PubMed · 8255490
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P A Löschmann, T Klockgether, M M Schugens. 1993. Combination therapy for PD.. https://doi.org/10.1212/wnl.43.12.2725
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Treatment of idiopathic Parkinson's has become increasingly complex during the past years. A revision of the guidelines for treatment which had been published in 1998 by a study group of the Swiss Neurological Society became necessary. Emphasis is again put on the correct choice of medication for the start of treatment. The new guidelines also contain hints to the management of the problems of long term treatment.
Our group investigated modulatory effects of apomorphine on cerebral activation patterns during finger tapping movements in seven Parkinson's disease (PD) patients off medication. Cerebral activation was measured according to an established fMRI protocol. Apomorphine application disclosed a reduction of cerebral activation patterns to the contralateral precentral gyrus affecting both clinically affected and unaffected sides; tapping with the unaffected hand additionally revealed activation in the contralateral postcentral gyrus. These findings contradict those of similar functional imaging studies performed in PD to date, which variously found augmentation of cerebral activation patterns in Parkinsonian patients after dopaminergic stimulation. One conceivable explanation for our singular results would be preferred binding of apomorphine to presynaptic dopaminergic receptors, leading to inhibition of endogenous dopamine release and resultant diminished dopaminergic stimulation, reflected in diminished cerebral activation patterns. These findings warrant future consideration and further investigation of possible central inhibitory effects of dopaminergic therapy in functional imaging studies in PD.
This Update reviews developments in the pathophysiology and treatment of Parkinson disease during the past several years. In the area of pathophysiology, studies have addressed the contribution of environmental factors such as caffeine and pesticides. Large-scale epidemiologic studies have also expanded the role genetic factors are thought to play. Detailed studies of kindreds with familial Parkinson disease due to alpha-synuclein and parkin have catalyzed basic science investigations into the pathologic mechanisms of the disease. These studies have led to the development of a pathophysiologic model of Parkinson disease that emphasizes abnormal protein aggregation. Studies of treatment have clarified the relative roles of l-dopa and dopamine agonists in early Parkinson disease and shown the potential for surgical interventions, particularly deep-brain stimulation, to relieve the symptoms of advanced, medically refractory disease.