Misplaced Pages

Revision as of 19:07, 12 July 2006

Role of L-tyrosine and neurodegeneration in PD

Recent edits have been inaccurate and misleading. The L-tyrosine study mentioned was an open-label, uncontrolled study that followed only 10 patients, and no follow-up studies have been done since. Dopaminergic cell loss as well as dysfunction is well-documented on pathologic studies. The Parkinson's forum recently added to the external links section contains highly questionable information, and belongs at the very end of the section, if it belongs there at all. Hence the revert. AFGriffithMD 01:10, 28 February 2006 (UTC)

What is written above is itself misleading and unscientific.

1. Not a single piece of scientific evidence contradicts the fact that : (1) L-tyrosine has been known for decades from biochemical studies to be the precursor of L-dopa and is therefore relevant to Parkinson's Disease, (2) L-tyrosine is known, from biochemical studies, to increase dopamine levels in Parkinson's Disease, (3) the two studies in which L-tyrosine has been used in Parkinson's Disease have shown a reduction in symptoms. There is no opposing evidence whatsoever. Can you provide any?

2. "Dopaminergic cell loss is well-documented on pathologic studies." Not a single study has ever demonstrated this. If this is "well documented" then provide the references for a study that proves it. Studies using the f-Dopa PET scan and enzyme studies do not measure cell death.If you can not provide a reference, then you are adding information that is scientifically baseless. Below is written : "Content....must be verifiable" , but your claim of massive cell loss has not been verified and nor could it be because no such studies exist.

3. What information on the Parkinson's Disease Forum is questionable ? Virtually all of it consists of newly published scientific studies, and is fully referenced, unlike most of what appears on Misplaced Pages's Parkinson's Disease page which is not. It is the only site wolrdwide tat provides daily updatyes of newly published research in Parkionson's Disease. Are all newly published scientific studies concerning Parkinson's Disease questionable as you claim ? If they are why have you not substantiated what you have written.

In response to what you have stated above:

1. Lack of opposing evidence does not constitute proof of efficacy. A small, open-label, uncontrolled, ten-patient study is not sufficient proof of efficacy.

2. For references, see the section I added recently entitled "Pathology." Heiko Braak's work systematically details the pattern of neuron death and degeneration throughout the stages of Parkinson disease. Also, see any medical textbook on pathology or neurology, including Adams and Victor's Principles of Neurology or Watts & Koller's Movement Disorders. Or go to your local medical school and ask to see pathologic specimens of brains from people who had Parkinson's. The neuron loss is very visible.

3. Your website contains the same sorts of inaccurate and misleading statements that you have posted above. AFGriffithMD 02:32, 2 March 2006 (UTC)

Criticisms of the response :

1. If every method of treatment that had not conclusively proven long term efficacy without side effects were eliminated from the section on Treatments, there would be nothing there. That would be what you call a "cure". The web site should include the variety of medical treatments that are either used, or have demonstrated a degree of clinical efficacy. None of the drugs listed get rid of Parkinson's Disease. They are proven to be only transient relief accompanied by widespread side effects. Both L-dopa and dopamine agonists contribute to the symptoms. L-dopa via feedback inhibition eventually elminates a person's capacity to produce their own L-dopa. Dopamine agonists greatly reduce the sensitivity of the very same receptors they are attempting to stimulate.

2. I have read all of the more than eighty books published on Parkinsons' Disease. I have read more than ten thousand studies on the biochemistry of Parkinson's Disease. I have been referred to books and studies of the kind you refer to. However, I have yet to see any evdience of a considerable loss of dopaminergic neurons in Parkinson's Disease. I have, however, seen plenty of evidence of a considerable loss of activity of the dopaminergic neurons

There are more than twenty cell types in the nervous system. They are intermingled and distributed throughout different regions of the brain. No one area of the brain is restricted to one type of cell such as the dopaminergic neurons. So you can not possibly see the selective loss of dopaminergic neurons as opposed to the loss of part of the brain. The claims of massive cell loss in Parkinson's Disease originated from autopsy studies carried out on people that had had severe Parkinson's Disease. Their supposed method of demonstrating cell loss was based on an examination of the activity of tyrosine 3-monooxygenase (known at the time as tyrosine hydroxylase)as this enzyme is responsible for L-dopa formation. However, the activity of tyrosine hydroxylase does not measure cell loss at all. It is the primary means of measuring cell activity in the dopaminergic neurons.They concluded massive cell loss, but what they actually proved was a considerable loss of cell activity.

More recent claims have been made of massive loss of cells based on the use of f-Dopa PET scans. This is the method you have based your (false) assumptions on. You, or whoever added it to this web site, have written "More recent data based on PET scans suggests that symptoms may occur when 50-60% of dopaminergic neurons are lost." However, of course, f-Dopa PET scans do measure the loss of cells. They measure the emission of positrons from flouro-Dopa. That is an indication of cell activity - not cell loss. The conclusions of massive cell loss simply do not match the methods used. There is no evidence of a massive loss of dopaminergic neurons rather than a massive reduction in the activity of those cells. It is one of the biggest fallacies in medicine.

3. You do not give any substantiation of your criticims of what I assume is part of what appears on "The Parkinson's Disease Forum" but my guess is that it only concerns the fallacy of massive cell loss in Parkinson's Disease. That has been answered above. The site includes more new research and is more scientifically substantiated with scientific references than any other web site concerning Parkinson's Disease, including this one !

Treatment

This is the next section in need of a major overhaul. Subsections probably need to be something like:

• Pharmacotherapy
  • Motor symptoms (including levodopa, dopamine agonists, amantadine, rasagiline, etc.)
  • Non-motor symptoms (antidepressants, atypical antipsychotics)
• Rehabilitation therapies
• Surgical therapies

AFGriffithMD 07:40, 27 February 2006 (UTC)

There is also note of the following: Due to feedback inhibition, L-dopa causes a reduction in the body's own formation of L-dopa. So a point is reached where the drugs only work for periods of a few hours ("on" periods) which are sandwiched between longer interval during which the drugs are partially or completely ineffective ("off periods").

While I am familiar with feedback inhibition in situations such as steroids and testosterone, I have not seen a study that addresses nor suggests that there is feedback inhibition. It may be premature to suggest that feeback inhibition is a problem.

Carlwfbird 12:43, 7 March 2006 (EST)

Role of ND5 in pathophysiology of Parkinson disease

"microheteroplasmic mutations in one of the mitochondrial complex I genes, ND5, were found to be sufficient to diagnose sporadic PD correctly in 27 out of 28 cases. While additional studies are needed, mitochondrial microheteroplasmic mutations may be the cause of the majority of PD cases."

I believe this passage from the Toxins section strongly overstates the relative importance of ND5 mutations in particular, and microheteroplasmic mutations in general with respect to the pathophysiology of Parkinson disease. The only PubMed article I could find on ND5 mutations being used to classify PD cases versus controls is this one , and it mentioned correct classification of 15 of 16 samples, not the 27 out of 28 cited above. This means there were only 8 cases and 8 controls, which is a pretty small sample size, certainly not enough to make the sweeping statement, "mitochondrial microheteroplasmic mutations may be the cause of the majority of PD cases." AFGriffithMD 01:05, 16 February 2006 (UTC)

Awakenings

Awakenings deals with Parkinson's? I thought it was encephalitis. - Montréalais

The patients in Awakenings were suffering from post-encephalitic Parkinsonism. The encephalitis had occurred 50 years earlier and the infection was over. However it had left damage, causing their Parkinsonism. RTC 06:06 Nov 2, 2002 (UTC)

Amphetamines

I think it is more than worthwhile to mention amphetamines as a possible cause. (Minor comment reg. your last statement: the epidemic was in 1919-20 and the movie appears to play in the early fifties...which fits to the CV of Oliver Saks :-)

I'm sorry I edited the page. I was trying to prove to someone it doesn't actually edit it in real-time. Boy was I wrong. I did fix it though. Sorry again.

it's worth noting that ritalin is quite useful for the ADD like deficits in attention in PD.Bldavids 05:46, 10 January 2006 (UTC)

I think it is worthwhile to mention that the drug Selegiline (Eldepryl) which appears to inhibit disease progression is broken down into amphetamine and methamphetamine.

Ozzy?

Does Ozzy Ozbourne really have Parkinsons Disease? I know he has Parkinsonian symptoms, but I thought it was due to drug-induced damage to the dopaminergic system rather than actual PD. - Sayeth 22:24, Nov 18, 2004 (UTC

"Parkinson Disease" or "Parkinson's Disease"

The first name seems to be the more popular and proper one, being referenced more often in recent literature and on Google. taion 11:10, 23 Nov 2004 (UTC)

Disagree - Kittybrewster 22:28, 9 July 2006 (UTC)

"inclinations towards Catholicism"

Is this a bogus edit?

It's a jibe at John Paul II. JFW | T@lk 00:49, 18 August 2005 (UTC)

You don't have to be Catholic to have PD!

No, you can convert to Islam and get it too.

removed Katharine Hepburn

Katharine Hepburn did not have Parkinson's Disease. She had a condition called Essential tremor.

Hitler's Parkinson's Disease was not caused by a gas attack. He did not have even his first noticeable symptom of Parkinson's Disease until 15 years after the gas attack in 1918. At the time, in 1918, he exhbited no symptoms that were Parkinson's Disease. The gas used in the attack was not one of those known to cause Parkinson's Disease.

Hitler's PD is believed to have been consequential to encephalitis lethargica (a kind of sleeping sickness). There was an epidemic in the 1910's and a lot of people who suffered from the disease later developed PD. These are people Oliver Sacks wrote about in Awakenings. Balok 00:32, 10 July 2006 (UTC)

Micrographia

One of the symptoms mentioned is "micrographia (small handwriting)" — is this accurate? Is small handwriting symptomatic of disease? Either way, the link currently goes to an article about a popular science book, which I don't think was the author's intention. -- 213.122.16.164 20:04, 17 August 2005 (UTC)

Well, micrographia alone is not particularly indicative of PD. In the context of other symptoms, though, it is an informative symptom. JFW | T@lk 00:48, 18 August 2005 (UTC)

The statement is accurate; it's a classic symptom. So, its presence is definitely informative but not diagnostic. sensitive but not specific. Bldavids 05:48, 10 January 2006 (UTC)

Exercise neuroprotective

I am dubious about the alleged "neuroprotective effect" of exercise. I'd like to see a reference please. --Dubbin 23:23, 23 September 2005 (UTC)

See: “Parkinson's Disease” an on-line summary @http://www.bcm.edu/neurol/jankovic/educ_pd.htm, by Joseph Jankovic, M.D., an internationally recognized expert on Parkinson disease, and the medical director of the Udall Parkinson Disease Research and Treatment Center in Houston (Note: “Udall Center” is a federal designation denoting excellence in PD treatment and research):

“Recent animal research has provided strong evidence that exercise can increase brain levels of neurotrophic factors, increase resistance to brain insult or injury, and improve learning and mental as well as motor performance.” Dr. Jankovic is a highly credible sourcer.Bldavids 05:50, 10 January 2006 (UTC)

Here's a good place to start: PMID 15214505. (Then click on "Related Articles" and you'll see many studies on the topic.) --Arcadian 18:08, 3 January 2006 (UTC)

see also:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15790541&query_hl=25&itool=pubmed_docsum

Terminology depends on which side of the Atlantic you are on

Parkinson disease is used in American scientific literature. There has bee a move away from the apostrophe (e.g. Alzheimer disease vs. Alzheimer's disease). The British and the rest of the world use "Parkinson's disease" (preferred term).

219.95.213.43 00:40, 20 October 2005 (UTC)M K Lee

I see 22.7 million for "Parkinson Disease" and 23.3 million for "Parkinson's Disease". The apostrophes have it. --PaulWicks 21:32, 19 June 2006 (UTC)

neuropsychiatric aspects of parkinson's disease

Depression, anxiety, and executive dysfunction have been estimated to account for up to 70 percent of the disability associated with Parkinson disease. Dementia and psychosis may ultimately effect more than a third of all Parkinson patients. There is a movement among researchers and patients to weaken the emphasis on "movement disorder" and strengthen the emphasis on "neuropsychiatric disease".Bldavids 06:35, 16 January 2006 (UTC)

If you have documentary support for this shift in paradigm it would make a very important point in the article. JFW | T@lk 12:17, 16 January 2006 (UTC)

Gladly:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15043801&query_hl=3&itool=pubmed_docsum

see also:

Curr Psychiatry Rep. 2003 May;5(1):68-76. Related Articles, Links

Neuropsychiatric aspects of Parkinson's disease: recent advances.

Marsh L, Berk A. Division of Psychiatric Neuroimaging, Geriatric and Neuropsychiatry Programs, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 300-C, Baltimore, MD 21287, USA. lmarsh@jhmi.edu

Psychiatric disturbances are a common feature of Parkinson's disease (PD), which is a degenerative disorder defined by its characteristic movement abnormalities. Its management is optimal when PD is viewed as a neuropsychiatric disorder, because this encourages consideration of the motor deficits along with its psychiatric and cognitive aspects. This review addresses the diagnosis and treatment of the most common psychiatric disorders in PD, and provides an update of related clinical research, including studies on neurosurgical treatments.

Is this sufficient? It's not a flippant question: I don't know the standard. Bldavids 04:42, 18 January 2006 (UTC)

Symptoms that cross over the physical into the cognitive and affective realms

The lists as constituted are poor vehicles for certain symptom sets: for example, speech-language problems. In PD, there are defects in articulation and breath support and voicing, but there are also problems with comprehension of complex syntax, with word finding, and with both expression and reception of prosody. Likewise vision and visual processing: the defects in vision are quite complex, seemingly a function of the combined effect of impaired attending, impaired gating of response, and slowed reaction time. The physical and cognitive and affective components of the disease are all snarled together, because the job of the pre-frontal cortex is precisely the integration of these kinds of inputs and outputs. The dysfunction observed in the prefrontal cortex when deprived of dopamine is subtle but radical: disconnects between physical stimulae and perception, between intention and action, between feelings and responses. At some point, these lists will not serve. Bldavids 23:18, 17 January 2006 (UTC)

I agree, the symptom section needs to be reorganized. I did a bit of minor cleanup in one section, but it should be something like:

Symptoms:

• Cardinal Symptoms
• Other Motor Symptoms
• Non-Motor Symptoms
  • Sensory
  • Visual
  • Neuropsychiatric
  • Cognitive

AFGriffithMD 23:31, 14 February 2006 (UTC)

dear afgriffith; you really did a super job. it's much clearer, more logical, and internally consistent. it also reads better. i appreciate that you left the language about patient rights and relationships, as that section above all others that i've contributed matters to me. i would like to ask you a question re: pd data, since i looked up your professional affiliation, and am very pleased to have someone with a connection to booth gardner contributing as you are: what is your best sense of both incidence and prevalence of dementia, by subpopulations, and also across the broadest historical study that you're aware of? i have found radically divergent estimations--30%, 40%, 40-80%. it strikes me that there mu[st be some real bias in the data, because people who are doing badly are more frequently lost to follow-up than are indvidiausl who are doing well. barb

Thanks, Barb. I'm working on this article section by section, mostly trying to reorganize without completely overwriting what has gone before, unless it's inaccurate or outdated. With respect to your question about dementia, I think Heiko Braak's work on Parkinson disease pathology is most illuminating. He published an article in Neurology linking incidence of dementia to severity of pathology. I'm going to be working on the pathology/pathophysiology section next, and will have more to say on that subject. AFGriffithMD 19:26, 20 February 2006 (UTC)

Dear A: I'd like to use your first name some variant of it, but don't wish to be presumtuous. may i use your your/ first initial? i'd also ask if you'd take a look at both this article and the wikipedia dementia article, in light of a citation i just came across: (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12567332&query_hl=21&itool=pubmed_docsum) "making it the most common cause of degenerative dementia after AD" and also: (http://jnnp.bmjjournals.com/cgi/content/extract/76/7/903) Patients with Parkinson’s disease (PD) have a significant risk of developing dementia in the course of their illness. Cross sectional studies suggest a dementia prevalence rate of 30% to 40%.1 Longitudinal studies indicate that the cumulative frequency of dementia in patients with PD is 60% to 80%.1 The risk of dementia for individuals with PD is approximately six fold greater than that of age matched controls.

80 percent is a looooong ways from 30 percent.

thanks for your thoughts.

I assume you know bill bell?

barb

Parkinson's speech

I didn't see anything about Parkinson's speech in this article. That isn't my speciality but I regularly get calls from PD patients whose speech has been affected. Judging from these individuals, speech symptoms are one of the most devastating effects of PD, so this article should say something about Parkinson's speech. I've written a short article about Parkinson's speech in WikiBooks. What I wrote is too short to be a WikiBook, but the subject is too big for a Misplaced Pages article. I'm hoping that someone with more expertise will expand my WikiBook article. I also added a link at the bottom of the Misplaced Pages article to my WikiBooks article, and a link to LSVT.Tdkehoe 18:11, 1 March 2006 (UTC)

Opening summary

the opening summary contains no mention of effects or symptoms of the disease, which might make more sense than a "sciencey" explanation of its causes.

This has now been added. --General Tojo 12:05, 13 April 2006 (UTC)

Revert to Boonukem : Reordering the introduction means that there are two separate and therefore duplicatory sections in the introduction dealing with symptoms. The alteration also uses the phrase "neurodegenerative disease" which effectively asserts that cell loss as the cause of Parkinson's Disease. Despite that widely being claimed, no such study has ever demonstrated cell loss as a widespread cause in idiopathic Parkinson's Disease.Content must be verifiable with in this case scientific studies as evidence --General Tojo 14:14, 23 April 2006 (UTC)

I reordered the introduction to reveal the most important information first. I imagine that external descriptions are more relevant than internal causes to someone who has no experience with the disease. I agree that using neurodegenerative disease may be unfounded, but it should at least be mentioned that it's a movement disorder. Even if this is obvious from the information about muscle contraction, the term itself is more immediately descriptive and recognizeable.

If by "duplicatory sections" you mean the mention of "primary symptoms" in my edit, the sentence could be shortened to "As dopamine can reduce muscle contraction, its deficiency can cause excessive muscle contraction." I assume you aren't referring to the mention of symptoms, as the previous version also contained their description (in a slightly awkward grammatical form).

I'll leave the decision to you as you seem to have more expertise in the subject and interest invested in the article. -- 70.81.118.123 07:47, 28 April 2006 (UTC)

Pathology section

I'm going to add to the mix my (probably) unwanted request to have in the pathology section something about the physiology of the diseas e.g. how the degenration of dopaminergic neurons causes the motor disorders. (Basal ganglia, anyone?). Yeah, and to ensure the universal hatred of me, four times the exact same link about the already well (perhaps even too) detailed biochemistry is definitely an overkill... --80.221.29.185 17:08, 10 May 2006 (UTC)

Understood the idea and actually fixed the links to point straight to the correspondings posts rather than the first one. Maybe that way it does not seem so repetitive. Still think it's overkill though.--80.221.29.185 18:07, 10 May 2006 (UTC)

Parkinson's Disease isn't physiologically caused. The faults resulting in the symptoms are biochemical. The reason why in most books on PD that you see anatomical or physiological rather than biochemical explanations is that medical graduates rarely study biochemistry and so instead wrongly try to interpret and understand it in terms of what they do know which is anatomy and physiology. The Parkinson's Disease page on Misplaced Pages was previously riddled with errors as a result of this.

The biochemistry provided really is the briefest amount. Just the information available concerning one dopamine receptor could fill up the entire page on its own. This information concerning the biochemistry of PD is not available anywhere else apart from Misplaced Pages and the link.

The biochemistry of PD is new to Misplaced Pages. There was nothing previously concerning it. Ther was little on toxic PD as well until recently. Due to the prolific turnover of information on Misplaced Pages, more information will inevitably come in concerning it. When that occurs, the links will start changing or being added to for each part of the biochemistry and toxicity sections. Biochemistry and toxicity are certainly not individual subjects for which one link will always suffice. I suspect that somebody will come in with more information concerning subjects such as Lewy Bodies or Ubiquitin. The present PDF biochemistry links do not cover them at all, and so there will have to be separate links for each section, rather than just one PD biochemistry link for everything.

You very cleverly amended the two links, or at least it looks clever to me. I'd do the other two biochemistry links myself if it wasn't for the fact that I don't have a clue how to do it.

--General Tojo 21:37, 10 May 2006 (UTC)

Please refer to the Misplaced Pages help page on links. The only aspect that this doesn't fully give the "how to" for is that the part of the URL after the # is the bookmark in the HTML code of the target page. The "clever" changes made by user:80.221.29.185 are just implementations of this general wiki format for external links. In his/her wisdom, he/she obviously grasped that in their original format, because all your citations looked identical, they gave an appearance of being something you had not intended, and which I had the temerity to question. Now that he/she has amended these citations such that they now all appear as different "link names", this has had the benefit of being an incremental improvement to the pathology section. To obtain each #bookmark simply required him/her to follow the original links, find the part of the page you were referring to, examine the HTML code, and constuct the external link complete with the bookmark accordingly. One might almost say that this could have been done without more than a rudimentary knowledge of biochemistry, as long as each bookmark name matched the topic you had described. DFH 19:36, 13 May 2006 (UTC)

Incidence

This Misplaced Pages article is already 50% lengthier than it is supposed to be. There is therefore not the scope for analysis and detail of all research referred to, despite its posssible significance. They way around this is to provide links to other web sites (such as PubMed) where the full abstract or further information can be provided. This is what has been done with other subjects on the Parkinson's Disease page. Misplaced Pages is worldwide, so the information should concern what occurs internationally rather than only in one or two countries, or parts of countries. Just one county in the U.S. (Copiah County) is clearly not representitive of the occurence of Parkinson's Disease internationally. Incidence rates differ enormously from one country to another. This is why the present range of incidence rates are given (Nebraska possibly the highest and Ethiopia possibly the lowest) rather than giving generalised incidence rates as if the occurence of Parkinson's Disease is almost uniform internationally when it very definitely isn't. The wide spread of figures given for sex ratio (2.55, nearly double, 1.55) shows how even sex ratio differs so much according to each region. In other countries there is even less consistency with the three figures given.--General Tojo 13:29, 19 June 2006 (UTC)

First, I find the tone implied by the bold type face offensive. Second, this is not your private web page, this is a wiki. One wonders what you are doing here if you're so unwilling to be part of a cooperative venture. Third, if you're concerned about length, your sections on dopamine synthesis, toxins, and nutrients could be shortened considerably. Fourth, you have demonstrated total lack of understanding of basic epidemiology and you therefore have no business cavalierly removing my contributions. To speak to the questions you raise: Copiah County is a classic study with methods that have been used in most descriptive epidemiology studies since - I did not mention the prevalence rates they found nor did I state that those rated reflected the US rates. Prevalence rates vary tremendously because of differences in diagnosis, awareness and ascertainment. Because incidence studies are performed using less biased methods, ie they count new cases rather than all cases, the rates vary much less. Nebraska and Ethiopia are not incidence rates; they are prevalence rates. Comparisons across countries are close to meaningless because so many factors can influence prevalence besides the underlying occurrence of disease. The sex ratio difference is not enough to make any kind of point. I have not deleted your lengthy and overdetailed pathophysio and toxin sections; please show me that same respect and do not delete mine. I shall otherwise report you. -- Dan 15:03, 19 June 2006 (UTC)

To find bold type offensive is ludicrous, as is describing this as a private web page. I am very happy to see different people contribute to Misplaced Pages, and have accepted without amendment the contributions of many people. Unfortunately, what you have added has been done without giving it any real thought. It is frequently false, irrelevant or inconsistent. Other people are more careful and consequently make amendments that are long lasting. As you don't critically evaluate what you add, other people have to do it for you. It appears that you want everyone to be happy with what you add regardless of how counterproductive it might be. The sections on toxicity and biochemistry are already vey short versions of what they link to, which are the most comprehensive source of information on both subjects. Other people have frequently defended what I have added against arbitrary alteration. Copiah County having used good methods is irrelevant, as it deals with only one single county. Misplaced Pages deals with the whole world. Try telling people in Japan, Africa or Russia that one single county is of great relevance to them. None of what you have written defends that obvious weakness. You have not managed to rebut even one of my criticisms of what you have added. You have instead just merely tried to distract attention by raising irrelevant or erroneous issues. This isn't the academic world where what you publish remains published. Everything is up for scrutiny and potential amendment. If I delete what you add you will report me ! You don't seem to realise how Misplaced Pages operates.Misplaced Pages gives a warning that contributors must be prepared to have their contributions altered. If you can't accept Misplaced Pages's way of doing things then you shouldn't contribute to Misplaced Pages.--General Tojo 16:06, 19 June 2006 (UTC)

Vanity links?

I observe that there are multiple instances of Toxic causes of Parkinson's Disease and The biochemistry of Parkinson's Disease, which look much to me as if they are all vanity links. As there is already a link to this forum at the top of the External links section, it is my view that these multiple instances could be removed from all earlier sections with no detriment to the article. Does everyone agree? DFH 16:50, 5 May 2006 (UTC)

To describe the links as "vanity links" is remarkably stupid and dishonest and demonstrates a total lack of attention to the information that is being provided. Information that is added must be verifiable. The links under "Toxic causes" and "Bicochemistry of Parkinson's Disease" are to fully referenced sources of information concering the subject they refer to. They are the most comprehensive Online source of information concerning these two subjects, and provide far more detail for those that want it. It is very clear that you have not even checked in detail or carefully considered the information it is linked to. Before attempting to resort to vandalism of the site, you should discuss it fully on the Talk pages as Wikepedia rules require. Noen of the alterations you made acutually provided any information at all, and instead attempted to reduce the availaibility of informaton for those that want verifiable references or far more detail than is possible on the Wikepedia site. --General Tojo 14:40, 6 May 2006 (UTC)

Please refer to Misplaced Pages:Etiquette and Misplaced Pages:External links. It was the multiple instances of the same links that I was calling into question, not the content of either. It's a pity that you didn't assume good faith on my part. I was certainly not being dishonest. Possibly my use of the word "vanity" was incorrect here in the talk page, yet to describe my edits to the main page as "vandalism" was equally so. If you believe that each separate "toxic cause" and/or each separate "biochemistry point" all require identical citations to the same forum, rather than a single reference to a relevant link in the references section, then please explain why. DFH 19:39, 8 May 2006 (UTC) You are an electrical engineer. I doubt if you even understand the scientific information on the Parkinson's Disease site. You should not even be considering altering a Parkinson's Disease site. That should be left to the Parkinson's Disease specialists. It is a pity that throughout Misplaced Pages there are some people that make arbitrary, useless or conterproductive alterations even when they know little about the subject they are dealing with. --General Tojo 14:52, 6 May 2006 (UTC)

I already know that I am but a humble electrical engineer, and not a Nobel prizewinner, yet you shouldn't generally presume that a person is unable to understand information outside his or her chosen speciality. The fact is that electrical engineering requires a good scientific education, which I have. Nowadays to become a Chartered Engineer requires a four year M.Eng degree or equivalent. The minor edits I made the other day were intended to improve the readability of the page. I was not seeking to reduce the availability of further information. Even so, I shall refrain from making any further edits to the Parkinson's Disease page main article. DFH 19:39, 8 May 2006 (UTC) "Possibly" your use of "vanity was incorrect". It could not have been more incorrect. Vandalism due to carelessness is correct, as you readily and unjustifiably removed links that would provide people with the most comprehensive online references and information concerning these subjects. People can opnly respond to what you write, not what you might have thought. I don't presume that a person is unable to understand information that is outside their area. We all know something about everything, and nobody knows everything about something. Sometimes somebody who is a bit detached from a subject can see things more clearly that those that are engrossed in the subject. Leonardo Da Vinci wasn't a bad engineer even though he was an artist. However, before making assertions and alterations outside their area, people should be extra careful by checking their facts first, or discuss it beforehand. You didn't do that. If I made suggestions about electrical engineering, about which I do not know much, no matter how good I thought my proposed alterations were I would check them out first on the talk page. Engineering may require a "good scientific education". However, it certainly does't cover advanced biochemistry. Medical degrees don't even cover basic biochemistry.

You obviousy hadn't considered how the links would be used in practice. For somebody to rely solely on the Parkinson's Disease Forum link near the bottom of the page would have led them solely to a discussion Forum. They would not have readily known from that lnk that there was fully referenced and far more substantial information concerning toxic causes of PD and the biochemistry of PD. The links to that information are each different from the general link to the Parkinson's Disease Forum that you would have had people rely on. As you admit to having a limited knowing little about the subject, it would have been better if you'd read the information on those links. You would then have been more knowledgeable about the subject and would have seen in practice how useful the links (that you removed) were. There are different subjects within the toxic causes and the biochemistry of PD. If there was only one link for all of toxic causes, and one link for all of PD biochemistry, then further amendments may may be made that contain better sources to some of the subjects of both. For example, somebody may add a better link to maneb toxicity (within toxic causes) or dopamine receptors (within PD biochemistry). Consequently, circumstances may arise where the present links are the best available for only some of the present subjects of toxic causes and PD bochemistry. Each area of toxicity and PD biochemistry is researched separately. So the links will be separate for each subject with toxicity and PD biochemistry. --General Tojo 20:57, 8 May 2006 (UTC)

Quick toxicology question: General Tojo, I assume you wrote the toxin remarks? If so, I'm feeling uncomfortable with the statement about rotenone. Granted, there's some strong findings, but saying it causes PD is a bit too far, no? And to whoever prepared the incidence section, from this neuroepidemiologist, not a bad effort, but you might want to add citations and perhaps a comment about how ascertation bias can affect _apparent_ differences in incidence.(dan strickland) --Dan 23:14, 1 June 2006 (UTC)

I think they're vanity links and later on I will attempt to find some recent reviews from PubMed that I can use to replace them with. General Tojo -> Viartis -> Keith Bridgeman. Look him up on Braintalk. --86.133.112.238 08:37, 2 June 2006 (UTC)

Toxins

You know just reading this page again, I think it's insane that there's a whole page about these utterly unfounded theories about "toxins" before you get to a brief mention of the frontline, highly effective treatment for PD, being the Dopamine agonists! I might even go so far as to suggest there is a new page called "hypotheses for the pathogenesis of Parkinson's Disease" in which these theories can be vaguely alluded to, but for now I think there is far too much emphasis placed on these scatty paragraphs. If the majority of other editors are in agreement I will begin the pruning. --PaulWicks 18:09, 19 June 2006 (UTC)

Agreed. Go. Good luck not getting reverted. --Dan 18:19, 19 June 2006 (UTC)

PaulWicks, there are some obvious fallacies in what you have written. 1. You have falsely assumed that the mention of toxic causes of Parkinson's Disease means that toxicity is the primary cause of Parkinson's Disease. I doubt that toxicity amounts to more than 10% of cases of Parkinson's Disease. The order of the subjects does not determine its relative merits or prominence. 2. You describe toxic causes of Parkinson's Disease as unfounded. You have obviously not checked the links attached to toxins. Every one of them is fully substantiated and based on a comprehensive assessment of the entire scientific literature.Every part of it is well documented and scientifically accurate. 3. Describing dopamine agonists as highly effective is ridiculous. Besides widespread side effects, in response to dopamine agonists, the dopamine receptors that they are supposed to stimulate become progressively less sensitive. Dopamine agonists consequently end up causing the very same symptoms that they initially relieve. I certainly do not agree with your factually baseless suggestions, as they are based on obvious errors. I will consequently revert them interminably. Profsnow would obviously want to alter anything I have added solely out of resentment that his amendments of the page have all been shown to be useless. It's a pity that some people prefer to act out of resentment rather than any genuine aim at being informative. --General Tojo 18:41, 19 June 2006 (UTC)

Don't "fallacy" me mate. --PaulWicks 21:23, 19 June 2006 (UTC)

You'll be fallacied when you write fallacies, such as the recent amendments. "Often" is correct because 30% of people do not have tremor. Muscular symptoms are the primary symptoms because many people with PD have only limited if any emotional disturbances.Excessive muscle contraction does cause muscle rigidity. Muscle rigidity does lead to walking difficulties, as can be readily seen by the walking difficulties increasing or decreasing in response to the level of muscle rigidity. --General Tojo 08:55, 20 June 2006 (UTC)

Diagnosis is performed clinically on the basis of at least two of the following three signs: bradykinesia (slow movement), resting tremor, rigidity. Therefore Parkinson's is not "often" characterised by these signs, it "is". --PaulWicks 14:19, 20 June 2006 (UTC)

MAJOR REVISION

This article is currently too long. There is some very useful stuff in here but it's not the sort of thing that's directly relevant to someone looking it up for the first time. There are also glaring omissions such as the diagnostic process. I am trying my best to chunk off new articles in as rational a fashion as possible in accordance with these two guidelines:

http://en.wikipedia.org/Wikipedia:Article_size http://en.wikipedia.org/Wikipedia:Summary_style

I am acting in good faith to make this a better article to read as I worry that a newly diagnosed patient would come across this and be utterly flummoxed!

I would appreciate the input of ALL the other editors on this article to help improve this article. --PaulWicks 14:53, 20 June 2006 (UTC)

http://en.wikipedia.org/WP:3RR

They would be far more flummoxed by the obviously detrimental alterations that you are trying to make. --General Tojo 18:28, 20 June 2006 (UTC)

I will wait until the admins have adjudicated on this revert war before doing any further revisions, I would recommend all others do the same. --PaulWicks 18:54, 20 June 2006 (UTC)

As PaulWicks current attempts at decimating the Parkinson's Disease page constitute a blatant breach of Misplaced Pages rules, there are no restrictions on anyone reverting his vandalism or in improving the page by other means. --General Tojo 19:26, 20 June 2006 (UTC)

I wasn't deleting them I was moving them into new articles so there'd be enough space for people like you to drill in more detail without making the main article too long. See:

http://en.wikipedia.org/Parkinson%27s_disease_pathology http://en.wikipedia.org/Striatonigral_degeneration http://en.wikipedia.org/Parkinson%27s_disease_mimics http://en.wikipedia.org/Non-motor_symptoms_of_Parkinson%27s_disease http://en.wikipedia.org/Motor_symptoms_of_Parkinson%27s_disease

And why take down the picture of Michael J Fox?

--PaulWicks 20:26, 20 June 2006 (UTC)

There is nothing more to add apart from Lewy bodies. The pages don't need spreading around. It is only symptoms that are comprehensive but far too ill organised. Nobody needs a picture of MJFox. We all know what he looks like anyway. --General Tojo 21:33, 20 June 2006 (UTC)

Well maybe you do but not everyone knows he has PD. I was going to add some more pix too, I'm trying to source a good image of a DAT scan. And I disagree, there's tons to add. My original aim was to add the contents of this conference (http://www.mdpdamsterdam.nl/) which I just attended to the non-motor symptoms section but I quickly realised it would need a whole article. --PaulWicks 21:38, 20 June 2006 (UTC)

MJFox is already on the site twice - his foundation web site and on the list of famous PDers. He also has his own page on Misplaced Pages that details his PD. It doesn't matter if people know he has it anyway. It's not going to get rid of their symptoms. How about a picture of Adolf Hitler on the site. I don't suppose most people know he had it either! --General Tojo 22:27, 20 June 2006 (UTC)

RFC

I was asked by Paul to have a look at the strange edit war here. I really do not understand General Tojo's reasons for reverting. Using capitals or boldface on talk pages and violating Godwin's law is also unlikely to achieve a resolution. Please be mindful of WP:CIVIL and WP:NPA.

I would propose that Paul announces every major edit before committing it. The reason is that we should be attempting to gain consensus of major edits. I don't think we should be forking content at the moment. Rather, all material that looks doubtful and is unsourced should be moved to the talkpage for discussion.

This article needs a lot of work, and I would like to encourage General Tojo and Paul Wicks to work together on this. Do we agree that this article should offer a reliable, neutral, basic overview of a very common medical condition, along with reliable sources for further information? Shall we try to implement this? JFW | T@lk 23:41, 20 June 2006 (UTC)

Thanks JFD, I'm in agreement with that. --PaulWicks 09:10, 21 June 2006 (UTC)

Major Revision - Principles

I'm going to try to outline my rationale for a major revision of the article Parkinson's disease.

1. The article is too long. (http://en.wikipedia.org/Wikipedia:Article_size).

2. The article goes in to too much detail about the biochemistry of Parkinson's, which whilst informative and valid is too complex for the vast majority of readers. In particular please consider this from http://en.wikipedia.org/Wikipedia:Summary_style: "Since Misplaced Pages is not divided into a macropaedia, micropaedia, and concise versions like Encyclopaedia Britannica is, we must serve all three user types in the same encyclopedia. Summary style is based on the premise that information about a topic should not all be contained in a single article since different readers have different needs;

• many readers need just a quick summary of the topic's most important points (lead section),
• others need a moderate amount of info on the topic's more important points (a set of multi-paragraph sections), and
• some readers need a lot of detail on one or more aspects of the topic (links to full-sized separate articles)."

3. There are other articles about neurological disease which are better. IMHO these include:

• Stroke
• Alzheimer's disease
• Motor neurone disease
• Amyotrophic lateral sclerosis

I don't see any reason why we can't make PD as good if not better and make it a featured article.

4. There are several people working on the article that are expert in various fields. For instance it would seem Profsnow is an epidemiologist, General Tojo is a biochemist, I'm a neuropsychologist. Therefore I would suggest that for now we stick firmly within our areas of expertise. We should find a neurologist to take an overview of the introduction, diagnosis, prognosis sections.

We've got a neurologist on board already, user AFGriffithMD. He's in on discussions further up the page. --Dan 16:04, 27 June 2006 (UTC)

5. Until these principles are agreed I don't think anyone should make anymore changes to the page. --PaulWicks 10:13, 21 June 2006 (UTC)

I support a revision, but please start by reducing unsourced nonsense. At the moment whole sections are unreferenced or use the p4.forumforfree.com site as sources. This is not acceptable. Scientific review articles are the ideal source, not primary studies (the impact of which cannot be judged). Please use your judgement in moving unsupported material to the talkpage, always leaving clear and polite edit summaries.

At present we have no Misplaced Pages neurologist, so unless one of you can recruit one we'll have to make do without.

I would like to propose that blind reverts are not performed on this article. Rather, a contentious edit can be discussed on this very talkpage, and reverted if other editors agree it was not appropriate.

All editors please familiarise yourself with cite.php and make it a habit to cite peer-reviewed academic studies rather than URLs on potentially unreliable websites. JFW | T@lk 10:43, 21 June 2006 (UTC)

The Parkinson's Disease Forum contains far more detail, is the most comprehensive source for the toxicology and biochemistry of PD, and and is fully referenced. There is no better source of information online. Brain Talk which is the world's most viewed PD Forum had the biochemistry of PD as their most viewed thread - clear evidence of the interest of people with PD in PD biochemistry.--General Tojo 16:03, 21 June 2006 (UTC)

But it's not peer-reviewed, and today the URLs gave a 504. As I said, academic references are much to be preferred. Do you disagree with that? JFW | T@lk 16:51, 21 June 2006 (UTC)

On the Parkinson's Disease Forum, I see 52 peer reviewed references concerning the toxic causes of Parkinson's Disease. It is based on a comprehensive review of the entire scientific literature. It contains far more information on toxic causes of PD that is possible on Misplaced Pages and so is a very useful and fully referenced additional source of information.

"URLs gave a 504" - I don't know what that means.

Peer reviewed doesn't impress me at all. It's certainly no guide to quality. Dr Hwang's "historical" stem cell breakthroughs were all peer reviewed and in prestigious journals, yet turned out to be the biggest fraud in medical history. All scientific research should be judged on its individual merits. Whether or not its peer reviewed gives little assurance of use or certainty. Approval or disapproval in science is often based on prejudice and has little to do with through scientific evaluation. The peer reviewed scientific literature is full of research that is useless or bogus or that makes false claims.--General Tojo 17:16, 21 June 2006 (UTC)

Is the PD Forum free from the influences that caused Dr Hwang's downfall? Your views on peer review are rather original and are certainly unusual for a biochemist. JFW | T@lk 18:06, 21 June 2006 (UTC)

Prognosis This section has litle to do with the realities of what occurs in most people with Parkinson's Disease. The first section claims increased mortality, but even the second section nullifies it. It then misrepresents what usually occurs by implying that most people with PD die of pneumonia. Very few do, and the biochemistry of pneumonia has nothing to do with PD biochemistry. In disorders such as HIV it is reelvant to describe what usually eventually occurs. However, in PD there is no usual. The prognosis section is misleading, and of no practical use to anyone with PD.

General Tojo from what I understand you are a biochemist. Not a patient. Not an advocate. Not a clinican. Therefore on what basis can you put yourself forward as a representative of "anyone with PD"?. Frankly I'm not finding your edits to be helpful. --PaulWicks 17:49, 21 June 2006 (UTC)

I have had dialogue with thousands of people with Parkinson's Disease. I read all new research on Parkinson's Disease. I have been involved in Parkinson's Disease far longer and far more extensively than anyone here. As for "I understand you are a biochemist. Not a patient. Not an advocate. Not a clinican", you know virtually nothing about me. --General Tojo 18:18, 21 June 2006 (UTC)

General Tojo did not read the paragraph properly. It makes it quite clear that increased mortality found in older studies is to be attributed mainly to dementia. As I said before, please avoid removal of well-referenced sections without good discussion. JFW | T@lk 17:56, 21 June 2006 (UTC)

It is referenced, but it is not relevant. If it relates to dementia it should be in the dementia section. Dementia and Pd are biochemically completely distinct. So please do not continue to revert. --General Tojo 18:18, 21 June 2006 (UTC)

The obvious suggestion, then, is to avoid the edit-war over whether the information should be included and concentrate instead on how it should be improved. RadioKirk (u|t|c) 18:45, 21 June 2006 (UTC)

It is obvious that we're talking here about dementia as part of Parkinson's. Also, they are both fairly common and it's quite possible that someone with Parkinson's will also develop dementia (James + Alois). All this is not reason to remove the whole paragraph. I'm pleased to see that General Tojo has now agreed to only remove part of the "prognosis" section. However, I would still like to see some data on the actual odds of death for PD patients. The argument that PD does not directly cause death is quite irrelevant: it predisposes for lethal conditions. Heart attacks do not cause death - only cardiac arrest does. JFW | T@lk 19:56, 21 June 2006 (UTC)

Dementia and PD often coincide, but they are still distinct. There are plenty of disorders that often coincide with PD - dystonia, depression, hypothyroidism, anxiety, dyskinesia, etc, but that doesn't justify including them all in a PD prognosis article. I haven't agreed not to delete the prognosis section in its entirety. I was informed by GraemeL that I could amend it but not remove it (yet) without going over the 3RR rule. I am eligible to revert again from tomorrow. Anyone with PD reading it would be under the impression that they will soon die of it. That is very serious and upsetting misinformation for anyone with PD. It is also detached from reality. Try telling those many people that have had PD for over 50 years that they were supposed to have died of it years ago. Because somebody could die of something does not mean they will. Information must be verifiable. There is not a shred of evidence on this site that demonstrates that most people with PD die of it. It is therefore in breach of Misplaced Pages guidelines. --General Tojo 22:21, 21 June 2006 (UTC)

Sigh... You know what I give up. I've got too much important stuff going on in my life at the moment (including being a PD researcher) to waste my effort on this. Good luck all. --PaulWicks 20:20, 21 June 2006 (UTC)

I am also a PD researcher, and a former Japanese war criminal, but I'll still find the time. --General Tojo 22:21, 21 June 2006 (UTC)

What?!--64.12.117.12 23:20, 21 June 2006 (UTC)

Once more unto the breach...

Right, that's better. OK what do you say we take up JFDWolff's suggestion about evidence? We could for instance start with adding and updating lines with the best evidence e.g. Cochrane reviews, then lit reviews, then big studies (esp RCTs), then small studies, then case series and then case reports.

Everyone might find it useful to read this section if they haven't already: WP:REF http://en.wikipedia.org/Wikipedia:Reliable_sources#Finding_a_good_source_may_require_some_effort

What do you reckon?

--PaulWicks 08:22, 23 June 2006 (UTC)

http://search.cochrane.org/search?q=parkinson%27s+disease&restrict=cochrane_org&scso_cochrane_org=this+site&scso_review_abstracts=reviews+only&scso_evidence_aid=evidence+aid&scso_colloquia_abstracts=colloquia+abstracts&scso_newsletters=newsletters&ie=&site=my_collection&output=xml_no_dtd&client=my_collection&lr=&proxystylesheet=http%3A%2F%2Fwww.cochrane.org%2Fsearch%2Fgoogle_mini_xsl%2Fcochrane_org.xsl&oe=&filter=0&sub_site_name=Cochrane.org+search

I would propose we try and get together a brief table of meds that patients might find useful, like a cutdown version of this: http://wiki.iop.kcl.ac.uk/default.aspx/Neurodegeneration/Drugs%20used%20in%20the%20treatment%20of%20PD.html

Sorry gotta go, back Monday. References would be nice! --PaulWicks 09:00, 23 June 2006 (UTC)

This is a useful way of presenting this information, especially if reliable sources are brought. Alternatively, we can start by simply presenting basic treatment algorhythms and leave in-depth comparison between the drugs for a separate page, such as antiparkinsonistic drug (compare anti-diabetic drug). JFW | T@lk 10:58, 23 June 2006 (UTC)

Cardinal symptoms

Neuro Prof (talk · contribs) is of the opinion that we cannot refer to the main symptoms as "cardinal" because "the majority of people with Parkinson's Disease not have all these symptoms simultaneously". That argument does not obviate the need to refer to these symptoms as "cardinal". A clinician will not diagnose PD in the absence of those symptoms. I suggest this pattern of removals and reverts should stop, because it is quite reminiscent of recent edits by General Tojo (talk · contribs). JFW | T@lk 11:03, 23 June 2006 (UTC)

"A clinician will not diagnose PD in the absence of those symptoms." - but they do all the time. About 30 % of people with Parkinson's Disease do not have tremor yet are diagnosed with Parkinson's Disease. Most people when initially diagnosed do not have akinesia. That usually comes much later. Many do not initially even have bradykinesia. Many people with Parkinson's Disease do not have walking difficulties. These "Cardinal" symptoms are a description of basic muscular symptoms of Parkinson's Disease at its ultimate extremes. Virtually no person initially diagnosed would have all these symptoms. Even those with typical Parkinson's Disease would not usually have all these symptoms. It is therefore misleading for people reading the article to describe these as Cardinal symptoms. Those readers of the site concerned that they might have Parkinson's Disease or have been wrongly diagnosed with Parkinson's Disease would wrongly assume that they can not possibly have Parkinson's Disease because they do not have all these symptoms. --Neuro Prof 11:26, 23 June 2006 (UTC)

In medical school we have learnt that bradykinesia, rigidity and tremor are cardinal features. Never mind the fact that they remain subtle during the initial presentation. Very few people with aortic regurgitation have Corrigan's sign, yet it is regarded as a cardinal sign. If you disagree with the exact wording please come up with something better, as long as that section indicates that the tetrad mentioned is classical for PD. You may consider "generally, these symptoms may not be fully apparent except in advanced disease" or something like that.

Your argument that readers may be overwhelmed or scared by the list of symptoms is very weak. On cancer we indicate that some forms of cancer are lethal. An encyclopedia does not play hide-and-seek with its readers. JFW | T@lk 11:39, 23 June 2006 (UTC)

Some Medical Schools may teach that, but it bears little resemblance to reality. At the outset some of these symptoms are not merely subtle they often do not exist at all. These cardinal symptoms are a description of how the muscular symptoms of Parkinson's Disease can ultimately end up - the worst case scenario. On the Hoehn and Yahr, diagnosis of Parkinson's Disease will certainly occur without all these symtoms occurring. --Neuro Prof 11:59, 23 June 2006 (UTC)

On the other hand, the reality is that these are the cardinal symptoms taught in medical school. I think it would be difficult to find a case where these aren't taught, at least in the U.S. Of course patients don't read textbooks, but these are worth mentioning as the classical findings. Andrew73 14:38, 23 June 2006 (UTC)

They shouldn't be taught in that way. Textbook descriptions of Parkinson's Disease are a massive oversimplification - often mocked by people that have the disorder. There are many very varied degrees of Parkinson's Disease, with very different emphases on different symptoms, and different associated disorders which diversify the appearance ever further. The Cardinal symptoms are only the extreme symptoms, the ultimate appearance of Parkinson's Disease at its worst. Most of the many people I know with Parkinson's Disease would say that it doesn't describe them. --Neuro Prof 15:00, 23 June 2006 (UTC)

There are more important issues about this article. A couple of things are giving me deja vu here. E.g. requoting of the "30% don't have tremor", suggesting the opinion of established orthodox medicine is inferior to that of a wikipedia editor who only started posting on June 22nd, needless reverts...--PaulWicks 15:23, 23 June 2006 (UTC)

It is well established and well known that about 30% of people with Parkinson's Disease do not have tremor. It has been on the Misplaced Pages page almost since the outset. To anyone that works with large numbers of people with Parkinson's Disease this is an obvious fact. They are usually referred to as akinetic-rigid. 100% of people with Parkinson's Disease having tremor is not established orthodox medicine. --Neuro Prof 15:50, 23 June 2006 (UTC)

I don't disagree on the point about tremor. What I meant was I must confess I am suspicious about people who materialise around the time that a troll is banned and continue to wax lyrical on the same topics that he did. I may be failing to assume good faith and if this is the case I apologise. I think we need to have cited references on all material in this article though, so if you would be kind enough to track down some references that would make life easier and the article better. --PaulWicks 16:23, 23 June 2006 (UTC)

If you cite all relevant references you will have pages of references. References are really only needed when either : something is contentious in order to prove it, or when people are likely to want more detail out of interest.--Neuro Prof 16:56, 23 June 2006 (UTC)

I'm afraid I disagree with you there, and for this reason: on this page EVERYTHING has been contentious. Therefore if anyone makes a statement they need to have references, it is not enough for any one of us to just say that we work in the field. I think the encyclopedia would rather have a long list of references than a long article of unreferenced material. --PaulWicks 14:05, 24 June 2006 (UTC)

If that is the case then you have a lot of work ahead of you in the symptoms section, because apart from blinking and facial expression there are no references for any one of the numerous other symptoms each of which will require its own reference. Even for a far less comprehensive description of the symptoms elsewhere, I have seen dozens of references. --Neuro Prof 15:33, 24 June 2006 (UTC)

Well I guess we'd all better get comfortable then, because I'm contracted until October 2008 to work on PD. --PaulWicks 15:45, 24 June 2006 (UTC)

Paul, there's a couple of points that come out of a pile of nonsense above - first, because PD is a disease with a long latency and development, with patients able to ignore symptoms or ascribe them to old age, presentation is highly variable and the collection of symptoms people will have through the course of their disease is likewise variable. Second, in nosology in western medicine we define diseases by three main ways: by the cause (eg. Tuberculosis or asbestosis), by the anatomic site affected (almost any cancer, or by the symptoms (Parkinson's, Depression, and tuberculosis before we knew about the bug). People can be sickened by a rhinovirus, and have differing constellations of symptoms - it does not negate the concept of 'common cold'. Just so, varying symptoms of Parkinson's patients does not negate that disease concept. One could argue that more successfully with something like "fibromyalgia" or "chronic fatigue syndrome", though. --Dan 19:42, 30 June 2006 (UTC)

Non-motor symptoms

I've made a first early attempts to start citing material from Pubmed. I've also paved the way for the non-motor symptoms of Parkinson's disease article as I think this could turn into a disproportinately large part of the article.

Sorry I wasn't logged in, I'm away from home and clearly failing to have my wikibreak --PaulWicks 15:48, 23 June 2006 (UTC)

Suspicious activity

Everyone please keep your eyes peeled for reverts and edits from anonymous IP's, some of which have false edit descriptions. e.g. , , --PaulWicks 19:59, 24 June 2006 (UTC)

I've made a request for this page to be semi-protected i.e. only registered users or accounts more than 96 hours old will be able to edit. --PaulWicks 21:50, 24 June 2006 (UTC)

I warned the first one at the time. If they're using misleading edit summaries, tag their talk page with {{subst:bv}} and report them to WP:AIV if they re-offend. Your request for semi-protection is fairly unlikely to be granted at the moment. The level of vandalism is probably too low. I have this page on my watchlist and will sprotect if I see the vandalism levels accelerating. Is this down to "absent friends"? --GraemeL 22:10, 24 June 2006 (UTC)

I'm going to go out on a limb and say yup. --PaulWicks 22:19, 24 June 2006 (UTC)

I have now semi-protected the article. --GraemeL 16:14, 25 June 2006 (UTC)

pathophysiology and epidemiology sections

a) Terminology

When people refer to Parkinson's disease, it seems they are usually referring to the idiopathic disease first described by Dr. Parkinson. There are other less common diseases that are symptomatically similar to idiopathic Parkinson's, but either present with a few different symptoms, or have a known cause (that means they're not really idiopathic anymore, right?).

I think it's confusing to refer to these Parkinson's-like diseases as Parkinson's.

I have heard various researchers propose using the term "parkinsonism" when referring to diseases similar, but not identical, to idiopathic Parkinson's. (The "Related Diseases" section seems to allude to that.)

Perhaps this article could do something similar with the terminology?

A terminology clarification would mostly help the pathophysiology section. As currently written, I think it is hard to tell which of the various listed genotypes, toxins, traumas, or drugs are causes of idiopathic Parkinson's, and which are causes of different diseases that present with symptoms of parkinsonism.

b) Unilateral Causes vs. Part of Multifactorial Disease

Which of the aforementioned mentioned causes will induce parkinsonism all by themselves, and which are associated with the disease without causing it singlehandedly? (see Sir Austin Bradford Hill's criteria for causation).

I could be mistaken, but except possibly for acute PD and MPTP, I don't think there are any unilateral causes. Here's a worthwhile article on causation . I adhere mostly to the Rothman model of causation, with a little Popper thrown in (we were all mad for Popper about 20 years ago). --Dan 15:43, 26 June 2006 (UTC)

That's what I thought ... I think this should be discussed in the pathophysiology section, because it doesn't really read that way now. I actually rather agree with PaulWicks's earlier opinion on that matter (see the Toxins discussion ...) --GeekPhilosopher 17:42, 26 June 2006 (UTC)

c) More Epidemiology

Speaking of these causes, I've heard of several twins studies and of a career study, the results of which would enhance the epidemiology section. Is there an epidemiology-saavy person out there?

GeekPhilosopher 09:04, 25 June 2006 (UTC)

Hi GeekPhilospher, my understanding is this: If it looks like Parkinson's but it's not idiopathic (e.g. resulting for neuroleptics, MPTP exposure, brain damage) then it is parkinsonism. If it's MSA or PSP then it's a Parkinson's plus syndrome. I agree that things have got a bit confusing. There is a parkinsonism article, I don't know if you'd like to weave those together.

And we do have an epidemiologist knocking around, ProfSnow, who should be back from holiday tomorrow. Twin studies are important, as are the suggestions of a premorbid low-sensation-seeking personality. Cheers, --PaulWicks 09:17, 25 June 2006 (UTC)

sounds good ... I will see what I can do incorporating that into the pathophysiology section. Speaking of, is "pathophysiology" the best name for that section? --GeekPhilosopher 12:27, 25 June 2006 (UTC)

And I am back from the Society for Epidemiologic Research meeting in Seattle - and it was a very nice holiday, thank you. Twin studies and career studies I'm not sure on but can find out. Off the top of my head I'd bet Carlie Tanner did any twin studies. As far as careers go, we're all pretty tightly focused on farming & have been ever since Bill Langston found the MPTP outbreak, and even before - maybe since Barbeau? I will put my descriptive epidemiology, including incidence, section back as soon as things are open again, or in an appropriate sub-article. I'd frankly rather have epidemiology separate from pathophys, if you all don't mind. --Dan 15:35, 26 June 2006 (UTC)

Parkinsonism is a medical disorder that can cause symptoms similar to those of Parkinson's Disease but via non-dopaminergic mechanisms (e.g. Hydrocephalus, Wilson's Disease). There are alternative causes of Parkinson's Disease that have a specific cause that do act via dopaminergic means (e.g. Manganism, MPTP). The means of differentiating between the two is whether or not the disorder acts via the interference with dopamine action. For example, Hydrocephalus does not affect dopamine levels, whereas manganese affects dopamine biosynthesis via tyrosine 3-monooxygenase.

Twin studies have been shown to be of no practical significance. Genetic versions of Parkinson's Disease have been shown to affect only a very small percentage of people with Parkinson's Disease, and even then they usually only incline somebody towards Parkinson's Disease rather than cause it, as is shown by the fact that a lot of people with PARK mutations never get Parkinson's Disease.

General Tojo

Although some of the things you say about Parkinson's disease may be true, General Tojo, your contentious behaviour and that of your apparent aliases (Emperor Hirohito, Parkinsons, Viartis, Keith Bridgeman, 88.106.XXX.XXX ... are there any more?) doesn't lend you an air of credibility. See Benford's law.

Not some of the things I write are true - all of the things. So is it wrong to disagree when I am right ? That means in your mind somebody either agrees with everything you say - even when you are completely wrong, or you consider them quarrelsome. That is remarkably selfish and arrogant - a real indication of intolerance. It was intolerance that saw the "demise" of my username General Tojo. One administrator banned the name without complying with Wiki procedures. He could not answer my criticisms of his objections, so he quickly banned the name to try to stop me making him look even more unreasonable than he already was. The use of other names was entirely because of him. That's not a sign of lack of credibility. That is evidence of his intolerance. Thr funny thing is that now I use the name all the time as evidence of how powerless he is - (including on his user page !), and yes I have many other pseudonyms. In fact you and me are the only ones here. All the other names are me LOL! General Tojo

Of course, why would I write something down unless I believed it were true! Andrew73 19:03, 26 June 2006 (UTC)

You believe it to be true, but that doesn't mean that it is true. So many people on this site are making changes without knowing the subect or checking the facts.When errors or inadequacies are pointed out they can't defend them and then start shooting the messenger. General Tojo

Hey Dan, sorry about mushing discussion about the epidemiology and pathophysiology together. I agree with you about keeping them separate in the article.

--GeekPhilosopher 17:42, 26 June 2006 (UTC)

Twin studies are significant in that they allow us to address the question of the degree of contribution of the genetics. Further, while the genetic PD comprises a small proportion of the disease in that there are few kindreds around at high risk, these rare situations teach us much about the etiology of the disease, and what to consider when examining associations with environmental factors, which of course do not affect everyone equally even when given equal exposure. Manganism is generally conceded to be an entity distinct from PD, and MPTP is an odd but useful toxic event. --Dan 17:46, 26 June 2006 (UTC)

The degree of genetic contribution is already known to be very small from a lot of surveys of genetic Parkinson's Disease. They teach us nothing about the pathology of PD. That is already well known as being due to as lack of dopamine, or to be more specific, dopaminergic action being inferior to cholinergic function. Twin studies don't even deal with the biochemistry involved anyway. Both manganese and MPTP affect dopamine biosynthesis. So they are lesser causes of Parkinson's Disease rather types of Parkinsonism which don't involve dopamine biosynthesis. It doesn't matter how some people consider them. Most people involved in PD have never studied biochemistry and so wouldn't understand it if you explained it to them. General Tojo

My advice would be not to feed the troll--PaulWicks 19:17, 26 June 2006 (UTC)

My advice would be to check out Wicksy on the Internet as I have so that you realise what an absolute beginner he is. General Tojo

Images

from my talk page, massive thanks to Chris_73, all round legend:

On a side note, Image:Parkinson surgery.jpg may be interesting to you -- Chris 73 | Talk 09:49, 25 June 2006 (UTC)

Just uploaded Image:PET scan Parkinson's Disease.jpg from a NASA (and hence free) site. CHeck also commons:Category:Parkinson's disease -- Chris 73 | Talk 09:56, 25 June 2006 (UTC)

One more: uploaded Image:Sir William Richard Gowers Parkinson Disease sketch 1886.jpg. Also Picture of Parkinson is here, which is PD due to its age. The image is not very good, however, and I do not know the painter or other source. Ok, hope this helps, best wishes, -- Chris 73 | Talk 10:08, 25 June 2006 (UTC)

Can someone more talented than me integrate these images? --PaulWicks 10:26, 25 June 2006 (UTC)

Sure can. See Misplaced Pages:Picture tutorial on how to do it yourself, and Misplaced Pages:Finding images tutorial for image needs -- Chris 73 | Talk 10:41, 25 June 2006 (UTC)

88.106.XXX.XXX

I've noticed that there seems to be a person is logging in from London under various IP addresses all starting with 88.106... making the same types of reverts each time.

I'm not sure what his/her goal is, but it seems that they are either trying to perserve some past version of the article or they're trying to maintain the prominence of an external reference to http://p4.forumforfree.com/parkinsons.html

I bring it up here because:

First, it's hard to resolve this conflict with this person because they're using various IP addresses. I've noticed that a few people (Fyver528, GraemeL, Merovingian) have given similar feedback on the talk pages of these various IPs basically asking him/her to stop doing things that could be construed as vandalism. I sorta think this person is ignoring their feedback. Perhaps this person would like to discuss his/her editing philosophy openly with everyone so we compromise and work together and move forward.

Second, failing a reasonable dialog with this editor, I want other editors to realize that they need to be aware of edits by IP addresses that start with 88.106...

--GeekPhilosopher 12:06, 25 June 2006 (UTC)

My editing policy ? It must be factual, relevant and on the right Misplaced Pages page. Some people think that when they revert they are making improvements, yet when other people revert they describe it as vandalism. They expect evryone to agre with them. If they don't they are being "contentious", "warring" or should be banned. Obvious double standards. General Tojo.

Troll JFW ? You're the troll. It's a pity that there are some remarkably ignorant yet arrogant "contributors" here. You and others didn't even know that huge numbers of people with PD don't have tremor. How can you possibly think yourself fit to add to this site when you don't even know basics ? To add to a site about a subject when you are only a novice shows delusion. The PD page is becoming worthless because of the various fallacies and the beginners like you that plainly aren't fit to add to it. General Tojo

Andrew 73 another of the deluded. You don't even work in Parkinson's Disease. Not only not an expert, not even a novice. It's a pity that there are so many trolls like you whose knowledge does not match their over inflated view of themselves. So wehn somebody points out your ignorance you can't contradict whet they say because you don't even know the subject. So you try to attack them instead. You're pathetic. General Tojo

Well I hate to say I told you so but... no, hang on, actually I quite like saying "I told you so" ;-) --PaulWicks 18:10, 25 June 2006 (UTC)

Wicks, you're the worst of them all. You were only a student last year, yet amazingly in that time you've become world expert. You've not treated anyone with Parkinson's Disease. You've not furthered research in Parkinson's Disease. In fact you've done and know next to nothing. That is very obvious when you read the very naive and false statements you have written. In the above exchanges you're another of the ignoramus's that think that everyone with Parkinson's Disease has tremor when they don't. Hundreds of people have contributed to this site yet you come along, a naive and ignornat student who arrogantly decides to rewrite it all. Delusion, ignorance and arrogance. You've got them all. General Tojo

Thank you for the compliments, but why all the boldface? Andrew73 19:54, 25 June 2006 (UTC)

You're welcome. Bold type looks better. No other reason. Why does everyone around here fuss so much about bold lettering ? I think there must be something somebody hasn't told me. It implies this or it implies that. I never imply anything. I bluntly state it. General Tojo

It's just that the bold face LOOKS LIKE YOU'RE YELLING, as if you are WRITING IN ALL CAPS. Andrew73 22:07, 25 June 2006 (UTC)

Just once I'd love to see General Tojo actually admit in detail what his credentials are - the most he'll say is something like "journals are all biased to academics" and "academics are elitist", thoughts one hears most often from people who are not in the mainstream or even the sidestream of medical research. He's never actually said how many patients he's treated, either - and I mean directly, hands-on medical treatment, not being connected to a mix of amino acids and minerals that "treats" PD. His pages that he points us to are little more than collections of clippings. What original research has he done? I'd be curious to hear. --Dan 03:37, 26 June 2006 (UTC)

Andy73 I never yell. Your feint type looks to me like you've run out of ink ! THIS DOESN'T MEAN ANYTHING. Neither does this. I can't understand why people think it does. What about italics ? As the letters lean over does that mean the author is drunk ? A confused General Tojo

Italics implying a drunk author...I got a chuckle out of that! Andrew73 12:03, 26 June 2006 (UTC)

Profsnow - My credentials regarding Patrkinson's Disease. Put simply, I know considerably more than you and everyone else on this page. Intellectually (fortunately not physically), Parkinson's Disease has for a long time been part of my life. It's now just a passing fancy as it is for some. I've never written "journals are all biased to academics" and "academics are elitist". You've made that up. Most of what passes for research, especially in Parkinson's Disease is completely useless. I know because I read every single bit of it. Academics have their own little society and hierarchy, just like all fields of work. A lot of it is not conducive to scientific fact. The amount of false claims and misleading statements in Parkinson's Disease in published research is enormous. It's unfortunatley the norm. I have seen people rid of Parkinson's Disease. It's a fallacy that its irreversible. One of the largest and most prestigious hospitals in Britain is presently undertaking a large clinical trial in order to demonstrate that formally. As for original research, amongst other things, I haved written by far the world's most comprehensive biochemistry of Parkinson's Disease, based on the assesment of over 10,000 of your peer reviewed academic studies. What appears on Misplaced Pages is only a very brief extract of that. It is way way beyond what is otherwise known. The Parkinson's Disease Forum I think you are referring to is aimed at dealing with all new research, news reports, books and web sites in Parkinson's Disease and related disorders. It enables people to keep up to date with what is new. If you want to keep up to date you should starte reading it every week. Additionally it has basic information such as symptoms, causes, biochemistry etc that people new to PD will want to know. General Tojo

QED --Dan 22:22, 27 June 2006 (UTC)

"Wicks, you're the worst of them all." That's so amusing I'm going to put it on my talk page. --PaulWicks 08:29, 26 June 2006 (UTC)

Finding that amusing shows what a really inflated view you have of your negligible knowledge of Parkinson's Disease. A novice who fools himself he's an expert. Everything you ever add will end up being wiped out. That's a promise. General Tojo

Protected

I have upgraded to full protection of this article due to apparent sockpuppetry from a blocked user. I have requested checkuser on the accounts involved. --GraemeL 14:50, 26 June 2006 (UTC)

I have blocked Emperor Hirohito (talk · contribs) indefinitely and Parkinsons (talk · contribs) for 48 hours for being General Tojo. JFW | T@lk 15:34, 26 June 2006 (UTC)

What about all the other usernames ? Shall I give you a list ? --General Tojo... 19:38, 26 June 2006 (UTC)

Restoring deleted comments...

This is more likely than not our troll General Tojo (talk · contribs) who has previously stated that this site is better than peer-reviewed science. Edits from this IP range can probably be reverted on sight. If the vandalism accelates, {{sprotect}} is our friend. The vandal will then create a login (or use the one he's used previously) and be easier to ban.JFW | T@lk 13:24, 25 June 2006 (UTC)

My editing policy ? It must be factual, relevant and on the right Misplaced Pages page. Some people think that when they revert they are making improvements, yet when other people revert they describe it as vandalism. They expect evryone to agre with them. If they don't they are being "contentious", "warring" or should be banned. Obvious double standards. General Tojo.

A look through the http://p4.forumforfree.com/parkinsons.html shows a preference for writing in bold...very reminescent of one of the contributors on this page. Andrew73 14:05, 25 June 2006 (UTC)

unsigned comment by 88.106.237.54

Restoring comment by 88.106.237.54 that was previously inserted into PaulWicks's comment

...General. And yes, I do admit to transvestism. I can't help it...— Preceding unsigned comment added by 88.106.237.54 (talk • contribs)

The guy made a remark on my tal page to the effect that I should stay out of Parkinson's Disease and stick to eating kimchi. Plainly Bridgeman has a problem with bigotry. --Dan 19:03, 2 July 2006 (UTC)

He certainly is dealing with many issues! Andrew73 19:22, 2 July 2006 (UTC)

Related disease section

Essential tremor and Wilson's disease have been included as part of the Parkinson-plus diseases. However, while they may be associated with parkinsonism, my (naive) sense is that these are distinct clinical entities and would not be considered a Parkinson-plus disease like Shy-Drager syndrome. Andrew73 12:16, 27 June 2006 (UTC)

Essential tremor and Wilson's disease are distinct medical disorders as are all the Parkinsonism disorders. However, all of them can produce symptoms similar to those of Parkinson's Disease. The relevance of their inclusion is that clinicians and patients can consider these as possible explanations of their symptoms as can often occur. THis avoids somebody beiung treated for Parkinson's Disease when they actually have Parkinson's lke symtoms due to Wilson's Disease or Hydrocephalus or Essential Tremor. Eliminating those medical disorders from the Parkinsonism means that somebody will not consider them. This can give rise to the situation I have encountered where somebody has been diagnosed with Parkinson's Disease without actually having it. They instead turned out to have one of the Parkinsonism disorders. Unaware that all these other disorders could cause the same symptoms, and therefore did not consider them, the neurologist gave a wrong diagnosis causing the patient to be treated for Parkinson's Disease when they never actually had it. So your sense is naive just as you have suggested. You have deleted other disorders that are Parkinsonism disorders. It will therefore be reverted. People shouold be better informed not worse informed. The phrase Parkinson plus, though widely used does not actually mean anything that has any scientific basis or practical use. General Tojo

I think we're on the same page. These disorders which have similar symptoms like Wilson's disease, etc. would probably be better off included under parkinsonism rather than under Parkinson's disease. Or alternatively, perhaps a section about differential diagnosis, so that the distinction can be more explicit. Andrew73 13:02, 27 June 2006 (UTC)

I like the differential diagnosis section with pointers very much, Andrew. Familial tremor is, of course, far and away the most common miss, probably simply because it's common. So perhaps we should think in terms of rate of misdiagnosis for a given disease, thereby correcting for the rarity. When you have diseases such as PD that are defined and diagnosed solely by symptoms that vary from person to person and even for hour to hour, both clinical diagnosis and research can be tricky. --Dan 15:24, 27 June 2006 (UTC)

Given that 25% of people with Parkinson's Disease are wrongly diagnosed it is important that this information be with Parkinson's Disease rather than be shifted to some other page that people will probably never even end up at. Ignorance of these other medical disorders can wreck people's lives. Even most neurologists aren't aware of them. It would be even better to have a brief summary of each of the Parkinsonism disorders with a link, when available, to the page on that specific disorder. The list of Parkinsonism disorders, some of which you wrongly deleted, was as comprehensive and as up to date a list of Parkinsonism medical disorders that I know of. --...General Tojo 13:48, 27 June 2006 (UTC) Ban ! What ban ?

I like the idea of a "differential diagnosis" section too. The "diagnosis" section does need plumping up too, maybe on average time to diagnosis or average symptom duration? Other things to include or link off to new articles might be dopamine challenge, DAT-scan, and of course progression. i.e. Although many people may be misdiagnosed at any one particular timepoint, diagnoses can be revised if a period of time has past in which progression is at an unusual rate (either too fast or too slow). --PaulWicks 16:42, 27 June 2006 (UTC)

The time to diagnosis question is a good one. I've done some work on that and on time from initial diagnosis to final, correct diagnosis assuming the initial dx wasn't right. PD patients typically do not attach much significance to their initial symptoms at the time, but once diagnosed they realize that that symptom on that day was the (clinical) start. I don't recall details, but the work I did showed that time to dx was shorter for women, of course. --Dan 19:49, 30 June 2006 (UTC)

Toxins

You try telling somebody who has developed Parkinson's Disease as a result of carbon monoxide, cyanide, mercury, copper or rotenone that they are irrelevant toxins. They are all known to cause Parkinson's Disease. See the following, which has been compiled from an analysis of the complete scientific literature for full details and references http://p4.forumforfree.com/toxic-causes-of-parkinsons-disease-vt14-parkinsons.html Deleting them is based on pure ignorance. They will be replaced. Educate don't decimate ! --General Tojo !!! 16:48, 27 June 2006 (UTC) Ban ! What ban ?

Why exactly were the toxins deleted ? Aren't major changes supposed to be discussed and fully justified beforehand ? --Saldanha 22:44, 27 June 2006 (UTC)

There has been extensive discussion. Unfortunately, a lot of that was deleted by the original poster of the toxin material, but you could look it up under the history. Some of it is still up above under "toxins" and "vanity links". Excepting the original poster, the rest of the regulars here are in agreement about cutting the toxin section - I was, in fact, conservative. Probably more should be deleted - manganese for one. The other problem is that the link, given repeatedly in that section, goes to a site that is the original poster's private website. That's fine, but he does hold a patent on a nutritional supplement that he states is a treatment for Parkinson's, and he talks about it on that website. Therefore he is most likely in violation of the ban on spamming ( see Misplaced Pages:Spam). If you wish, we could get into full discussions, unless, of course, you're Bridgeman again. --Dan 23:09, 27 June 2006 (UTC)

Hi Saldanha, welcome to a contentious litle corner of the Wiki! I think we need to be taking the article back to basics and thinking about the sort of information that will benefit most people interested (or diagnosed) with PD. Even General Tojo in his most enthusiastic state never suggested that toxins were a causative factor for more than a small minority of patients. Therefore it makes sense to rationalise the proportion of the article which they take up relative to other, better referenced, issues. Hope that helps. --PaulWicks 09:25, 28 June 2006 (UTC)

I have checked for previous discussions concerning the toxins carbon monoxide, cyanide, mercury, copper, but there is no mention of them. There is only the initiation of a discussion concerning rotenone. At present the deletions have not been substantiated. Therefore please provide referenced scientific evidence that opposes the linked scientific references that have already been provided in favour.

I have checked the links to references and further information concerning toxins that were preveiously present. However, there is no mention of any Parkinson's Disease supplement on those web pages. I have checked the rest of that site, yet I can only find one obscure mention on one other web page.

Misplaced Pages guidelines requires that substantial changes be discussed and justified in advance. However, I can find no evidence of this having been done concerning recent deletions concerning toxins. Please therefore provide scientific references that substantiate your amendments or revert that information that you have deleted.

The listing of toxic causes, types of treatment, types of Parkinsonism, does not imply the degree of their significance. The site should list all toxic causes no matter how many or few people are affected by them, virtually all treatments without this implying that one is better than another, and all types of Parkinsonism even if some types may have few victims. This Misplaced Pages page is meant as a summary that should aim at linking to other pages and web sites in order to provide more information on any particular subject for those that want it.

--Saldanha 09:39, 28 June 2006 (UTC)

With all due respect, I disagree. Do your toxin research on pubmed, plug in the toxin and PD. There is no evidence for many of the toxins listed, and some of the others have been demonstrated only in animal models or cause a syndrome that is etiologically and clinically distict from Parkinson's Disease. Long laundry lists of possible exposures are useless and uninformative, in my opinion. If you could provide references from the peer-reviewed literature substantiating anyof the deleted toxins as causes of Parkinson's Disease, I'd gladyl see them restored. Treatments should be only those demonstrated to be effective through randomized clinical trials - otherwise they simply don't work. And, Mr. Bridgeman, this sounds suspiciously like you, especially given that this user name is new, in which case I expect your usual blustering, evasive, and insubstantial answer. --Dan 14:46, 28 June 2006 (UTC)0

Hi Saldanha. I think you will find people on this page hesitant to enter in to a complex discussion of this because of a very recently banned user who is operating multiple sockpuppets under a variety of names. Please forgive my paranoia but I'm not willing to devote a great deal of time to arguing about toxins. --PaulWicks 14:54, 28 June 2006 (UTC)

What a stupid suggestion saying that toxicity must be proven in clinical trials. Carbon monoxide poisoning can only occur after the carbon monoxide has caused somebody to go in to a coma. So what you want is for a clinical trial in which people are deliberately poisoned with carbon monoxide until they are comatose! There are dozens of studies on the Toxic causes of Parkinson's Disease Thread demonstrating toxicity causing Parkinson's Disease. If you had any self respect (and I don't think you do), you'd provide a detailed rebuttal of each of the studies. There are plenty of them. However, you have provided zero opposing evidence. No asssessment at all of all of those studies. Toxicity is responsible for only a small percentage of cases of Parkinson's Disease, but it is one of the causes, and all of the toxins listed are potential causes.

When somebody such as you provides no evidence, and tries to disregard all opposing evidence (such as with you really ridiculous and impractical need for clinical trials) it makes me strongly beleive that you have an ulterior motive. There is ceratinly not an ounce of logic or reasoning in what you write. I reckon you are convinced that Parkinson's Disease is caused by one specific means and that you don't like to see any evidence that appears to contradict that. Own up. What do you claim the cause to be ? Then we'll understand your complete disregard of evidence and facts.

It's funny how you now think everybody is me. When in doubt you can get administrators to check IP addresses. However, I'd rather you didn't because I find it very amusing that you now fear everyone on every site, wrongly beleiving that they are all really General Tojo. I'll leave you both in a state of paranoia. Everybody on every site you add to is really me LOL.Wimpy Wicks got stung badly by SIMULTANEOUSLY running me down as General Tojo, whilst sucking up to me as Neuro Prof. How embarrassing! What exactly did you want to try to gain out of him ? --.....General Tojo 15:56, 28 June 2006 (UTC)

You're looking a little silly, here, Mr. Bridgeman - if you read carefully you'll notice I said Treatments should be only those demonstrated to be effective through randomized clinical trials. And my standards for proof of toxins "causing" PD don't include your web page. As I told Saldanha, if you can find articles in the peer-reviewed journals saying X toxin is associated with Parkinson's Disease - not symptoms that bear some resemblance to PD - in humans with the usual standard of a relative risk of 2 or better, then we can discuss.

The web pages concerning the Toxic causes of Parkinson's Disease provide references for each toxin. Those references are ALL taken from PubMed. They are a summary of the ENTIRE scientific literature concerning toxic causes of Parkinson's Disease. So don't even bother claiming that it's only me that claims it to be true, as its the scientific community as a whole that has produced these studies. I've yet to see a detailed rebuttal from you of even one of those studies - simply because you can't. If you're looking for studies that state A causes B then you are being naive. Studies that that make such clear cut claims are the most unreliable of all. Scientific evidence is rarely so clear cut. The most that somebody could ever claim is that toxin X in very large quantities can be a rare cause of disease Z. You not surprisingly dodged the question regarding your motivations. General Tojo

My motivations are an interest in elucidating the causes of the disease, something that is a necessary precedent to prevention. You dodged the question about your passionate outcry about RCTs of toxins. If you're interested in possible toxic causes, you might take a look at Walter Rocca's and Alberto Ascherio's very recent contributions. --Dan 17:05, 28 June 2006 (UTC)

What's RCT? I went through ALL published studies on toxicity and Parkinson's Disease - over 2000 of them. I analysed and organised them all. There is nothing left for me to look at. What I have written concerning it is the most comprehensive summary bar none. You have yet to be able to rebut a single part of it. General Tojo

Yawn. Don't feed the troll. --PaulWicks 17:44, 28 June 2006 (UTC)

You're the troll Wicksy. I've seen your photograph on the Internet. You look a complete wimp. I am far bigger than you emotionally, intellectually and physically. How about you meet me face to face to see how ready you'd be to run me down to my face ? If you don't take up my invitation you will prove yourslef to be the complete COWARD that you are. You're just another keyboard coward that the Internet unfortunately breeds. Too frightened to say anything to anyone's face you only say it from a distance. I know exactly where you are and what you look like. I am quite near to you. How about I turn up unnannounced and ask you to repeat what you write to my face. We'd then see what a pathetic COWARD you are. You're only a fresh out of college student who has already proven what a complete novice he is with the complete garbage you write. General Tojo

I know, I know, but I sometimes can't resist. Anyway, this might be useful to others. An RCT, my highly informed expert, is a Randomized Clinical Trial. A comprehensive summary of current knowledge would be here: or here: and a website indicating current questions is here: . --Dan 17:51, 28 June 2006 (UTC)

Don't you mean a RPCCT or a DBPCCT ? Nobody I know uses "RCT", they just say the type of trial they mean.

Is that really the level of your knowledge - a couple of crappy text books and a useless web site. They don't cover even more than the basics of toxicity. I have read over 80 books on Parkinson's Disease. That makes it 80 against your 2 my "highly informed expert". Even then I wouldn't rely on them at all when I can go directly to Pubmed for a comprehensive assessment which is what I did.

So far, evidence in favour of the toxins - a complete assessment of the entire scientific literature. Evidence against - none whatsoevere. Despite repeated requests you haven't been able to come up with anything.

General Tojo

RCT is standard terminology. I'm not familiar with RPCCT or DBPCCT. Andrew73 18:15, 28 June 2006 (UTC)

The lesson to learn is don't use abbreviations. Otherwise a couple of CW's who think they're WE's won't have a FC what you're talking about. General Tojo.

American Academy of Neurology

Recently a colleague coincidentally emailed me an article from Neurology about PD. It was one of four reports on Parkinson's disease this year by the Quality Standards Subcommittee of the American Academy of Neurology. They were made through systematic review of the current literature by a committee of movement disorder specialists and general neurologists.

See Neurology 66(7):966-1002 ... it's free to download at http://www.neurology.org/content/vol66/issue7/

Anyway, I think the 4 articles outline quite well the important questions and the answers currently known regarding diagnosis and treatment of PD, so I'm copying the conclusions from their abstracts:

"Diagnosis and prognosis of new onset Parkinson disease" (Neurology 66:968-975)

1. Early falls, poor response to levodopa, symmetry of motor manifestations, lack of tremor, and early autonomic dysfunction are probably useful in distinguishing other parkinsonian syndromes from Parkinson disease (PD).

2. Levodopa or apomorphine challenge and olfactory testing are probably useful in distinguishing PD from other parkinsonian syndromes.

3. Predictive factors for faster disease progression (more rapid motor progression, nursing home placement, and shorter survival time) include older age at onset of PD, associated comorbidities, presentation with rigidity and bradykinesia, and decreased dopamine responsiveness.

"Neuroprotective strategies and alternative therapies for Parkinson disease" (Neurology 66:976-982)

1. Levodopa does not appear to accelerate disease progression.

2. No treatment has been shown to be neuroprotective.

3. There is no evidence that vitamin or food additives can improve motor function in PD.

4. Exercise may be helpful in improving motor function.

5. Speech therapy may be helpful in improving speech volume.

6. No manual therapy has been shown to be helpful in the treatment of motor symptoms, although studies in this area are limited.

"Treatment of Parkinson disease with motor fluctuations and dyskinesia" (Neurology 66:983-995)

1. Entacapone and rasagiline should be offered to reduce off time (Level A). Pergolide, pramipexole, ropinirole, and tolcapone should be considered to reduce off time (Level B). Apomorphine, cabergoline, and selegiline may be considered to reduce off time (Level C).

2. The available evidence does not establish superiority of one medicine over another in reducing off time (Level B). Sustained release carbidopa/levodopa and bromocriptine may be disregarded to reduce off time (Level C).

3. Amantadine may be considered to reduce dyskinesia (Level C).

4. Deep brain stimulation of the subthalamic nucleus (STN) may be considered to improve motor function and reduce off time, dyskinesia, and medication usage (Level C). There is insufficient evidence to support or refute the efficacy of deep brain stimulation (DBS) of the globus pallidus interna (GPi) or ventral intermediate (VIM) nucleus of the thalamus in reducing off time, dyskinesia, or medication usage, or to improve motor function.

5. Preoperative response to levodopa predicts better outcome after DBS of the STN (Level B).

"Evaluation and treatment of depression, psychosis, and dementia in Parkinson disease" (Neurology 66:996-1002)

Screening tools are available for depression and dementia in patients with PD, but more specific validated tools are needed. There are no widely used, validated tools for psychosis screening in Parkinson disease (PD).

The Beck Depression Inventory-I, Hamilton Depression Rating Scale, and Montgomery Asberg Depression Rating Scale should be considered to screen for depression in PD (Level B). The Mini-Mental State Examination and the Cambridge Cognitive Examination should be considered to screen for dementia in PD (Level B).

Amitriptyline may be considered to treat depression in PD without dementia (Level C).

Cholinesterase inhibitors are effective treatments for dementia in PD, but improvement is modest and motor side effects may occur.

For psychosis in PD, clozapine should be considered (Level B), quetiapine may be considered (Level C), but olanzapine should not be considered (Level B).

Hope that's of interest (despite the length). I think it may help with cleaning up the PD article. --GeekPhilosopher 03:09, 29 June 2006 (UTC)

The above merely constitutes opinion. It is not scientific evidence. --Mestre 13:32, 29 June 2006 (UTC)

Very nice; thank you. To my mind, we need a good study of the incidence of dementia in PD patients compared with general population of that age. I put in a proposal to the feds a coupla years back to do that, and included stuff about developing a dementia instrument specific to PD. The reviewers thought we were biting off too much. I should go back in on that, though - I think it still hasn't been done, and I have the credibility in the field. What do you guys think? The underlying alternate hypothesis is that dementia is diagnosed more often in PD patients because they're seen more often by docs and because docs are keyed to look for it. --Dan 04:31, 29 June 2006 (UTC)

Stalevo photograph

The site is already well over the size limitation. Photographs take up a lot of file memory. The photograph serves no practical purpose, as everyone knows what tablets look like. It is also plainly tablets of Stalevo, a clearly commercial and recently introduced make that is currently undergoing sales campaigns.--Zamalek 15:53, 30 June 2006 (UTC)

I am concerned that Zamalek may be a sockpuppet of GT. --PaulWicks 17:38, 30 June 2006 (UTC)

Propose putting up pictures of Dopavite and see how he reacts ;-) --Dan 18:32, 30 June 2006 (UTC)

In addition to Zamalek, Atterton and Brockwell may be sock puppets as well. Have a look at the edits of Alzheimer's disease. Andrew73 21:12, 30 June 2006 (UTC)

You're right - look at this wording on an edit " (Averages are very misleading because they differ enormously in different countries)" - that's Bridgeman. --Dan 21:43, 30 June 2006 (UTC)

To straighten this out, I've put in an additional request for checkuser . Andrew73

Ahem. http://en.wikipedia.org/Wikipedia:Long_term_abuse#Unique_entities ? --PaulWicks 22:29, 30 June 2006 (UTC)

User Oxford Don is clearly Bridgeman - I look for him to show up as NobelLaureate soon --Dan 14:33, 1 July 2006 (UTC)

Only a Nobel Laureate ? That's beneath me! --God Allmighty 14:22, 2 July 2006 (UTC)

I am glad to see that God is here Himself to help out with this article! Andrew73 14:25, 2 July 2006 (UTC)

Even God doesn't know as much as me about Parkinson's Disease, even though he invented it !--General Tojo !!!! 14:33, 2 July 2006 (UTC)

And it looks like Dr June is a friend or Bridgeman himself. Let's get that main page semi-protected again, please, we're being vandalized. --Dan 15:08, 1 July 2006 (UTC)

There have been additional sock puppets confirmed by CheckUser. Of course, I don't have the authority to block them! Andrew73 16:41, 1 July 2006 (UTC)

Blocked them, not yet including the latest unconfirmed batch. -- Chris 73 | Talk 18:40, 1 July 2006 (UTC)

Also blocked the last two. -- Chris 73 | Talk 18:49, 1 July 2006 (UTC)

People?

Some of the other common disease have lists of afflicted famous people, such as List_of_people_with_multiple_sclerosis. Would it be worth consideration for this page set as well? Bdelisle 00:38, 4 July 2006 (UTC)

Yes. A lot of people with Parkinson's Disease are interested in who else has had the disorder. Such a list was already on the page. It was removed during vandalism by Profsnow, but has just been replaced. --Bio Doc 22:27, 4 July 2006 (UTC)

Bridegman, recheck the edit history. I did not remove the famous people list. --Dan 15:57, 5 July 2006 (UTC)

Hey Tojo, long time no see. Guess what, you're blocked. JFW | T@lk 22:32, 4 July 2006 (UTC)

Added section again (removed here by a liar) -- Chris 73 | Talk

Get your facts right. Check the incidence section of the version I have always maintained. The link to famous people has always been there. - http://en.wikipedia.org/search/?title=Parkinson%27s_disease&oldid=62197411

In fact the culprit was Paul Wicks. Compare 17.39 20 June 2006 70.22.186.101 with 17.52 20 June 2006 Paul Wicks. he doesn't care what he decimates.

General Tojo

While we're at it, I also restored the "see also" section. This one, however, may need some population. -- Chris 73 | Talk 16:27, 5 July 2006 (UTC)

They are now at Category:Parkinson's disease sufferers which incorporates people said to have died from it, or complications around it- Kittybrewster 22:33, 9 July 2006 (UTC)

Compliments

... to all editors who manage to improve this article in the face of numerous Tojo socks. JFW | T@lk 08:47, 9 July 2006 (UTC)

Toxins

Just to clarify, my understanding is that reactions to toxins like cyanide produce an acute onset syndrome resembling Parkinson's disease. But they do not produce Parkinson's. Is that correct? So should these toxins be listed under Parkinsonism rather than Parkinson's disease? --PaulWicks 17:31, 10 July 2006 (UTC) http://www.postgradmed.com/issues/1999/07_99/conley.htm

Agreed. I tried clarifying that with a sentence in the beginning, but perhaps this needs to be stated more explicitly. Andrew73 17:40, 10 July 2006 (UTC)

Cyanide can cause Parkinson's Disease symptoms although the mechanism has not been fully proven. Cyanide is also a toxin. Therefore, cyanide is a (rare) toxic cause of Parkinson's Disease. Whether it is described as a rare type of Parkinson's Disease or a type of Parkinsonism depends on the precise definitions of Parkinson's Disease and Parkinsonism. There are many different definitions of both, most of which are inadequate, and don't matter anyway. "Parkinson plus disorders" don't mean anything of any practical use. The practical significance of knowing potential toxic causes or types of Parkinsonism is that they not be confused with idiopathic Parkinson's Disease so that they can be treated appropriately. With Toxic causes, the primary act must be to avoid the cause of the toxicity. However, varieties of Parkinsonism must be treated by entirely different means. --DiamondPlus 17:51, 10 July 2006 (UTC)

The distinction I've seen made clinically is this;

• Parkinsonism is a syndrome of symptoms resembling idiopathic PD which usually does not usually respond to DA treatment such as sinemet or DA agonists. It can be caused by brain damage, vascular infarcts, and toxins. Sometimes it is progressive, sometimes not. In the case of toxicity, it may be reversible following removal of the toxin. The most obvious case I have heard of is poisoning by antipsychotic medication leading to an acute but reversible parkinsonism. Other toxic causes may be irreversible.
• Parkinson's disease is progressive and responds to dopamine therapy and is the main clinical syndrome we all know and love.
• Parkinson's Plus refers to PSP and MSA which are important to identify for the reason that they can be more aggressive and in the case of PSP have greater ocular and cognitive involvement. --PaulWicks 19:04, 10 July 2006 (UTC)

Parkinson Plus is clinically highly relevant, e.g. when there is a need to treat autonomic phenomena in MSA with autonomic features (formerly Shy-Drager). Toxins are certainly relevant, and if there has been rapid clinical deterioration a clinician may suspect carbon monoxide poisoning. Other toxicities are not generally suspected unless there are obvious clues (e.g. plethora and/or polycythemia in chronic HbCO). This is one of the reasons why in the UK the diagnosis of PD is now left to neurologists rather than general physicians. JFW | T@lk 20:38, 10 July 2006 (UTC)

Toxins and copper

Perhaps a separate section should be created that more explicitly states toxins that may lead to parkinsonism v. Parkinson's disease.

In addition, as far as I'm aware, copper toxicity isn't necessarily a classic cause of parkinsonism. The pathophysiology behind Wilson's disease and Parkinson's disease is quite distinct, and a clear distinction can be made between the two diagnostically. In adddition, the copper toxicity in Wilson's disease is different than excess occupational exposure to copper, so this should be stated more clearly. Andrew73 11:38, 11 July 2006 (UTC)

Excess copper can cause the formation of a copper-dopamine complex, which leads to the oxidation of dopamine to aminochrome. So it interferes with the action of dopamine. Whether this is due to Wilson's Disease in which there is an abnormal accumulation of copper, or whether copper levels have been raised by consuming toxic levels of copper the mechanism is the same.

Whether either or both of these are forms of Parkinson's Disease or Parkinsonism is a fairly academic question. Toxic causes of Parkinson's Disease are all effectively forms of Parkinsonism. The only difference between types of Parkinsonism and toxic causes of Parkinson's Disease is that toxic causes are due to an externally derived toxin rather than an innate biochemical or physical fault. None of them are anything more than rare causes of Parkinson's Disease symptoms. The term "Parkinson plus" is not a good one, because they are not Parkinson's Disease plus something else. They are only the something else.

General T***

DBS photographs

The Parkinson's Disease page is already well over size. When possible, information should be on other Misplaced Pages pages or on external links. Exactly the same DBS photographs are already produced on the DBS page and there is already a link under surgery to the DBS page. It isonly a click away. So the photographs provide no new information. For those people with no interest in having DBS, the picture wil be of no use. For those people with an interest in DBS they will want to see far more than just one picture. The DBS link provides them with that information and exactly the same picture. General T***

Agreed, though I think one picture does spruce up the article a little bit (even if it's exactly the same on the DBS article). Andrew73 15:42, 11 July 2006 (UTC)

If you just want a bit of decoration why not Titian or Tintoretto ? They'd look a lot better than gruesome pictures of some poor soul having a hole drilled in his head. General Tojo

Some ideas for parts that could be split off into new pages

Just ideas to cut down on article size and varying levels of detail, let's discuss before doing anything.

• http://en.wikipedia.org/Parkinson%27s_disease#Symptoms - These could be summarised more briefly on the PD page with the main articles being Motor symptoms of Parkinson's disease and Non-motor symptoms of Parkinson's disease which would allow more space for explanation

• http://en.wikipedia.org/Parkinson%27s_disease#Pathology - The level of detail here might be too much for the overview article. Suggest creating new article for full biochemistry.

• http://en.wikipedia.org/Parkinson%27s_disease#Toxins - A version of this that cited original references could be useful.

Interested in views. --PaulWicks 17:01, 11 July 2006 (UTC)

p.s. Updated the drugs table above. We could if we wanted to split off another page for that as suggested a while back by JFDWolff, copied below. --PaulWicks 17:15, 11 July 2006 (UTC)

This is a useful way of presenting this information, especially if reliable sources are brought. Alternatively, we can start by simply presenting basic treatment algorhythms and leave in-depth comparison between the drugs for a separate page, such as antiparkinsonistic drug (compare anti-diabetic drug). JFW | T@lk 10:58, 23 June 2006 (UTC)

There are three obviously bulky sections : symptoms, toxins, biochemistry. The Parkinsonism section is also a bit excessive.

Symptoms - The primary symptoms could be summarised in a paragraph on the Parkinson's Disease page. The symptoms could then be linked and removed in their entirety to a new Misplaced Pages page "Symptoms of Parkinson's Disease" where they could then be worked on and tidied up independently.

Toxins - The toxins could be summarised in a few lines and linked to a comprehensive source of information. A separate page on Misplaced Pages for toxic causes has already been rejected. Due to copyright restrictions, such a page would have been limited anyway. Like it or not, by far the most comprehensive source of information concerning toxic causes of Parkinson's Disease is presently on the Parkinson's Disease Forum. I am presently preparing the removal of that information to a stand alone web site devoted to toxic causes of Parkinson's Disease. A few line summary (instead of the present twelve paragraphs), on the Parkinson's Disease page, with one link (instead of the previous 12) would mean a major reduction in size of the PD article. For example, "Some toxins have been shown or indiacted to cause symtoms of Parkinson's Disease. These include cyanide, copper, paraquat, ............. carbon disulfide. For details and references see Link."

Biochemistry - The same could be done with PD biochemistry, although it might require a paragraph rather than a few lines for the summary. This would greatly also reduce the size of the PD page.

Parkinsonism - There should only be at most a line for each disorder. Discussion and detail should either be on separate Misplaced Pages pages or more practically be linked to extenral sites specific for each those disorders. For example, Essential Tremor : a dsiorder in which tremor is the only apparent symptom

--DiamondPlus 17:41, 11 July 2006 (UTC)

Rather than linking to an external website, the information should be self-contained within Misplaced Pages (isn't that the whole point of Misplaced Pages!), with references to the published literature. This would be most in the spirit of Misplaced Pages and be comparable to other articles in Misplaced Pages on medical topics. Andrew73 17:53, 11 July 2006 (UTC)

Misplaced Pages should aim at providing the best information by whichever means that is. The fact that there are hundreds of thousands of links on Misplaced Pages is evidence of the fact that it not just a source of information. It is an organised source of links to further information. Most of the information provided by Misplaced Pages is by links. Symptoms can ceratinly be produced as a separte article linked to the main PD page, although it does need some organising and tidying up when it gets there. Separate articles exist on Misplaced Pages on only some of the Parkinsonism disorders. So a link to those pages with some disorders and external sites for some other disorders is presently the most practical means of linking to what exists. A proposed "toxic causes" page on Misplaced Pages has already been rejected by the Administrators, so it is not even an option. It could also not have made use of all the information available without there being a copyright violation."--DiamondPlus 18:08, 11 July 2006 (UTC)

Administrators have no power over content. What you need to split off toxic causes of Parkinson's disease is consensus here on the talkpage. But it needs to be accurate, sourced and original.

Misplaced Pages is not a source of links to further information. There's web directories for that. It is an encyclopedia, condensing all available knowledge into accessible articles. For that purpose it uses references but never "for more information look at this or that website". JFW | T@lk 07:10, 12 July 2006 (UTC)

Rotenone

I wasn't sure why the link to the experimental model of rotenone toxicity was deleted, so I restored the text. The speculation here is grounded in a published article, so I think it's worthwhile including the reference. Andrew73 02:50, 12 July 2006 (UTC)

External links

Is there a guideline on what order to put external links in? It's a bit higgledypiggledy. First it's GT's forum, then one for Europe, then Canada... Alphabetical? By size of organisation? --PaulWicks 07:27, 12 July 2006 (UTC)

Differential

I removed this list of differential diagnoses:

Diseases that are in the differential for Parkinson's disease include:

• Cerebellar thoracic outlet syndrome
• Antiphospholipid syndrome
• Vascular parkinsonism
• Encephalitis lethargica
• Hydrocephalus
• Essential tremor
• Wilson's disease

It is unreferenced, it has come from nowhere, and doesn't explain the relationship. Antiphospholipid syndrome is not associated with any extrapyramidal phenomena in the vast majority of cases. Essential tremor is usually ruled out early-on on clinical grounds. Wilson's disease should be mentioned, but not in such a random fashion (young PD patients should have copper studies, though).

Can we get a list from a reliable medical textbook, instead of someone's personal preferences? JFW | T@lk 07:33, 12 July 2006 (UTC)

All of the above are well known to cause symptoms some of which can coincide with those of Parkinson's Disease. A link was previously provided to the Parkinsonism page of the The Parkinson's Disease Forum. They are also linked to pages on Misplaced Pages where more information is given. So if somebody wants to expand on this section with additional brief inormation for each disorder the links and information are available for them to do this.

I agree with JFW that a laundry list of diseases that may resemble Parkinson's disease is not necessarily that useful (e.g. echoing again antiphospholipid antibody syndrome, which is quite distinct diagnostically and clinically). Andrew73 12:13, 12 July 2006 (UTC)

All of those medical disorders are distinct, but some of their symptoms can coincide with those of Parkinson's Disease, including Antiphospholipid Syndrome : Movement Disorders Mar 14 (Martino D, Chew NK, Mir P, Edwards MJ, Quinn NP, Bhatia KP.) Atypical movement disorders in antiphospholipid syndrome. There is a very practical purpose in listing disorders whose symptoms can coincide : to avoid wrong diagnosis, and in Parkinson's Disease clinical trials to ensure the exclusion of those people with these medical disorders. Can people confuse these disorders with PD. They certainly do. I know people personally that have been wrongly diagnosed with PD and treated for it, when they actually had one of these disorders, and this was by neurologists. Given that 25% of people with PD turn out not to have it, it is very important that people are aware of what else could cause the same symptoms. Most people, even neurologists are very ignorant of the range of medical disorders whose symptoms coincide with PD. --DiamondPlus 12:49, 12 July 2006 (UTC)

I just read the article describing three patients with movement disorders. All of these patients underwent intensive investigation, since their symptoms were more than just parkinsonism (apraxia, etc.). It doesn't seem like these patients were given a primary diagnosis of Parkinson's disease, the concern that you raised. It seems a bit of an overcall then to include APA in the differential. Andrew73 12:58, 12 July 2006 (UTC)

A woman recently contacted me about her Parkinson's Disease. However, it soon became obvious that she didn't have Parkinson's Disease. She had no rigidity, no slowing or loss of movement - only jaw tremor. She had Essential Tremor due to an excess of synthetic thyroid hormones. Had this not been pointed out she could have been wrongly treated for Parkinson's Disease for the rest of her life. Misdiagnosis is a serious problem that comes about because of ignorance. Out of the listed medical disorders, some will inevitably be more significant than others, with Essential Tremor being a serious potential problem at the top of the list, and Antiphospholipid Syndrome being the least significant. However, it serves no purpose having a cut off point. Rather than eliminating all these disorders, a line or two clarifying their relevance to Parkinson's Disease would be an improvement. --DiamondPlus 13:51, 12 July 2006 (UTC)

Parkinson sufferer photograph

This photograph is not informative. In fact in this resoect it is really misinformative. It is a stereotypical depiction of somebody with Parkinson's Disease that resembles few people. The old stooping man with a hand tremor is how I used to think of PD when I knew nothing about it. There are 11 year olds with PD. There are very nice looking 30 year old women with women with PD. There are old people with PD that do not stoop and that don't have any tremor. The PD Society once put out a large advert with dozensof people in a pub. There were people in their 20's, 30's, 40's, 50's, 60's, 70's. They were all enjoying themselves, laughing and talking except for one stoney faced old man sitting in a wheelchair. It asked, which of these people has Parkinson's Disease ? The answer most people gave was the old man - the stereotypical view of Parkinson's Disease. In fact the actual answer was all of them ! GT

The point of the figure is to be stereotypical to illustrate some of the hallmarks of late stage Parkinson's disease for instructional purposes. I don't think people would automatically make the conclusion that you have to look like this to have Parkinson's disease. It may be specific, but not sensitive. Nevertheless, for historical purposes, it's worth including in the article. Andrew73 12:11, 12 July 2006 (UTC)

Reminds me of the stereotypical pictures of Jews that the Nazis used to publish in the 1930's. "The point of the figure is to be stereotypical to illustrate some of the hallmarks of late stage Parkinson's disease for instructional purposes." - It doesn't depict any symptom except stooping. You can't see tremor in that picture (unless you shake the picture from side to side !). You can't see lack of movement as nobody moves in a picture. The Nazi pictures are historical. See the reaction on the Jewish pages if you suggest putting the Nazis stereotypical pictures of Jews. It could indicate what Judaism is like in late stages. I don't think so. People need to be informed as to what PD isreally like, not provided with pointless stereotypical pictures. --DiamondPlus 12:55, 12 July 2006 (UTC)

I thought of the Nazi figures as well as a counter argument. However, the difference here is that the Nazi figures were for propaganda purposes. I don't think an academic illustration by Sir Gowers is directly comparable. Andrew73 13:00, 12 July 2006 (UTC)

The picture certainly isn't propaganda, but it is equally mirepresentitive. Most people know little about Parkinson's Disease, and so are easily led in to what they believe it to be. A drawing, being only 2 dimensional can not possibly depict tremor, bradykinesia, akinesia and rigidity anyway. So it doesn't serve a beneficial purpose, yet is unintentionally misinformative. Being genuinely informative would be to provide links under the symptoms sections to some of the numerous video sites that show what PD symptoms are like. --DiamondPlus 13:40, 12 July 2006 (UTC)

The point in my eyes was to illustrate the point that PD has been known about for some time by Charcot-era neurologists, and in the absence of pathophysiology, neuroimaging, and dopamine response, how else are we to know that what they witnessed really was PD? By their clinical descriptions which often included illustrations. Therefore the picture is of use.

I think this and some of the issues raised above are all about the same issue here: the target audience, their motivation for coming to this page, and the level of knowledge we can assume they have to start with. Your point about PD being heterogeneous is well-taken; I saw a video today of someone who'd had it since age 17. But why do people come to an encyclopedia? To learn about the horses, not the zebras. --PaulWicks 14:02, 12 July 2006 (UTC)

The picture simply does not depict Parkinson's Disease. Tremor can not be seen in a 2D image. Neither can slowness or loss of movement because there is no mevement in the picture. It is simply a stooping man. He doesn't resemble any of the hundreds of people I know with Parkinson's Disease. Why should a stereotypical depiction that does not actually depict Parkinson's Disease be better than links to videos (with moving pictures) of what PD is actaually like ? On a page about horses, people want to know about horses not zebras. However, which horses are we taling about, tiny Shetland ponies, Apache war horses, Massive Carthorses, Mustangs. By depicting what horses are like by only showing them a picture of The Kentucky Derby winner is very misleading. People with Parkinson's Disease vary even more than that. --DiamondPlus 14:27, 12 July 2006 (UTC)

Two things: 1: Please watch WP:3RR! 2: Can the description under the picture be modified to be more precise, in order to avoid reverts? -- Chris 73 | Talk 15:03, 12 July 2006 (UTC)

re Image - it shows a classic form that any doctor should recognise as a "spot diagnosis". Yes I quite agree a severe advance late-stage form but this illustrates the "classic" appearance of the disease as it actually would be untreated and in the form that the pioniers of early neurology saw, described, wrote about and started the search for effective treatments. Of course a mild case may show no features, and likewise a severe case that is well treated may also look like a normal person.

Take a wider look at images other editors feel appropriate to illustrate this encyclopedia - asthma uses not a totally well person, but a child about to use their inhaller (a image any family member or school friend might see), demolition is not used as an advertisement about how neat and tidy modern demolition firms are at clearing up after themselves, polio shows not an apparently non-disabled person but Franklin D. Roosevelt in a wheelchair, Hemodialysis shows not a person enjoying life at home & work but complex machines, grusome venous/arterial access diagrams and a patient attached to a machine.

I would have no problem with re-captioning the picture, but does it currently include the drawings "official title" ? - if so then enclose this in quotes and add clarrification of being an untreated severe late-stage case.... David Ruben 15:17, 12 July 2006 (UTC)

People using this depiction as a spot diagnosis is a very good reason for not using the picture. Thisispurely no more than a misrepresentive stereotypical view. They shopuld not be using the notion of people with PD being like this as being what Parkinson's Disease is like. 25% of people with PD being misdiagnosed is hard evdience as to the ignorance amongst many of the medical profession as to what Parkinson's Disease looks like. The picture only shows a stooped postured man - no tremor, no akinesia, no bradykinesia - all of which would not be possible in a picture anyway. It consequently doesn't depict even severe Parkinson's Disease, let alone mild or severe. The severest of those with PD can not even walk as the man in the picture appears to. Because some people previously depicted PD in this way does not make them right. Some cartographers previously depicted the world without America existing. Were they right as well ? Why isiseven being proposed that this entirely is representive picture is better than links to videos of what PD is really like ?--DiamondPlus 15:28, 12 July 2006 (UTC)

The picture isn't meant to be 100% accurate but more of a demonstration of a historical viewpoint of Parkinson's disease. Do you have an alternative picture in mind then? Andrew73 15:40, 12 July 2006 (UTC)

DiamondPlus, please stop using bold posts - it is equivalent of "shouting" and no editor should appear to be trying to have greater say/clout than any other.

As previously stated this is a printed image that our medical predicessors would have recognised and as such seems a respectful nod to the history of the condition. PD's identification and careful description remains the core of how generalists and neurology specialists continue to diagnose the condition (sure we now have advanced imaging, but the potential diagnosis must still first be made). As for moving images, wikipedia should largely be a self-contained body of knowledge and not rely on outside sources to fill a gap (rather to verify facts and pointer to a depth of info beyond a general encyclopedia). As far as I am aware, wikipedia does not generally include moving images (?even has the format) and, in the past, no textbook would ever show movement in a still image, and indeed nor will the eventual planned Misplaced Pages 1.0 in hardcopy form (if/when ever produced).

Misplaced Pages is a consensus work, so perhaps leave topic open for others to offer their opinion. I would suggest allowing a few days to see how many voice an opinion/comment, but if a poor response perhaps we can raise a wider Misplaced Pages:Requests for comment ? David Ruben 15:53, 12 July 2006 (UTC)

Here is a video site that is far far better than that misinformative stereotypical picture : http://pwnkle.com/champion.htm The first part of the video shows people with PD talking about it. The second part shows an examination of each of the symptoms in a way that an aged drawing never could. There are other video sites besides this that do actually depict tremor, rigidity, akinesia and in a variety of people rather than a stereotypical person. --DiamondPlus 16:33, 12 July 2006 (UTC)

1. Bold font is entirely within Wikpedia guidelines. It is a matter of personal choice. It is not up to you what font other people use. It is not the equivalent of shouting. Nobody has ever given any rational explanation as to how it could be. Any objection to it is entirely irrational. If I wrote to somebody "I hope you enjoy your day" would that be more aggressive than "Shut your f****** mouth !!!" solely because it is in bold font ?

2. "Giving a respectful nod to history" does not really mean anything and is not the purpose of the PD page. It is a very inferior way of viewing PD that has led to a lot of people's lives being messed up because they were misdiagnosed by people that did not know how to recognise it.

3. "Misplaced Pages should be self contained". - but (1) it certainly isn't as it has hundredes of thousands of links to other information, and (2)the picture is itself from outside sources - Misplaced Pages didn't produce it.

4. "Misplaced Pages is a consensus work, so perhaps leave topic open for others to offer their opinion." Nobody is restricted in giving their opinion. Facts are not a matter of consensus anyway. If two people on Misplaced Pages claim that George W.Bush is Bulgarian and one person disagree does that make him Bulgarian. If people maintain view despite their reasons not having any logic or factual basis then it brings in to question why they are maintaining such a view. The reasons so far given for using a stereotypical and misleading depiction of Parkinson's Disease simply don't stand up to any scrutiny. Rather than educating, it is perpetuating ignorance and stereotypes. I know plenty of people with PD that would find it offensive for them to be wrongly depicted in this way. --DiamondPlus 16:33, 12 July 2006 (UTC)

Bold font is annoying. Do you want to be annoying?

The Gowers picture is representative of classical, several Parkinson's. The caption states clearly that this is historical and the article states clearly that PD can be treated. Are you suggesting PD is "no big deal"?

Again, outside sources are primarily for reference, and occasionally as a source of further information. The picture is illustrative.

You are mischaracterising consensus. Occasionally one editor finds himself disagreeing with a large number of opponents. That doesn't mean there is no consensus. Biological psychiatry recently had that problem. It required the Arbitriation Committee. I'm getting annoyed with your statements that other editors are ignorant etc. And the opinion of PD patients themselves is not actually a guiding force in writing an encyclopedic monograph about PD - many adherents of George W. Bush would disagree with his article on Misplaced Pages. That does not diminish from the encyclopedic value of the article. JFW | T@lk 17:19, 12 July 2006 (UTC)

1. People telling others what they can or cannot do when they have neither right nor rationale is annoying. Do you want to be annoying ?

2. The picture is not a depiction of classical severe PD. It is a classical depiction of severe PD that completely fails to represent it as it does not even depict the main symptoms and does it using a stereotypical and unrepresentitive patient.

3.Are you suggesting PD is "no big deal"? - Given that I have spent far more time on Parkinson's Disease than everyone here put together is that a deliberately rude question ? On what basis do you ask it because you ceratinly haven't given any.

4. "I'm getting annoyed with your statements that other editors are ignorant etc." It's hard to respond to "etc". In fact it's hard to respond to any alleagtion when somebody has completely failed as you have done to substantiate it.

5. "You are mischaracterising consensus." - but I haven't even defined it.

6. "It doesn't matter what the patients think" !!! - I value the patients far more than you. It is them that have to put up with it.

I have yet to see even one rationale for using this stereotypical and wholly uninformative picture. The reasons when criticised and dropped and then replaced by other reasons that are even more vague and inconsistent. When reasons have run out altogether, as often happens the frustrated forget any valid reasoning and instead start initiating petty or deceitful personal attacks : "I don't like your font", "You think that PD is nothing", "I don't like your views of other people". It seems that some people don't care if they are right - they solely want to feel that they are right.

--DiamondPlus 17:42, 12 July 2006 (UTC)

The use of a normal font is just standard operating procedure in Misplaced Pages. Why should your comments on visual terms stand out more than anyone else's?

The rationale for using the figure is as per above: 1. historical interest, 2. some (okay not all) of the classical findings, the hands depicted as if they are doing a pill rolling tremor. Of course, the figure could be improved. Andrew73 17:59, 12 July 2006 (UTC)

What I do is up to me. What you do is up to you. If you want what you write to stand out more then use bold font. What I write stands out because it is right - not because of the font I use.

Rationale ? There still isn't any. 1. Historical interest - firstly it's not interesting, and secondly it solely shows what an inadequate view of Parkinson's Disease they had, and what a misleading and stereotypical view it still perpetuates. 2. It is very obvious that it does not depict any tremor at all. Tremor involves repeated movement. You can not possibly depict repeated movement in one drawing. Not depicting all symptoms ??? It doesn't depict any symptoms at all except for stooping, which can occur due to other medical disorders. It doesnt depict tremor, akinesia, bradykinesi, rigidity, and it uses a stereotypical patient that is unrepresentitive of what people with PD are like. Check out the third person in the video link I gave you. That young woman has severe Parkinson's Disease. It's not all old men.

I was thinking of putting on the Jewish pages one of the Nazi's 1930's stereotypical depictions of what Jews are like. It's historical. It shows what Jews can be like at their extreme. It does depict some aspects of what being Jewish is like. Much the same arguementsthat are being used here, but do you think that picture would last more than 5 minutes ????

--DiamondPlus 18:23, 12 July 2006 (UTC)

Oh good.. Diamond / GT, can you not see that we are all bending over backwards to be accomodating here? The recent de-escalation of hostilities was I think welcomed by all parties and you have shown that you are capable of making useful edits that improve the quality of an article.

I always made useful edits. If you check the records, most of the PD pages originates from me. I have added more than everyone else put together. Hostilities were due to the intolerance of other people. Unjustified hostility ceased towards me only because it was obvious that I could not be beaten. I don't see anyone bending over backwards here. The reasoning simply doesn't stand up to any scrutiny. As each reason is shown to have no substance, another even weaker or even vaguer reason is substituted. I don't see any logic at all in the arguements. All I see are dogmatic attempts at trying to maintain viewpoints solely because they were the ones they started with. --DiamondPlus 19:07, 12 July 2006 (UTC)

However I also think characterising other editors as being unknowledgeable is not helpful. As a matter of fact I work for the only team in the UK recognised as a "Centre for Excellence", one of only 5 in Europe. The consultant I work with is one of the most respected clinicans in all of movement disorders, my line manager has been involved in psychological research of PD for some 20 years, and the head of my Neurology department is one of the most respected neurologists in the world. No, I am not an expert on PD. But they are. When I hear information at talks, meetings, etc. I try to put as much as I can up on Misplaced Pages, hence my recent expansion of the apomorphine article and the information I added on Rotenone. So whatever you think of me (and I do have a PhD whilst we're on the subject), I am doing everything I can to put the best information I have available up on Misplaced Pages. It is the manner of your participation more than your content which has earned you such a response.--PaulWicks 18:41, 12 July 2006 (UTC)

You describe them as a "Centre of Excellence" but I don't. I don't respect the people involved, as they are obviously not experts on Parkinson's Disease. How many people have they cured of Parkinson's Disease - absolutely none ! Repeat - absolutely none. Would you consider somebody an expert car mechanic if they had never in their life repaired a car ? Of coure not. Their knowledge of the biochemitsry of Parkinson's Disease you could put on the back of a matchbox. I've read all the PD books. I've met plenty of supposed "world experts". The only thing that impressed me was how shamefully ignorant they were, and how irrational their views were. PhD - totally unimpressed - doesn't mean anything. They give them out for research that is absolutely rubbish. 50 dollars on the Internet nowadays ! What annoys some people here is that I sometimes not only strongly disagree, but that I do it very impressively and in a way that they are unable to answer. --DiamondPlus 19:07, 12 July 2006 (UTC)