Yang|last4=Barton|first4=Brandon|last5=de Bie|first5=Rob M. A.|last6=Seppi|first6=Klaus|last7=Coelho|first7=Miguel|last8=Sampaio|first8=Cristina|title=International Parkinson and movement disorder society evidence-based medicine review: Update on treatments for the motor symptoms of Parkinson's disease|journal=Movement Disorders|volume=33|issue=8|year=2018|pages=1248–1266|issn=08853185|doi=10.1002/mds.27372}}</ref> | |||
*Use [[rivastigmine]] for [[Parkinson disease]] [[dementia]]. There is no evidence of [[memantine]] usefulness for mild [[cognitive impairment]].<ref name="SeppiRay Chaudhuri2019">{{cite journal|last1=Seppi|first1=Klaus|last2=Ray Chaudhuri|first2=K.|last3=Coelho|first3=Miguel|last4=Fox|first4=Susan H.|last5=Katzenschlager|first5=Regina|last6=Perez Lloret|first6=Santiago|last7=Weintraub|first7=Daniel|last8=Sampaio|first8=Cristina|last9=Chahine|first9=Lana|last10=Hametner|first10=Eva‐Maria|last11=Heim|first11=Beatrice|last12=Lim|first12=Shen‐Yang|last13=Poewe|first13=Werner|last14=Djamshidian‐Tehrani|first14=Atbin|title=Update on treatments for nonmotor symptoms of Parkinson's disease—an evidence‐based medicine review|journal=Movement Disorders|volume=34|issue=2|year=2019|pages=180–198|issn=0885-3185|doi=10.1002/mds.27602}}</ref> | |||
*Use [[selective serotonin reuptake inhibitors]], [[SSNRI|selective serotonin norepinephrine reuptake inhibitors]], and [[tricyclic antidepressants]] for [[depression]] in [[Parkinson disease]].<ref name="SeppiRay Chaudhuri2019" /> | |||
*Use [[anticholinergics]], [[amantadine]], [[dopamine agonists]], [[Monoamine oxidase B|MAO-B inhibitors]] for [[psychosis]] in [[Parkinson's disease|Parkinson disease]].<ref name="SeppiRay Chaudhuri2019" /> | |||
*Use [[fludrocortisone]], [[midodrine]], and [[droxidopa]] are all possibly useful for [[orthostatic hypotension]] in [[Parkinson's disease|Parkinson disease]].<ref name="SeppiRay Chaudhuri2019" /> | |||
*Prescribe an appropriate [[exercise]] regimen at the time of [[diagnosis]] and throughout the [[disease]].<ref name="Marinode Souza2020" /> | |||
*Use [[deep brain stimulation]] and other [[Surgeries|surgical]] approaches when individuals with [[Parkinson's disease|Parkinson disease]] experience either the “wearing off” phenomenon or [[Dyskinesia|dyskinesias]] that do not respond to [[medication]].<ref name="Marinode Souza2020" /> | |||
==Don'ts== | ==Don'ts== | ||
* | *Do not use [[neuroimaging]] or [[genetic screening]] for [[Parkinson's disease|Parkinson's disease]] [[diagnosis]].<ref name="SuchowerskyReich2006">{{cite journal|last1=Suchowersky|first1=O.|last2=Reich|first2=S.|last3=Perlmutter|first3=J.|last4=Zesiewicz|first4=T.|last5=Gronseth|first5=G.|last6=Weiner|first6=W. J.|title=Practice Parameter: Diagnosis and prognosis of new onset Parkinson disease (an evidence-based review)|journal=Neurology|volume=66|issue=7|year=2006|pages=968–975|issn=0028-3878|doi=10.1212/01.wnl.0000215437.80053.d0}}</ref> | ||
*Do not confuse [[Parkinson's disease|Parkinson's disease]] with a [[Parkinsonism|parkinsonian syndrome]]. Distinguish them by performing a dopaminergic challenge with either [[levodopa]] or [[apomorphine]].<ref name="AlbaneseBonuccelli2001">{{cite journal|last1=Albanese|first1=Alberto|last2=Bonuccelli|first2=Ubaldo|last3=Brefel|first3=Christine|last4=Chaudhuri|first4=K. Ray|last5=Colosimo|first5=Carlo|last6=Eichhorn|first6=Tobias|last7=Melamed|first7=Eldad|last8=Pollak|first8=Pierre|last9=Van Laar|first9=Teus|last10=Zappia|first10=Mario|title=Consensus statement on the role of acute dopaminergic challenge in Parkinson's disease|journal=Movement Disorders|volume=16|issue=2|year=2001|pages=197–201|issn=0885-3185|doi=10.1002/mds.1069}}</ref><ref name="pmid10410742">{{cite journal |vauthors=Hughes AJ |title=Apomorphine test in the assessment of parkinsonian patients: a meta-analysis |journal=Adv Neurol |volume=80 |issue= |pages=363–8 |date=1999 |pmid=10410742 |doi= |url=}}</ref> | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Resident survival guide]] | [[Category:Resident survival guide]] | ||
[[Category: | [[Category:Up To Date]] | ||
Latest revision as of 14:10, 4 March 2021
Parkinson Resident Survival Guide Microchapters |
---|
Overview |
Causes |
Diagnosis |
Treatment |
Do's |
Don'ts |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D., Moises Romo, M.D.
Synonyms and keywords:Parkinson's disease management, Parkinson's disease workup, Parkinson's disease approach, approach to Parkinson's disease, Parkinson's disease treatment
Overview
Parkinson's disease is a degenerative movement disorder of the central nervous system. It is characterized by motor symptoms such as bradykinesia, rigidity, and tremor, but also cognitive and comunicative symptoms such as facial masking and dysarthria. These primary symptoms are the results of decreased stimulation of the motor cortex by the basal ganglia, normally caused by the insufficient formation and action of dopamine. Diagnosis is mainly clinical, it may be supported by MRI findings and dopamine transporter single-photon emission computed tomography (DaT SPECT), but definitive diagnosis is made by autopsy. The mainstay of therapy for motor symptoms of Parkinson disease are: Levodopa, dopamine agonists, monoamine oxidase (MAO) B inhibitors, anticholinergic agents, amantadine, catechol-O-methyl transferase (COMT) inhibitors, estrogen and other drugs such as Exenatide, uric acid, isradipine, nilotinib and GDNF infusion. Other therapies will depend on comorbidities.
Causes
Life Threatening Causes
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
- Parkinson's disease is not a life-threatening condition that may result in death or permanent disability within 24 hours if left untreated.
Common Causes
- The cause of Parkinson's disease is a dopamine depletion due to a necrosis of dopaminergic neurons in the substantia nigra.
- Factors that may contribute to the development of Parkinson's disease are:
- Low norepinephrine levels
- The presence of Lewy bodies
- Autoimmune factors
Diagnosis
Shown below is an algorithm summarizing the diagnosis of Parkinson's disease according to the American Academy of Neurology guidelines:[1]
Prodromal period | |||||||||||||||||||||||||||||||||||||||
Possible early symptoms of Parkinson disease
• Hyposmia | Family history
• Known Parkinson disease gene mutation in family | ||||||||||||||||||||||||||||||||||||||
Physical examination Findings must include
• Short step length | Patient medical history Symptoms may include
• Depression and/or anxiety | Other factors • Dopamine transporter single-proton emission computed tomography imaging findings • Genetic data | |||||||||||||||||||||||||||||||||||||
Evaluation consistent with Parkinson disease | |||||||||||||||||||||||||||||||||||||||
Assessment of features potentially indicative of atypical parkinsonism
• Cerebellar findings (eg, dysmetria) | |||||||||||||||||||||||||||||||||||||||
All features present? | |||||||||||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||||||||||
Evaluate for patient response to levodopa | |||||||||||||||||||||||||||||||||||||||
Response? | |||||||||||||||||||||||||||||||||||||||
Yes | No | Consider diagnosis of atypical parkinsonism | |||||||||||||||||||||||||||||||||||||
Confirmation of Parkinson disease diagnosis | |||||||||||||||||||||||||||||||||||||||
(DO NOT MODIFY)
Treatment
Shown below is an algorithm summarizing the treatment of Parkinson's disease according to the American Academy of Neurology guidelines:[1]
Parkinson disease motor symptoms • Bradykinesia with or without rigidity • Tremor | |||||||||||||||||||||||||||||||||||
Initial medical therapy | |||||||||||||||||||||||||||||||||||
Tremor and/or bradykinesia options
| Tremor only (eg, trihexyphenidyl) | ||||||||||||||||||||||||||||||||||
Subsequent medical therapy | |||||||||||||||||||||||||||||||||||
Increasing doses and add-on therapies for “wearing off”
| |||||||||||||||||||||||||||||||||||
Advanced therapy | |||||||||||||||||||||||||||||||||||
Tremor and/or bradykinesia options | Tremor only | ||||||||||||||||||||||||||||||||||
• Levodopa carbidopa
enteral suspension infusion | • Unilateral focused
ultrasound thalamotomy | ||||||||||||||||||||||||||||||||||
(DO NOT MODIFY)
Do's
- Use levodopa preparations, dopamine agonists, and monoamine oxidase-B (MAO-B) inhibitors initially for motor symptoms.[1]
- Be aware of cognitive impairment and other side effects when using anticholinergic agents in young people.[2]
- Use rivastigmine for Parkinson disease dementia. There is no evidence of memantine usefulness for mild cognitive impairment.[3]
- Use selective serotonin reuptake inhibitors, selective serotonin norepinephrine reuptake inhibitors, and tricyclic antidepressants for depression in Parkinson disease.[3]
- Use anticholinergics, amantadine, dopamine agonists, MAO-B inhibitors for psychosis in Parkinson disease.[3]
- Use fludrocortisone, midodrine, and droxidopa are all possibly useful for orthostatic hypotension in Parkinson disease.[3]
- Prescribe an appropriate exercise regimen at the time of diagnosis and throughout the disease.[1]
- Use deep brain stimulation and other surgical approaches when individuals with Parkinson disease experience either the “wearing off” phenomenon or dyskinesias that do not respond to medication.[1]
Don'ts
- Do not use neuroimaging or genetic screening for Parkinson's disease diagnosis.[4]
- Do not confuse Parkinson's disease with a parkinsonian syndrome. Distinguish them by performing a dopaminergic challenge with either levodopa or apomorphine.[5][6]
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Marino, Bianca L.B.; de Souza, Lucilene R.; Sousa, Kessia P.A.; Ferreira, Jaderson V.; Padilha, Elias C.; da Silva, Carlos H.T.P.; Taft, Carlton A.; Hage-Melim, Lorane I.S. (2020). "Parkinson's Disease: A Review from Pathophysiology to Treatment". Mini-Reviews in Medicinal Chemistry. 20 (9): 754–767. doi:10.2174/1389557519666191104110908. ISSN 1389-5575.
- ↑ Fox, Susan H.; Katzenschlager, Regina; Lim, Shen-Yang; Barton, Brandon; de Bie, Rob M. A.; Seppi, Klaus; Coelho, Miguel; Sampaio, Cristina (2018). "International Parkinson and movement disorder society evidence-based medicine review: Update on treatments for the motor symptoms of Parkinson's disease". Movement Disorders. 33 (8): 1248–1266. doi:10.1002/mds.27372. ISSN 0885-3185.
- ↑ 3.0 3.1 3.2 3.3 Seppi, Klaus; Ray Chaudhuri, K.; Coelho, Miguel; Fox, Susan H.; Katzenschlager, Regina; Perez Lloret, Santiago; Weintraub, Daniel; Sampaio, Cristina; Chahine, Lana; Hametner, Eva‐Maria; Heim, Beatrice; Lim, Shen‐Yang; Poewe, Werner; Djamshidian‐Tehrani, Atbin (2019). "Update on treatments for nonmotor symptoms of Parkinson's disease—an evidence‐based medicine review". Movement Disorders. 34 (2): 180–198. doi:10.1002/mds.27602. ISSN 0885-3185.
- ↑ Suchowersky, O.; Reich, S.; Perlmutter, J.; Zesiewicz, T.; Gronseth, G.; Weiner, W. J. (2006). "Practice Parameter: Diagnosis and prognosis of new onset Parkinson disease (an evidence-based review)". Neurology. 66 (7): 968–975. doi:10.1212/01.wnl.0000215437.80053.d0. ISSN 0028-3878.
- ↑ Albanese, Alberto; Bonuccelli, Ubaldo; Brefel, Christine; Chaudhuri, K. Ray; Colosimo, Carlo; Eichhorn, Tobias; Melamed, Eldad; Pollak, Pierre; Van Laar, Teus; Zappia, Mario (2001). "Consensus statement on the role of acute dopaminergic challenge in Parkinson's disease". Movement Disorders. 16 (2): 197–201. doi:10.1002/mds.1069. ISSN 0885-3185.
- ↑ Hughes AJ (1999). "Apomorphine test in the assessment of parkinsonian patients: a meta-analysis". Adv Neurol. 80: 363–8. PMID 10410742.