PARKINSONISM: A GENERAL MOTOR DISABILITYAbstract
Parkinson’s disease (PD) is one of the most common neurodegenerative disorders in the population above 60 years of age. The movement abnormalities in PD are credited due to an imbalance between the acetylcholine and dopamine which results in uncontrolled movements. It is characterized using resting tremor, postural impairment, bradykinesia, and rigidity. The degeneration of midbrain dopaminergic neurons and accumulation of inclusions containing α-synuclein (termed “Lewy bodies”) throughout the nervous system are few of the most prominent features of PD. Still, there is no cure; we have several management options for the early treatment of PD. Several objective methods have been proposed for improving the diagnostic accuracy of PD, for enabling earlier diagnosis, to quantify the severity of disease and progress of treatment given. These methods include motor performance tests, olfaction tests, imaging techniques, and biochemical tests of blood and cerebrospinal fluid. None of the proposed methods is widely available or clinically used for PD. The validation of the objective methods takes time, and a large number of regulatory requirements need to be considered before a new instrument can be accepted as a clinical tool. It is probable that a combination of several methods will be needed for PD. The cardinal motor symptoms of PD only emerge after the degeneration of about 60-80% of the dopaminergic neurons; thus patients get diagnosed at a very late disease stage. As the disease progresses, the management of late-stage motor complications and non-motor symptoms remains particularly challenging and will benefit from further clinical research. To fully understand the etiology and mechanisms involved in the pathogenesis of PD, valid model systems are needed.
R. Singh and A. Srivastava *
Hygia Institute of Pharmaceutical Education and Research, Lucknow, Uttar Pradesh, India.
17 November 2018
30 April 2019
01 May 2019
01 June 2019