Clinical review of Parkinson's disease

A recent clinical review of Parkinson's disease, drawn from new evidence based guidelines, outlines management approaches and provides an insight into future strategies. Professor Carl Clarke (Department of Neurology, University of Birmingham, UK) provides a comprehensive clinical review of Parkinson's disease, based on recently published guidelines from the National Institute for Health and Clinical Excellence (NICE), which are consistent with the current American Academy of Neurology guidelines. Introducing his paper Professor Clarke notes that the NICE recommendations advise that all patients with suspected Parkinson’s disease should be referred to a specialist for accurate diagnosis and management. However, he adds that non-specialists also need to be aware of the features and management of Parkinson’s disease to enable rapid referral and to facilitate care between primary and secondary settings. As such, the review not only discusses Parkinson's disease presentation, diagnosis and the treatment of early stages but touches on the management of more advanced disease, and aspects such as when surgery should be considered, the roles for nursing and allied health staff and potential future treatments. Professor Clarke summarises: • Parkinson’s disease should be suspected in someone with tremor, stiffness, slowness, balance problems, or gait disorders • All patients with suspected Parkinson’s disease should be referred untreated to a specialist in differential diagnosis and be reviewed regularly by the specialist for accurate diagnosis and treatment • Much debate surrounds which drug class should be used as initial treatment for Parkinson’s disease and which adjuvant therapy should be added when patients taking levodopa develop motor complications • Patients should have access to a Parkinson’s disease nurse specialist and allied health professionals throughout the course of the disease When considering future treatments the review highlights strategies for continuous dopaminergic stimulation, the development of non-dopaminergic agents for parkinsonian symptoms and/or dyskinesias and the prospect of neurorestoration with stem cells.  "It is crucial that neuroprotective agents are found to slow or halt the progression of Parkinson’s disease. However, fundamental questions remain about the design of neuroprotection trials, particularly “delayed start” trials and futility studies," Professor Clarke adds. Reference...