2017 is an important year for Parkinson's research, as it marks 200 years since the seminal publication "An Essay on the Shaking Palsy" was published by James Parkinson. Based on careful observation (even from afar - a number of the 6 patients he described he "casually met with in the street"), it reads even today as a fantastic example of accurate clinical phenotyping and clear exposition.
The definition of the 'shaking paralysis' is very specific and recognisable:
"Involuntary tremulous motion, with lessened muscular power, in parts not in action and even when supported; with a propensity to bend the trunk forwards, and to pass from a walking to a running pace: the senses and intellects being uninjured"
and I think many patients would empathise with the description of the beginning of the disease
"So slight and nearly imperceptible are the first inroads of this malady, and so extremely slow its progress, that it rarely happens, that the patient can form any recollection of the precise period of its commencement. The first symptoms perceived are, a slight sense of weakness, with a proneness to trembling in some particular part; sometimes in the head, but most commonly in one of the hands and arms".
It is instructive, looking back at the history of the disease, in what ways our concepts have changed. This special essay by a number of eminent Parkinson's specialists sheds some light on the very accurate descriptions of a number of features - the emphasis on specific characteristics of the tremor, the gait difficulties which lead to balance problems and risk of falls. The assumption that the intellect is uninjured is less accurate and there is a wealth of understanding now of the significance of non-motor features and clinical heterogeneity that is less well brought out in the original text. In the context of Parkinson's 200 year history, the authors underline the urgency of neuroprotective treatments, and the promising advances in neuroimaging and genetics.
I think field still has much to gain from employing Parkinson's transparent approach and humanity; his clarity when his thoughts are only "conjecture founded on analogy" and the hope that "the leading of the attention of those who humanely employ anatomical examination in detecting the causes and nature of diseases, particularly to this malady" will start to bear significant fruit before another 200 years passes.
http://onlinelibrary.wiley.com/doi/10.1002/mds.27115/full
This article reviews and summarizes 200 years of Parkinson's disease. It comprises a relevant history of Dr. James Parkinson's himself and what he described accurately and what he missed from today's perspective. Parkinson's disease today is understood as a multietiological condition with uncertain etiopathogenesis. Many advances have occurred regarding pathophysiology and symptomatic treatments, but critically important issues are still pending resolution. Among the latter, the need to modify disease progression is undoubtedly a priority. In sum, this multiple-author article, prepared to commemorate the bicentenary of the shaking palsy, provides a historical state-of-the-art account of what has been achieved, the current situation, and how to progress toward resolving Parkinson's disease. © 2017 International Parkinson and Movement Disorder Society.
The definition of the 'shaking paralysis' is very specific and recognisable:
"Involuntary tremulous motion, with lessened muscular power, in parts not in action and even when supported; with a propensity to bend the trunk forwards, and to pass from a walking to a running pace: the senses and intellects being uninjured"
and I think many patients would empathise with the description of the beginning of the disease
"So slight and nearly imperceptible are the first inroads of this malady, and so extremely slow its progress, that it rarely happens, that the patient can form any recollection of the precise period of its commencement. The first symptoms perceived are, a slight sense of weakness, with a proneness to trembling in some particular part; sometimes in the head, but most commonly in one of the hands and arms".
It is instructive, looking back at the history of the disease, in what ways our concepts have changed. This special essay by a number of eminent Parkinson's specialists sheds some light on the very accurate descriptions of a number of features - the emphasis on specific characteristics of the tremor, the gait difficulties which lead to balance problems and risk of falls. The assumption that the intellect is uninjured is less accurate and there is a wealth of understanding now of the significance of non-motor features and clinical heterogeneity that is less well brought out in the original text. In the context of Parkinson's 200 year history, the authors underline the urgency of neuroprotective treatments, and the promising advances in neuroimaging and genetics.
I think field still has much to gain from employing Parkinson's transparent approach and humanity; his clarity when his thoughts are only "conjecture founded on analogy" and the hope that "the leading of the attention of those who humanely employ anatomical examination in detecting the causes and nature of diseases, particularly to this malady" will start to bear significant fruit before another 200 years passes.
http://onlinelibrary.wiley.com/doi/10.1002/mds.27115/full
Mov Disord. 2017 Sep;32(9):1264-1310. doi: 10.1002/mds.27115.
Past, present, and future of Parkinson's disease: A special essay on the 200th Anniversary of the Shaking Palsy.
Obeso JA, Stamelou M, Goetz CG, Poewe W, Lang AE, Weintraub D, Burn D, Halliday GM, Bezard E, Przedborski S, Lehericy S, Brooks DJ, Rothwell JC, Hallett M, DeLong MR, Marras C, Tanner CM, Ross GW, Langston JW, Klein C, Bonifati V, Jankovic J, Lozano AM, Deuschl G, Bergman H, Tolosa E, Rodriguez-Violante M, Fahn S, Postuma RB, Berg D, Marek K, Standaert DG, Surmeier DJ, Olanow CW, Kordower JH, Calabresi P, Schapira AHV, Stoessl AJ
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