Parkinson’s Disease

Part of the series Advances in Experimental Medicine and Biology pp 131-155

Problems in the Treatment of Parkinsonism

  • Roger C. DuvoisinAffiliated withDepartment of Neurology, The Mount Sinai School of Medicine, The City University of New York

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The progress achieved in our understanding of parkinsonism and its treatment in the last decade has greatly improved the lot of our patients but has also brought new sets of problems. The very effectiveness of levodopa therapy has modified the clinical spectrum of symptomatology. By suppressing tremor and rigidity and prolong ing our patients’ lives, we have uncovered other manifestations of parkinsonism which were previously less prominent. The greater specificity of levodopa has rendered precise diagnosis more important, but at the same time the recognition of new entities has changed the nosology of parkinsonism. Although the diagnosis of extrapyramidal disorders depends almost exclusively on clinical observation, new diagnostic tools are beginning to alter the character of neurology and promise to have a significant impact on the clinical evaluation of patients with basal ganglia diseases.

Our better understanding of the modus operands of various drugs used in treating extrapyramidal disorders has in some ways complicated the physician’s task. In place of the simple empiricism that prevailed a decade ago, there is now a body of knowledge and theory which one must appreciate to obtain optimal therapeutic results.

The remarkable relief of Parkinsonian symptomatology possible in some patients has thrown into relief cases of treatment failure and placed additional emphasis on manifestations of parkinsonism which are either unresponsive to therapy or are actually exacer-bated by it. Finally, the diagnosis and management of intercurrent illnesses in Parkinson patients on levodopa therapy has presented additional new problems to the clinician.