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March 6, 1996, Vol 275, No. 9 >
ARTICLE | March 6, 1996

A 61-Year-Old Man With Parkinson's Disease FREE

C. Warren Olanow, MD
[+] Author Affiliations

Dr Olanow is Professor and Chairman of the Department of Neurology, Mount Sinai School of Medicine, New York, NY.

This conference took place at the Neurology Grand Rounds of the Beth Israel Hospital, Boston, Mass, on November 1, 1995.

Reprint requests to Division of General Medicine and Primary Care, Beth Israel Hospital, 330 Brookline Ave, LY339, Boston, MA 02215 (Ms Walzer).

Clinical Crossroads at Boston's Beth Israel Hospital is produced and edited by Thomas L. Delbanco, MD, and Jennifer Daley, MD; Janet Walzer, MEd, is managing editor. Clinical Crossroads section editor: Margaret A. Winker, MD, Senior Editor, JAMA.


JAMA. 1996;275(9):716-722. doi:10.1001/jama.1996.03530330060031
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References

Dr Delbanco: Dr H, a 61-year-old dentist, was diagnosed with Parkinson's disease (PD) in August 1990 by one of his patients, a neurologist, who noticed a change in his gait and difficulty in swallowing and speech. There was no tremor. Married and the father of three children living close to his home in the Boston, Mass, suburbs, Dr H has individual health insurance through a private managed care plan.

Dr H's patient encouraged him to seek a formal opinion, and a consulting neurologist confirmed that Dr H had PD; his condition was considered to be in the early stages. In retrospect, his primary care doctor, Dr C, now believes that earlier episodes of drooling and voice changes were due to PD. Of note in his medical history is mild hypertension and a resection of a right frontal meningioma in 1978, which has not recurred and left no neurologic residua. His

REFERENCES

1 +
Lillienfeld DE, Perl DP.  Projected neurodegenerative disease mortality in the United States, 1990-2040. Neuroepidemiology . 1993;;12:219-228.
2 +
Hoehn MM.  Parkinsonism treated with levodopa: progression and mortality. J Neural Transm . 1981;;19:253-284.
3 +
Jankovic J, McDermott M, Carter J, et al.  Variable expression of Parkinson's disease: a baseline analysis of the DATATOP cohort. Neurology . 1990;; 40:1529-1534.
4 +
Tanner CM, Langston JW.  Do environmental toxins cause Parkinson's disease? a critical review. Neurology . 1990;;40:17-30.
5 +
Morens DM, Grandinetti A, Reed D, White LR, Ross GW.  Cigarette smoking and protection from Parkinson's disease: false association or etiologic clue? Neurology . 1995;;45:1041-1051.
6 +
Langston JW, Ballard P, Tetrud JW, Irwin I.  Chronic parkinsonism in humans due to a product of meperidine-analog synthesis. Science . 1983;;219: 979-980.
7 +
Golbe L.  The genetics of Parkinson's disease: a reconsideration. Neurology . 1990;;40:7-14.
8 +
Mazzetti P, Leguern E, Bonnet AM, Vidailhet M, Brice A, Agid Y.  Familial Parkinson's disease and polymorphism at the CyP2D6 locus. J Neurol Neurosurg Psychiatry . 1994;;57:871-872.
9 +
Olanow CW.  Mechanisms of cell death in Parkinson's disease. J Neurol Transm Suppl . 1993;;91:161-180.
10 +
Olanow CW.  A radical hypothesis for neurodegeneration. Trends Neurosci . 1993;;16:439-444.
11 +
Jenner P, Schapira AHV, Marsden CD.  New insights into the cause of Parkinson's disease. Neurology . 1992;;42:2241-2250.
12 +
Hughes AJ, Daniel SE, Kilford L, Lees AJ.  Accuracy of clinical diagnoses of idiopathic Parkinson's disease: a clinico-pathologic study of 100 cases. J Neurol Neurosurg Psychiatry . 1992;;54:388-396.
13 +
Olanow CW.  Magnetic resonance imaging in parkinsonism. Neurol Clin . 1992;;10:405-420.
14 +
Fahn S.  Adverse effects of levodopa.  In: Olanow CW, Lieberman AN, eds. The Scientific Basis for the Treatment of Parkinson's Disease . London, England: Parthenon Publishing Group; 1992;:89-112.
15 +
Mayeux R, Chen J, Mirabello E, et al.  An estimate of the incidence of dementia in patients with idiopathic Parkinson's disease. Neurology . 1990;;40: 1513-1517.
16 +
Nutt JG.  Levodopa-induced dyskinesia: review, observations, and speculations. Neurology . 1990;;2:340-345.
17 +
Marsden CD, Parkes JD.  'On-off' effects in patients with Parkinson's disease on chronic levodopa therapy. Lancet . 1976;;1:292-296.
18 +
Mouradian MM, Chase TN.  Hypothesis: central mechanisms and levodopa response fluctuations in Parkinson's disease. Clin Neuropharmacol . 1988;;11: 378-385.
19 +
Woodward WR, Olanow CW, Beckner RM, et al.  The effect of L-dopa infusions with and without phenylalanine challenges in parkinsonian patients: plasma and ventricular CSF L-dopa levels and clinical responses. Neurology . 1993;;43:1704-1708.
20 +
Nutt JG, Woodward WR, Hammerstad JP.  The 'on-off' phenomenon in Parkinson's disease: relation to levodopa absorption and transport. N Engl J Med . 1984;;310:483-488.
21 +
Stacy M, Jankovic J.  Current approaches in the treatment of Parkinson's disease. Annu Rev Med . 1993;;44:431-440.
22 +
Rinne UK.  Combined bromocriptine-levodopa therapy early in Parkinson's disease. Neurology . 1985;;35:1196-1198.
23 +
Muenter MD.  Should levodopa therapy be started early or late? Can J Neurol Sci . 1984;;11:195-199.
24 +
Fahn S, Bressman SB.  Should levodopa therapy for parkinsonism be started early or late? evidence against early treatment. Can J Neurol Sci . 1984;;11: 200-205.
25 +
Mayeux R, Stern Y, Rosen J, Leventhal J.  Depression, intellectual impairment, and Parkinson's disease. Neurology . 1981;;31:645-650.
26 +
Koller WC, Paulson G, eds. Therapy of Parkinson's Disease . New York, NY: Marcel Decker; 1990;.
27 +
Newsletters of National Parkinson's Disease Foundation, Miami, Fla; United Parkinson's Disease Foundation, Chicago, Ill; American Parkinson's Disease Foundation, New York, NY; Parkinson's Disease Foundation, New York, NY.
28 +
Parkinson's Study Group.  Effects of tocopherol and deprenyl on the progression of disability in early Parkinson's disease. N Engl J Med . 1993;;328:176-183.
29 +
Tetrud JW, Langston JW.  The effect of deprenyl (selegiline) on the natural history of Parkinson's disease. Science . 1989;;245:519-522.
30 +
Olanow CW, Hauser RA, Gauger L, et al.  The effect of deprenyl and levodopa on the progression of signs and symptoms in Parkinson's disease. Ann Neurol . 1995;;38:771-777.
31 +
Tatton WG, Ju WYH, Wadia J, Tatton NA.  Reduction of neuronal apoptosis by small molecules: promises for new approaches to neurological therapy.  In: Olanow CW, Jenner P, Youdim MHB, eds. Neurodegeneration and Prospects for Neuroprotection . London, England: Academic Press; in press.
32 +
Lees AJ; on behalf of the Parkinson's Disease Research Group of the United Kingdom.  Comparison of therapeutic effects and mortality data of levodopa and levodopa combined with selegiline in early mild Parkinson's disease. BMJ . 1995;;311:1602-1607.
33 +
Olanow CW, Godbold J, Roller WC.  Deprenyl and Parkinson's disease: no evidence of increased mortality. BMJ . In press.
34 +
Brundin P, Bjorklund A.  Survival, growth and function of dopaminergic neurons grafted to the brain. Prog Brain Res . 1987;;71:293-308.
35 +
Olanow CW, Freeman T, Kordower JH.  Fetal nigral transplantation in Parkinson's disease. Trends Neurosci . In press.
36 +
Lindvall O.  Neural transplantation in Parkinson's Disease.  In: Dunnett SB, Bjorklund A, eds. Functional Neural Transplantation . New York, NY: Raven Press; 1994;:103-137.
37 +
Freeman TB, Olanow CW, Hauser RA, et al.  Bilateral fetal nigral transplantation as a treatment for Parkinson's disease. Ann Neurol . 1995;;38:379-388.
38 +
Kordower JH, Freeman TB, Snow BJ, et al.  Neuropathological evidence of graft survival and striatal reinnervation after the transplantation of fetal mesencephalic tissue in a patient with Parkinson's disease. N Engl J Med . 1995;;332:1118-1124.
39 +
Laitinen LV, Bergenheim AT, Hariz MI.  Lecksell's posteroventral pallidotomy in the treatment of Parkinson's disease. J Neurosurg . 1992;;76:53-61.
40 +
Albin RL, Young AB, Penney JB.  The functional anatomy of disorders of the basal ganglia. Trends Neurosci . 1995;;18:63-64.
41 +
Bergman H, Wickmann T, DeLong MR.  Reversal of experimental parkinsonism by lesions of the subthalamic nucleus. Science . 1990;;249:1436-1438.
42 +
Bakay RA, DeLong MR, Vitek JL.  Posteroventral pallidotomy for Parkinson's disease. J Neurosurg . 1992;;77:487-488.
43 +
Lozano AM, Lang AE, Galvez-Simenez N, et al.  Effect of Gpi pallidotomy on motor function in Parkinson's disease. Lancet . 1995;;346:1383-1387.
44 +
Benabid AI, Pollack P, Gervason C, et al.  Long-term suppression of tremor by chronic stimulation of the ventral intermediate thalamic nucleus. Lancet . 1991;;337:403-406.
45 +
Limousin P, Pollak P, Benazzouz A, et al.  Effect on parkinsonian signs and symptoms of bilateral subthalamic nucleus stimulation. Lancet . 1995;;345:91-95.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Lillienfeld DE, Perl DP.  Projected neurodegenerative disease mortality in the United States, 1990-2040. Neuroepidemiology . 1993;;12:219-228.
2 +
Hoehn MM.  Parkinsonism treated with levodopa: progression and mortality. J Neural Transm . 1981;;19:253-284.
3 +
Jankovic J, McDermott M, Carter J, et al.  Variable expression of Parkinson's disease: a baseline analysis of the DATATOP cohort. Neurology . 1990;; 40:1529-1534.
4 +
Tanner CM, Langston JW.  Do environmental toxins cause Parkinson's disease? a critical review. Neurology . 1990;;40:17-30.
5 +
Morens DM, Grandinetti A, Reed D, White LR, Ross GW.  Cigarette smoking and protection from Parkinson's disease: false association or etiologic clue? Neurology . 1995;;45:1041-1051.
6 +
Langston JW, Ballard P, Tetrud JW, Irwin I.  Chronic parkinsonism in humans due to a product of meperidine-analog synthesis. Science . 1983;;219: 979-980.
7 +
Golbe L.  The genetics of Parkinson's disease: a reconsideration. Neurology . 1990;;40:7-14.
8 +
Mazzetti P, Leguern E, Bonnet AM, Vidailhet M, Brice A, Agid Y.  Familial Parkinson's disease and polymorphism at the CyP2D6 locus. J Neurol Neurosurg Psychiatry . 1994;;57:871-872.
9 +
Olanow CW.  Mechanisms of cell death in Parkinson's disease. J Neurol Transm Suppl . 1993;;91:161-180.
10 +
Olanow CW.  A radical hypothesis for neurodegeneration. Trends Neurosci . 1993;;16:439-444.
11 +
Jenner P, Schapira AHV, Marsden CD.  New insights into the cause of Parkinson's disease. Neurology . 1992;;42:2241-2250.
12 +
Hughes AJ, Daniel SE, Kilford L, Lees AJ.  Accuracy of clinical diagnoses of idiopathic Parkinson's disease: a clinico-pathologic study of 100 cases. J Neurol Neurosurg Psychiatry . 1992;;54:388-396.
13 +
Olanow CW.  Magnetic resonance imaging in parkinsonism. Neurol Clin . 1992;;10:405-420.
14 +
Fahn S.  Adverse effects of levodopa.  In: Olanow CW, Lieberman AN, eds. The Scientific Basis for the Treatment of Parkinson's Disease . London, England: Parthenon Publishing Group; 1992;:89-112.
15 +
Mayeux R, Chen J, Mirabello E, et al.  An estimate of the incidence of dementia in patients with idiopathic Parkinson's disease. Neurology . 1990;;40: 1513-1517.
16 +
Nutt JG.  Levodopa-induced dyskinesia: review, observations, and speculations. Neurology . 1990;;2:340-345.
17 +
Marsden CD, Parkes JD.  'On-off' effects in patients with Parkinson's disease on chronic levodopa therapy. Lancet . 1976;;1:292-296.
18 +
Mouradian MM, Chase TN.  Hypothesis: central mechanisms and levodopa response fluctuations in Parkinson's disease. Clin Neuropharmacol . 1988;;11: 378-385.
19 +
Woodward WR, Olanow CW, Beckner RM, et al.  The effect of L-dopa infusions with and without phenylalanine challenges in parkinsonian patients: plasma and ventricular CSF L-dopa levels and clinical responses. Neurology . 1993;;43:1704-1708.
20 +
Nutt JG, Woodward WR, Hammerstad JP.  The 'on-off' phenomenon in Parkinson's disease: relation to levodopa absorption and transport. N Engl J Med . 1984;;310:483-488.
21 +
Stacy M, Jankovic J.  Current approaches in the treatment of Parkinson's disease. Annu Rev Med . 1993;;44:431-440.
22 +
Rinne UK.  Combined bromocriptine-levodopa therapy early in Parkinson's disease. Neurology . 1985;;35:1196-1198.
23 +
Muenter MD.  Should levodopa therapy be started early or late? Can J Neurol Sci . 1984;;11:195-199.
24 +
Fahn S, Bressman SB.  Should levodopa therapy for parkinsonism be started early or late? evidence against early treatment. Can J Neurol Sci . 1984;;11: 200-205.
25 +
Mayeux R, Stern Y, Rosen J, Leventhal J.  Depression, intellectual impairment, and Parkinson's disease. Neurology . 1981;;31:645-650.
26 +
Koller WC, Paulson G, eds. Therapy of Parkinson's Disease . New York, NY: Marcel Decker; 1990;.
27 +
Newsletters of National Parkinson's Disease Foundation, Miami, Fla; United Parkinson's Disease Foundation, Chicago, Ill; American Parkinson's Disease Foundation, New York, NY; Parkinson's Disease Foundation, New York, NY.
28 +
Parkinson's Study Group.  Effects of tocopherol and deprenyl on the progression of disability in early Parkinson's disease. N Engl J Med . 1993;;328:176-183.
29 +
Tetrud JW, Langston JW.  The effect of deprenyl (selegiline) on the natural history of Parkinson's disease. Science . 1989;;245:519-522.
30 +
Olanow CW, Hauser RA, Gauger L, et al.  The effect of deprenyl and levodopa on the progression of signs and symptoms in Parkinson's disease. Ann Neurol . 1995;;38:771-777.
31 +
Tatton WG, Ju WYH, Wadia J, Tatton NA.  Reduction of neuronal apoptosis by small molecules: promises for new approaches to neurological therapy.  In: Olanow CW, Jenner P, Youdim MHB, eds. Neurodegeneration and Prospects for Neuroprotection . London, England: Academic Press; in press.
32 +
Lees AJ; on behalf of the Parkinson's Disease Research Group of the United Kingdom.  Comparison of therapeutic effects and mortality data of levodopa and levodopa combined with selegiline in early mild Parkinson's disease. BMJ . 1995;;311:1602-1607.
33 +
Olanow CW, Godbold J, Roller WC.  Deprenyl and Parkinson's disease: no evidence of increased mortality. BMJ . In press.
34 +
Brundin P, Bjorklund A.  Survival, growth and function of dopaminergic neurons grafted to the brain. Prog Brain Res . 1987;;71:293-308.
35 +
Olanow CW, Freeman T, Kordower JH.  Fetal nigral transplantation in Parkinson's disease. Trends Neurosci . In press.
36 +
Lindvall O.  Neural transplantation in Parkinson's Disease.  In: Dunnett SB, Bjorklund A, eds. Functional Neural Transplantation . New York, NY: Raven Press; 1994;:103-137.
37 +
Freeman TB, Olanow CW, Hauser RA, et al.  Bilateral fetal nigral transplantation as a treatment for Parkinson's disease. Ann Neurol . 1995;;38:379-388.
38 +
Kordower JH, Freeman TB, Snow BJ, et al.  Neuropathological evidence of graft survival and striatal reinnervation after the transplantation of fetal mesencephalic tissue in a patient with Parkinson's disease. N Engl J Med . 1995;;332:1118-1124.
39 +
Laitinen LV, Bergenheim AT, Hariz MI.  Lecksell's posteroventral pallidotomy in the treatment of Parkinson's disease. J Neurosurg . 1992;;76:53-61.
40 +
Albin RL, Young AB, Penney JB.  The functional anatomy of disorders of the basal ganglia. Trends Neurosci . 1995;;18:63-64.
41 +
Bergman H, Wickmann T, DeLong MR.  Reversal of experimental parkinsonism by lesions of the subthalamic nucleus. Science . 1990;;249:1436-1438.
42 +
Bakay RA, DeLong MR, Vitek JL.  Posteroventral pallidotomy for Parkinson's disease. J Neurosurg . 1992;;77:487-488.
43 +
Lozano AM, Lang AE, Galvez-Simenez N, et al.  Effect of Gpi pallidotomy on motor function in Parkinson's disease. Lancet . 1995;;346:1383-1387.
44 +
Benabid AI, Pollack P, Gervason C, et al.  Long-term suppression of tremor by chronic stimulation of the ventral intermediate thalamic nucleus. Lancet . 1991;;337:403-406.
45 +
Limousin P, Pollak P, Benazzouz A, et al.  Effect on parkinsonian signs and symptoms of bilateral subthalamic nucleus stimulation. Lancet . 1995;;345:91-95.

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