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Treatment for Parkinson Disease

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

I'm pretty sure its a parkinsonism just like you describe, not PD. Article? chuckiej 10:50, Oct 3, 2006 (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 been 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

To current editors - I think both Griffith & Davids are no longer editting this, however they raise an interesting point. Coupla years ago I did a bit of research & susbequently submitted a grant ptoposal (turned down, sob!) with a friend who's a psychometrician because we found that the accounts of dementia in PD were simply clinical observation, no comparisons. We thought, well for heavens sake!, people that age tend to get demented anyway. The question was (and still is) do people with PD get dementia at a different rate and in a different fashion than other people their age. We don't know, unless someone has answered the question since I last looked. --Dan 15:20, 15 July 2006 (UTC)

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)

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)

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)

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)

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:

Misplaced Pages:Article size Misplaced Pages: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)

• Parkinson's disease pathology
• Striatonigral degeneration
• Parkinson's disease mimics
• Non-motor symptoms of Parkinson's disease
• Motor symptoms of Parkinson's disease

And why take down the picture of Michael J Fox?

--PaulWicks 20:26, 20 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. (Misplaced Pages: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 Misplaced Pages: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)

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)

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)

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)

I really like teh succinctness of this table, teh article can discuss at greater length each treatment group, but as a quick aid this is well thoughtout. The risk is that too much info gets inserted over time - shorter is better. Also standardise/shorten method descriptions as 'COMT inhibitor: decreases dopamine metabolism' & 'MAOB inhibitor: decreases dopamine metabolism' and reverse word-order Levodopa method of action to 'Dpopamine precursor'. David Ruben 18:27, 15 July 2006 (UTC)

Cardinal symptoms

Paul, - 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)

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)

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)

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)

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)

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

An RCT 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)

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)

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)

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)

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)

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)

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)

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)

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)

On the subject, I noticed there is a mistake in spelling in a sentance in that part of the article. Rotenone is an insecticide that has the (poptential)... --Sonicos 20:47, 28 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)

You mean order at the bottom of the article? I think it simply goes by order of citation in the article; I could be mistaken...--Dan 15:25, 15 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)

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 cure for Parkinson's disease

1. Everyone who has a PhD has expertise in that subject ??? Be serious. He never said that - you're setting up a strawman. --Dan 22:25, 12 July 2006 (UTC)

Well then it's not a personal attack as you claimed when I point out that PhD's mean nothing. I assume you don't have one? The bare minimum qualification as a scientist? --PaulWicks 07:20, 13 July 2006 (UTC)

2. None of those people he referred to have ever cured anyone of Parkinson's Disease is a very relevant fact.

Have you ever cured anyone of PD? Last I heard it was an incurable disease. --Dan 22:25, 12 July 2006 (UTC)

I'd like to know of the cure for Parkinson's too! Andrew73 00:33, 13 July 2006 (UTC)

I have seen some people rid their symptoms altogether, and have seen many more continuously reduce their symptoms. That is why one of the largest and most prestigious hospitals in Britain is very enthusiastically arranging a full scale clinical trial to prove this formally and on a large scale. The methods Wimpys so called experts support could never cure anyone because they are so scientifically unsound from the outset.

Could you provide additional detail about this trial? Andrew73 00:33, 13 July 2006 (UTC)

Just because a trial is being discussed it doesn't mean it will happen. Even if it does it does not mean it will work. I've seen major hospitals do trials of quack substances before just out of curiosity. Also if there's money involved they'll do quite a lot of things.

I'm interested in the fact that when I use an appeal to authority (working at a large and prestigious hospital) you denigrate it, whereas when you're trying to persuade us, you want us to know that the trial is going on at another "of the largest and most prestigious hospitals in Britain". Or is it only institutions which you deem to be large and prestigious? --PaulWicks 07:20, 13 July 2006 (UTC)

3. Neurologists do not study biochemitsry. It is simply not part of a medical degree courses.

Actually, they do and it is. and in any case, so what? Biochemists don't study neurophysiology, so shouldn't be expounding on neurologic diseases. --Dan 22:25, 12 July 2006 (UTC)

Yup, all the neurologists I know are quite handy with their biochemistry actually. It sort of helps when you're prescribing drugs, but you've never done that.--PaulWicks 07:20, 13 July 2006 (UTC)

Actually, the formation of dopamine is studied in medical school, at least in the U.S. Andrew73 00:33, 13 July 2006 (UTC)

Likewise in UK David Ruben 00:37, 13 July 2006 (UTC)

I know it is at GKT. --PaulWicks 07:20, 13 July 2006 (UTC)

Thanks for the information. I'm not familiar with how clinical trials are done in the UK, but in the U.S. they're generally registered at http://clinicaltrials.gov/. Is there a similar reporting mechanism for this trial? I'm surprised that the full formulation has not yet been disclosed if it's already undergoing a clinical trial. Andrew73 12:15, 13 July 2006 (UTC)

Sorry Keith, I do apologise. I can see now where this has all sprung up from, it's a great misunderstanding.

I had incorrectly assumed that because you used the language of a scientist and spoke with such authority that you might actually be one. But if you don't have a PhD (even though I have three) then no wonder you're unable to work within the field (although I have all my adult life), publish peer-reviewed articles (although I've been published in seven languages in over 150 countries), obtain grant funding (even though I have), or collaborate with others (even though I am doing so continuously, and have done so for many years). We've all been addressing you as a fellow scientist (even though you're not one yourself) when in reality you are a layman (even though I'm not). I'm very sorry for the confusion this must have caused you, we will all endeavour to explain the way of the world in simpler terms from here on. --PaulWicks 14:02, 13 July 2006 (UTC)

So let me summarise then - there is no current available cure for Parkinson’s, but you are involved in a study that hopes to change this. Whilst I wish the study luck, there is therefore, as yet, no published peer-reviewed paper (WP:Reliable sources) to back up the current accepted wisdom that Parkinson’s is incurable - assertions to the contrary is, for now, just personal opinion/speculation and not acceptable under WP:NOR policy. If and when the study you are involved with is published, then medical knowledge will have advanced and wikipedia will I am sure reflect this (with suitable citations provided to verify).

Tyramine containing foods

I've included the comment about tyramine-containing foods being okay with MAO-B inhibitors in order to distinguish it from other MAO inhibitors that are used for depression, e.g. phenelzine. I imagine this is practically relevant information that should be kept in the article. (I'm not saying that tyramine-containing foods are a treatment for Parkinson's disease!) Andrew73 12:17, 13 July 2006 (UTC)

Incidence rates

True Parkinson's disease is global and Misplaced Pages is global. However, I think it's worthwhile to include the incidence rates, even if it's specific to one area. The information is factual and referenced. Instead of not including it at all, why not add information about incidence rates globally? Andrew73 18:33, 13 July 2006 (UTC)

Incidence and prevalence vary globally for many reasons, primary among them being diagnostic and ascertainment differences, with risk factor and true rate differences adding to that variation. Incidence rates are ascertained by counting all cases of disease arising in a defined population over a defined period of time. There are very few places in the world where that sort of study is practical Notice that I did include European studies. There are very few Asian PD epidemiologists, and those are mostly focused on risk factor epidemiology rather than descriptive epidemiology, although I have reviewed a prevalence study from Korea. The rates from northern California are solid because they come from a closed, well-defined population (Kaiser Permanente) with systematic surveillance mechanisms and excellent diagnostic standards (Dr. Caroline Tanner). --Dan 19:24, 13 July 2006 (UTC)

Incidence of 13.4 per 100,000 per year in California

Incidence of 186.8per 100,000 per year in Spain

Limited quoting of incidence rates is useful - either it highlights a need for the WP article to have a more rounded review of reported results added, or if there is a paucity of studies from which cite then that in itself is notable and should be commented upon. Likewise if there is great discrepency of reported incidence rates, this may indicate poor studies, different criteria for the studies (either diagnositic or inclusion criteria eg prospective or retrospective) or truely indicate that there might be genetic or environment variability. None of these suggest removing data just for being incomplete - WP after all specifically allows incomplete articles, namely stubs, which are tagged as such until they can be expanded into a full articles - no one goes about deleting stubs just for being incomplete. David Ruben 00:00, 14 July 2006 (UTC)

See, David, here's the thing. What you're really after with descriptive epi is etiological hypotheses. As you know, prevalence studies are limited in their value for that because they're too prone to bias. Incidence studies are sounder methodologically, but tougher to do (ie expensive) because you have to count all new cases in a defined population over time. And after you've done the study, what do you have? Well, some interesting rates and maybe some ideas on who gets more/less of the diease. But with Parkinson's, we think we've already got some pretty good ideas and what might be causing it, i.e. the farming chemicals, so why bother with the incidence studies - makes much more sense (and more likely to be funded) to jump right into the hypothesis testing studies, case-control design (if you're Karen Semchuk or Walter Rocca) or even cohort studies (if you're Alberto Ascherio and have access to the Nurses' Health Study). Which means the next section I oughta write up is the risk factor epidemiology section. I'm not convinced farming chemicals are going to be the big payoff everyone thought after Bill Langston found that MPTP outbreak back in what, 1986? I think there might be something else about farming. But we shall see. --Dan 14:44, 14 July 2006 (UTC)

Thanks for the points raised. My posting was mainly counter-arguement to DiamondPlus objecting to any such incidence info, if not a complete world-picture. You make some good points, but if "I'm not convinced farming chemicals are going to be the big payoff everyone thought " then perhaps "we think we've already got some pretty good ideas and what might be causing it" is not the case (hence a need appropriate studies). Even if hypothesis testing studies prove the cause, the cause might not be eliminatable: if it proved (for sake of discussion) due to nitrogenous toxins from meat-eating, then are people really going to fully stop eating meat (issues also of risks iron deficiency) - and I still would like to know the incidence rates (clearly 100% of meat eaters do not go on to get PD, if 10% risk it might affect my dietary habits, but at 0.1% I might decide to ignore the risk). Similarly incidence rates are useful in health planning. Leaving aside reduced incidence rates if the causative factors are identified and eliminated, if 2% of the current population have already been exposed to a causative factor and will inevitably now get PD at some point, then this will be a major health care service requirement, yet if incidence rates are just 0.1% then provision needs are relatively small compared to other diseases. Even if cause of PD is found and 100% prevention ensues, I would still like to know how much of a historical imposition this was to healthcare/social-services/individuals (in increasing importance) :-) David Ruben 15:39, 14 July 2006 (UTC)

Yup, good counter-points. Being an etiologic epidemiologist, the health services/public health impact tends to be something that occurs to me later rather than earlier, but of course for someplace like Nebraska, with a proportinally large old population, it's a serious matter. The town of Grand Island, for instance, in the late 90s underwent a boom in old people because some very nice supported living and nursing homes were built, drawing lots of people from the surrounding counties (nobody lives in those counties anyway), so of course the Nebrasks Parkinson's registry observed a rise in prevalence in Grand Island. At the same time, however, an obnoxious neurologist in north-eastern Nebraska steadfastly refuses to report his PD patients to the registry, so of course prevalence seems low there. --Dan 16:01, 14 July 2006 (UTC)

Risk Factor Epidemiology

A new section for the page, to go below "Descriptive Epidemiology". It would, I hope, help to answer some of the questions raised above, eg. "why aren't more descriptive studies being done?". One should perhaps call it "Analytic Epidemiology Studies", but that's a little too epidemiology-nerdy. So, try this for starters:

Introduction

Perception of a risk of Parkinson’s disease with rural exposures was not considered until the finding of acute Parkinson’s disease produced by a garage lab-made street narcotic in the early 80’s . Since MPTP resembles certain common herbicides (viz. paraquat), investigations of “rural” exposure or “well-water” use are a proxy for toxic chemicals. Since those initial descriptive studies we have moved from using the proxy exposure to see if the association exists to looking directly at the specific farm chemicals. Even more recently, lack of clear results from studies of pesticide exposure has led the PD research community to an interest in pesticide-gene interactions. There really is comparatively little work on rural exposures other than pesticides. Some of the other possibilities include diet; occupational chemicals other than pesticides - such things as heavy metals, sawdust, engine fumes, paints, and so on; zoonotic infectious agent exposures from farm animals. Farmers often have ample opportunity for exposure to all of these, and given that many farmers find it financially necessary to take supplementary jobs in the local area, they also have opportunity for more exposure to the types of industry, often quite dirty, commonly seen in rural areas. Tojo raised the question about sawdust, how could that be a risk factor - it seems unilkely, but of course farmers do their share of carpentry, and the sawdust generated includes not only wood components, but the chemicals the wood is often treated with for preservative and other reasons. Carpenters have been shown to have high rates of certain cancers, so sawing wood does pose health hazards.

and a bit of history

Early Observations

It's interesting that while PD in its later stages is readily noticeable and distinct, it was first described in detail by James Parkinson in 1817 , as the Industrial Revolution was gathering speed. A number of other neurologic conditions had been well described before that time. Therefore it might be that until Parkinson’s day the disease was very rare. Parkinson indeed noted conspicuous symptoms such as a gentleman who found it necessary to have a servant walk backwards in front of him to keep him from falling forward. It was not long following Parkinson that PD was noted to be among the more common illnesses seen in neurologic practice . Possibly some environmental exposure added significantly to the population risk of Parkinson’s Disease in the cities of the European Industrial Revolution. These may have now shifted to the rural areas as cities have become cleaner. This doesn't mean necessarily that the rural exposures are agriculturally related, but could be a result of some of the dirtier industries preferentially locating in more remote areas, whether to be near natural resources needed in that industry or to avoid the more restrictive regulatory environment of major cities.

Here's the early risk factor epidemiology, which was heavily influenced by Langston's findings, although at that time no animal model for PD existed.

Preliminary Descriptive and Ecologic Studies

Before the MPTP studies, a study in Finland relied upon the traditional two stage prevalence study design to examine descriptive epidemiology issues, but did not find a significant rural/urban difference, something they do not remark upon. While they did not regard this as a major concern, slightly later workers, in particular Ali Rajput cite the Langston work as a rationale for believing rural living to be a concern. Later workers followed Rajput’s lead in this.

Numerous case-control studies (Need a definition here?) report elevation of risk in rural areas , a few report elevated risk in urban areas , and there are reports of no association . Part of these differences are likely a result of geographic differences (comparing China versus Kansas, for instance), part due to methodologic problems, but part remains unexplained. Carlie Tanner suggests risk is associated with rural living in developed countries and city living in poorer countries.

A question not fully addressed by the early studies is precisely what is meant by “rural living”. Does it refer to farming, cattle ranching, living in the deep woods? Barbeau and Zayed both differentiated rural areas into farming and areas of rural industries, but ranches have not to this writer's knowledge been examined for association with PD, and the size of a community before it is termed ‘rural’ has had only cursory examination. Most of the arly studies focused upon proxies for chemical exposure such as use of well water or length of time spent in farming regions or occupations.

Literature Cited

1. Langston J.W., Ballaro P. and Tetrud J.W., Chronic Parkinsonism in humans due to a product of mepridine-analog synthesis, Science, 219, 979, 1983.

2. Langston J.W. and Irwin I., MPTP: current concepts and controversies, Clin. Neuropharmacol., 9, 485, 1986.

3. Ross G.W. et al., Association of coffee and caffeine intake with the risk of Parkinson disease, JAMA, 283(20), 2674, 2000.

4. Parkinson J., An Essay On The Shaking Palsy, London: Sherwood, Neely and Jones, 1817.

5. Charcot J.M., Lectures On The Diseases Of The Nervous System, Vol 1, Sigerson G., trans. London: The New Sydenham Society, 1878.

6. Gowers W.R., Diseases Of The Nervous System, American ed. Philadelphia: P Blakiston, Son and Co, 1888.

7. Barbeau A. and Roy M., Uneven prevalence of Parkinson’s disease in the province of Quebec, Can. J. Neurol. Sci., 12,169,1985b.

8. Aquilonius S.M. and Hartvig P., A Swedish county with unexpectedly high utilization of anti-Parkinsonian drugs, Acta. Neurol. Scand., 74, 379, 1986.

9. Rybicki B.A. et al., Parkinson’s disease mortality and the industrial use of heavy metals in Michigan, Mov. Disord., 8, 87, 1993.

10. Granieri E. et al. Parkinson’s disease in Ferrara, Italy, 1967 through 1987, Arch.. Neurol., 48, 854, 1991.

11. Svenson L.W., Platt G.H. and Woodhead S.E., Geographic variations in the prevalence rates of Parkinson's disease in Alberta, Can. J. Neurol. Sci., 20, 307, 1993.

12. Barbeau A. et al., Environmental and genetic factors in the etiology of Parkinson's Disease, Adv. Neurol., 45, 299, 1985a.

13. Tanner C.M. and Langston J.W., Do environmental toxins cause Parkinson's disease? A critical review, Neurology, 40(supp 3), 17, 1990.

14. Marttila R.J. and Rinne U.K., Epidemiology of Parkinson’s Disease in Finland, Acta. Neurol. Scandinav., 53, 81, 1976.

15. Bermejo F. et al., Problems and issues with door-to-door, two-phase surveys: An illustration from central Spain, Neuroepidemiology 20, 225, 2001.

16. Rajput A.H. et al., Etiology of Parkinson’s disease: environmental factor(s), Neurology, 34 (Supp I, 1), 207, 1984.

17. Rajput A.H. et al., Early onset Parkinson's disease and childhood environment, Adv. Neurol., 45, 295, 1986.

18. Rajput A.H. et al., Geography, drinking water chemistry, pesticides and herbicides and the etiology of Parkinson's Disease, Can. J. Neurol. Sci., 14, 414, 1987.

19. Ho S.C., Woo J. and Lee C.M., Epidemiologic study of Parkinson's disease in Hong Kong, Neurology, 39, 1314, 1989.

20. Koller W. et al., Environmental risk factors in Parkinson's disease, Neurology, 40, 1218, 1990.

21. Tanner C.M., Influence of environmental factors on the onset of Parkinson's disease, Neurology, 36(suppl), 215, 1986.

22. Tanner C.M., et al., Dietary antioxidant vitamins and the risk of developing Parkinson’s disease, Neurology 39(suppl), 181, 1989.

23. Zayed J. et al., Facteurs environnementaux dans l'étiologie de la maladie de Parkinson, Can. J. Neurol. Sci., 17, 286, 1990.

24. Butterfield P.G. et al., Environmental antecedents of young-onset Parkinson's disease, Neurology, 43,1150, 1993.

25. Stern M. et al., The epidemiology of Parkinson's disease: a case-control study of young-onset and old-onset patients, Arch. Neurol., 48, 903, 1991.

26. Semchuk K.M., Love E.J. and Lee R.G., Parkinson's disease and exposure to rural environmental factors: A population based case-control study, Can. J. Neurol. Sci., 18, 279, 1991.

27. Barbeau A. et al., Ecogenetics of Parkinson's Disease: Prevalence and environmental aspects in rural areas, Can. J. Neurol. Sci.,14, 36, 1987.

28. Sethi K. et al., Neuroepidemiology of Parkinson's disease: Analysis of mortality data for the U.S.A. and Georgia, Intern. J. Neuroscience, 46, 87, 1989.

29. Tanner C.M. et al., Environmental factors and Parkinson's disease: A case-control study in China, Neurology, 39, 660, 1989.

30. Sasco A.J. and Paffenbarger R.S. Jr., Measles infection and Parkinson's disease, Am. J. Epidemiol., 122(6), 1017, 1985.

Protection?

While the article is protected (which is likely to last a few weeks), we should discuss which sections of this important article need improvements, and in what way. I think the "toxins" section, despite General Tojo's insistence, occupies way too much space and should be reduced to the most established toxic causes (e.g. MTPT, HbCO). There may be room for a subarticle if all material is found to be highly-relevant (toxic causes of Parkinson's disease). JFW | T@lk 09:50, 14 July 2006 (UTC)

Agree, it needs to be debulked or spun off into a subarticle. Right now, it reads like a laundry list. I'm surprised that H₂O or O₂ aren't listed. Andrew73 12:27, 14 July 2006 (UTC)

You know what? I was looking through the older versions of the article, and up till Feb 2006 or so, as Barb Davids finished up her contributions, this was a pretty darn good page. Needed some epidemiology, of course, but it was pretty good. --Dan 19:00, 14 July 2006 (UTC)

Agreed. Please note that I created two other subpages, Motor symptoms of Parkinson's disease and Non-motor symptoms of Parkinson's disease that we can use to go into more detail. A postdoc just started in our team who specialises in hallucinations and I'd really like her to add more on non-motor symptoms. There simply isn't need for such detail on the main page though. If everyone's happy with the drug table I've put on the talk page (or would like to add to it) then I think we should have a drugs used in the treatment of parkinson's disease as Jfdwolff has suggested in the past. --PaulWicks 21:18, 14 July 2006 (UTC)

I reduced to semi-protection, as Tojo uses newer socks Jaranda 23:26, 15 July 2006 (UTC)

Re-protection please. --PaulWicks 11:54, 16 July 2006 (UTC)

(Personal attack) --Porcupine 99 11:58, 16 July 2006 (UTC)

Removed --GW_Simulations_{|User Page | Talk | Contribs | E-mail} 12:13, 16 July 2006 (UTC)

Possible forks created

I have noticed two new articles that are possible forks of this article have recently been created by a new user: The symptoms of Parkinson's Disease and Biochemistry of Parkinson's Disease. As I am not familiar enough with the topic to determine if these are valid content spin-offs or POV forks, and given the current protection status of the main article, I am bringing attention to the articles here so that appropriate actions may be taken by others if needed. --Allen3  21:10, 18 July 2006 (UTC)

Looking the material over, those are almost certainly posted by Bridgeman, aka General Tojo and over 150 sockpuppets. --Dan 21:22, 18 July 2006 (UTC)

Certainly look that way to me. Admins can you nominate for deletion please? --PaulWicks 21:46, 18 July 2006 (UTC)

The AfD for both articles is at Misplaced Pages:Articles for deletion/The symptoms of Parkinson's Disease. --Allen3  22:13, 18 July 2006 (UTC)

I've blocked Dundee Cake as tojo. If there's no use in having these pages, I could just delete them; or I (or anyone else) could remove all the content and redirect them here; or if anyone wants it to, the AfD discussion can continue: that's the default action unless there's a near-universal consensus to do something else. Tom Harrison 22:59, 18 July 2006 (UTC)

I'm inclined to think with what we've got from the pre-Bridgeman days (before Feb 2006) and what the rest of can contribute, we have plenty of solid, accurate material. --Dan 23:03, 18 July 2006 (UTC)

IMHO there should be a link under Notable Parkinson's sufferers to Category: Parkinson's disease sufferers - Kittybrewster 09:01, 29 July 2006 (UTC)

Archive?

I'd like to archive the older parts of this talk page. Is there a date before which the discussions are no longer active? Tom Harrison 18:06, 14 July 2006 (UTC)

Is the size a problem? I think most stuff before Jan 2006 is no longer active, since those earlier contributors - like BLDavids - aren't around anymore. A shame, but part of the size problem is Bridgeman's proliferative posting. --Dan 18:35, 14 July 2006 (UTC)

It's not so long as to be a problem, if it's useful to keep it. I'll leave it alone for now. Tom Harrison 19:52, 14 July 2006 (UTC)

Why not just archive all that is GT-related and leave the actual discussions up? Also please leave my drug table there! --PaulWicks 21:20, 14 July 2006 (UTC)

If you want I'll try to refactor the page, removing GT's remarks and all the replies to them. They'll still be in the history if anyone wants to refer to them. I'll be sure and leave the drug table. I'll try to do it tomorrow if no one objects. Tom Harrison 21:29, 14 July 2006 (UTC)

I wouldn't mind. --Dan 21:30, 14 July 2006 (UTC)

Some form of archiving is required - this page takes ages to load on my slow dial-up connection (almost makes me dread the boredom of waiting to view the latest postings here)- I agree in first instance archive off GTs trolling and then lets see if/where we wish to archive older historical discussion threads. David Ruben 23:47, 14 July 2006 (UTC)

I have finished refactoring the page. I tried to remove all the extraneous conversations, and in a few cases summarized people's words. Please correct any mistakes I made. The un-refactored version will of course be available in the history. Tom Harrison 13:14, 15 July 2006 (UTC)

Thanks, Tom - good work. Hope this helps you, David. Alternatively I hope Santa Claus (or maybe your Hallowe'en bag) brings you a fast connection. --Dan 15:31, 15 July 2006 (UTC)

Talk page now a pleasure to visit it loads so fast :-) Suspect will need wish hard, as would need faster computer to cope with broadband... David Ruben 13:34, 16 July 2006 (UTC)

Reprotected

King of Hearts (talk · contribs) unprotected the page, and within hours Tojo is all over it again. I see no other option but to protect it again. JFW | T@lk 22:31, 2 August 2006 (UTC)

Copyright vios

I'd like to thank DocRogers for removing a lot of the irrelevant info that has been clogging up that article for a while. Please don't anybody revert his improvements. --PaulWicks 12:51, 4 August 2006 (UTC)

Not to mention he directed us yet again to his private PD pages. And reminded us that there was some sort of copyright violation somewhere. Maybe we copied his copies. --Dan 16:09, 4 August 2006 (UTC)

I'm not sure what the copyright violation is specifically. Perhaps it's just a ruse. Andrew73 17:30, 4 August 2006 (UTC)

(rm Tojo -- Chris 73 | Talk 12:58, 8 August 2006 (UTC))

Perhaps you could provide more specifics about which linked sites? Andrew73 18:09, 4 August 2006 (UTC)

(rm Tojo -- Chris 73 | Talk 12:58, 8 August 2006 (UTC))

If I recall correctly, I think you may have been the one who originally incorporated this information in the Misplaced Pages article! Isn't this sort of like the pot calling the kettle black? Andrew73 18:36, 4 August 2006 (UTC)

(rm Tojo -- Chris 73 | Talk 12:58, 8 August 2006 (UTC))

Okay, I restored an earlier version of the toxins section that does not incorporate material from the viartis.net site. Andrew73 19:22, 4 August 2006 (UTC)

• chuckle* Great minds think alike, eh Andrew? --Dan 19:43, 4 August 2006 (UTC)

That's a given. Andrew73 19:49, 4 August 2006 (UTC)

Perhaps the easier route might be to not incorporate the sections DocROgers is concerned about. An earlier revision, with lots of work by users AFGriffithMD and Bldavids, has a lot of good material. |This revision immediately predates the first entries by a user who posted links to p4.forumforfree.com/parkinsons.html The Parkinson's Disease Forum. --Dan 19:28, 4 August 2006 (UTC)

I ended up including a later version (I don't remember the exact one), before it morphed into something like the viartis.net entry. Andrew73 19:53, 4 August 2006 (UTC)

Spam what spam ???

Why exactly did Mwanner revert Npang's link ? To describe it as spam is either due to deceit or not actually reading it. Too often editors revert what they describe as spam that is not spam at all. Spam is blatant advertising, but the link goes to a non commercial site that is plainly a very good Parkinson's Disease information site. --Leilania 12:05, 12 August 2006 (UTC)

Err, because the site is bursting at the seams with banner ads? Because the information adds nothing to what is on the article already? Spam doesn't have to be "blatant advertising" to be spam. If the intention of adding content to Misplaced Pages is to drive traffic to a site, I'd say that's a pretty good reason to take it down. --PaulWicks 14:46, 12 August 2006 (UTC)

Expertise: What determines?

I know I disappeared before things heated up around here--four psychiatric diagnoses, all wrong, but huge havoc to my life, damage to me emotionally, and hostility on my part toward med psych--but I wrote a good deal of early text which is preserved here. I am not adept in this format, do not have a Phd (MA journalism, MA linguistics, MA anthropology, MPH, ABD in Med Anthro, clinical work on drug resistance and TB in Thailand--1 1/2 years in the field there, 2 years in Africa, but I have early onset PD. That's the sole reason I don't have a Phd. The language of "Now we have this expert (MD OR PHD) and now we have that expert is more than a bit offensive. BDavidson

By all means, don't let that be a bar to editing here. The articles on Misplaced Pages are not "owned" by anybody, you are free to write whatever you want whenever you want. However I think it can only help Misplaced Pages that people who are professionals in a particular field do contribute to articles within their fields. That doesn't mean they take them over! I only know about a small slice of PD, and many of the other physicians contributing here are not PD specialists. My text below was in regards to expanding a specialist page off of the main PD page which would go into more detail on a particular aspect, namely non-motor symptoms. I did not think that could be interpreted as offensive, but if you are offended than I apologise. --PaulWicks 07:46, 7 September 2006 (UTC)

Barb, it's good to see you back - you and Griffith had a pretty good page put together before the tojo makeover. Having said that, I truly don't see why conversations about having expertise on tap would be offensive. I regard it as a valuable resource, a groups of people who are plugged into various specialty areas and are aware of what current conversations are happening. For instance, I was just looking over some old data of mine, and found a mild association between PD and heptachlor, a now-banned (mostly) insecticide that was used a lot by termite exterminators. Looking to see what's out there about heptachlor, I came across a hypothesis that it acts as a first blow to the dopamine producing areas, softening them up as it were, and making them vulnerable to damage from other factors that would not ordinarily cause problems. Interesting, eh? Anyway, before I went off on that digression, I want to ask you to please not take wrongly our valuing particular expertise. With one notable exception, we have not engaged in disparaging people based upon perceptions about qualifications. So don't take offense at us who do have higher degrees. --Dan 20:39, 7 September 2006 (UTC)

higher than what? i've jokingly tried to argue that a certain number of MAs should equal a Phd, but no luck so far. I finished field work and research, but a 1 1/2 year major depression, plus criminally inept psychiatry (no exaggeration; i'd sue except it would also cost me my family dr and mds--drs can't apologize, don't testify against each other, etc, no maater how egressious the injury, unless you can pay an expert witness; ethics are important, don'tcha know) have cost me my marriage, my kids, and my housing. i'm currently homeless and on state papers. why keith bridgeman thinks i'm worth bashing is beyond me. my husband--who is trying to move his girlfriend in even before the divorce is final--did a quite adequate job. too personal, i know, but how much bashing am I supposed to be able to take? i never picked fights here or anywhere. thanks for the words of support and i admit that i'm to sensitive. dan, i just read your most recent comments above; thanks again; the material that is still deleted that i feel most strongly about is the section -- and it could be quite brief-- about the need for interdisciplinary specialty treatment, protection of the rights of patients, and involvement of family and friends in care. I was three days away from a state facility--my current psych dx is "anxiety"; that's it!--and three people from my church saved my life. for real. that material matters; please consider, particularly because i have both a strong science background and particularly relevant and bitter recent experience. the reason i've been absent is because i haven't had access to a computer; committed patients in locked wards don't go those, even the doctors f///k up four or five times in a row. been there, done that. sorry for anger--you have no idea; i need to find constructive outlets and value support. thanks again. bd

Barb, I'm going to offer some unsolicited (maybe) advice - "higher degree", "advanced degree" and the like are common usage; there's no implication that the bearer thereof is of greater value. The education likely is of greater value - PhDs are qualitatively different from Masters, but you're repeatedly making a point of our usage and implying thereby that Paul and I are making a class distinction of some sort. Would you say that if we were talking about "high" school (well, I would use that term, anyway, Paul's in England where they have some totally incomprehensible system involving forms). Anyway, it appears to me that you are being overly sensitive about class distinctions. This is a not uncommon problem in the States where we pretend to have an egalitarian, classless society. You and I both know this to be a deception. Railing against it, however, and claiming that we are all equal, only puts dents in your forehead from banging it against that particular brick wall. We would be better off, I feel, to acknowledge that there are inequalities in the world - in our country - and that to some extent they're inavoidable, a fact of nature. Where we should pick our fights, though, is where the inequalities are enforced, say by birth, where the classes are not open regardless of effort or merit. I've found, through being married into a Confucian society, that acknowledging class differences should bear with it reciprocal responsibilites, one to another. We in the US live in a place where we place highest value on the individual, with the result that we aren't very good at bearing those responsibilities toward each other. We tend to blame those lower on society's ladder for their weakness, and resent those higher on the ladder for their ruthlessness, venality, what-have-you. And, getting political here, this is a situation encouraged by those who profit from society being divided. I suspect I've gone on altogether too long, but there it is. Do you know how to pick through the history of the page, so you can find the bits you liked and clip those in? If not, whistle & I'll give you a hand with it. --Dan 05:20, 11 September 2006 (UTC)

I would suggest trying out "Braintalk 2" whilst BT1 is down but Bridgeman is there already too. http://forums.braintalk2.org/forumdisplay.php?f=34 --PaulWicks 08:51, 10 September 2006 (UTC)

pretty up to date, paul, as a friend just told me same yesterday. thanks for support.User: Barb Davidson10 sept

Merge of non-motor symptoms page

It has been suggested that the Non-motor symptoms of Parkinson's disease page I created be merged into the main article. I originally created the page so that I could expand it beyond the scope of a main article. My intention was to add more about depression in PD, and our new postdoc who did her PhD on hallucinations in PD could expand the rest. However the GT incident put me off editing for a bit. If we leave the link there for now I will expand it in the coming months. But if other editors want to delete it for now that's fine too and I can always reinitialise it once some new content has been written. --PaulWicks 20:14, 26 August 2006 (UTC)

I have begun work on this page. Would appreciate input from everybody else on this one too if you have time, especially wikification of my text! Cheers! --PaulWicks 15:53, 13 September 2006 (UTC)

RCP guideline

I don't think this article is complete without at least a cursory mention of the UK Royal College of Physicians national guideline - it recommends (amongst other things) that all patients with Parkinsonian symptoms are referred to a specialist for adequate diagnosis, rather than management by generalists. JFW | T@lk 13:07, 21 September 2006 (UTC)

Qigong

Mr. Doyle - it's customary to talk things over on this page before deleting material from the article with no more than a statement of "no evidence". One could, for example, ask the editor to provide evidence that supports the assertion. I am not aware of evidence speficiclly for Qigong, but I am aware of ongoing clinical trials that support a beneficial effect of a variety of exercise programs. --Dan 16:15, 26 September 2006 (UTC)

None of the numerous alterations made to this article over the past month have been justified by prior discussion. I should not have to comply with a custom that nobody else complies with. Evidence was asked for concerning Qijong as soon as it was added, but none has ever been provided. --Gerard Doyle 17:44, 26 September 2006 (UTC)

I'd suggest you peruse the discussion page a bit more carefully. Many of changes made over the past month were more in the way of improving readibility and flow. MMoneyPenny, for instance, did quite a bit of editting, and where he'she did change something substantive, we corresponded and changed it back. If I remember correctly, the user who added the Qigong piece was Barb Davidson, and as you can see sh'e not a daily visitor or even a weekly visitor. I'd suggesting restoring what you deleted and being a bit more patient. Or perhaps adding a reference that says "we ran a trial of Qigong on PD patients & it didn't work." The attitude of "everybody else misbehaves" really doesn't hold water, and in any case is not a valid reason for acting badly. --Dan 17:53, 26 September 2006 (UTC)

I haven't claimed that "everybody else misbehaves". I pointed out that no alterationshave been made as a sresult of discussing them, and that there is no reason why I alone should have to discuss everything first. --Gerard Doyle 18:39, 26 September 2006 (UTC)

Yes, you did - you said "a custom that nobody else complies with". Literally, you didn't say "everybody else misbehaves" but that was certainly the meaning of your statement. Second, your point that "no alterationshave been made as a sresult of discussing them" is also incorrect, as you would see readily by perusing this page. Just an example, the section on Risk Factor Epidemiology above is currently under discussion for inclusion. --Dan 16:33, 27 September 2006 (UTC)

I did not claim that "everybody else misbehaves", and my statement did not imply it. My statement is entirely correct, and means nothing more than it states. Of the numerous edits over the months I see virtually no prior discussion. Your one counter example (Risk Factor Epidemiology) is not even under discussion as you have suggested. You added it over two months ago and nobody has discussed it. It is a blunt fact on this article that alterations are rarely justified after prior discussion. I think anyway that apart from really major changes that it is better to make alterations and to enter into disussions only if somebody disagrees with them, because most alterations are not objected to anyway. --Gerard Doyle 17:06, 27 September 2006 (UTC)

Hi Gerard, as a relatively new editor I would invite you to contribute further to wikipedia. Perhaps if you come across articles that need sources it might be helpful to go and find sources which either support or refute your statement rather than removing text outright? Also, feel free to do what ever you like on Misplaced Pages. I hope you will find being additive more enjoyable than subtractive! --PaulWicks 17:55, 26 September 2006 (UTC)

The Misplaced Pages guidelines require that somebody must be able to substantiate what they add. It is up to the editor to have that evidence available if it is asked for. However, since it was asked for the editor has unable to provide it. Improvements can be made by being either additive OR subtractive. --Gerard Doyle 18:39, 26 September 2006 (UTC)

I agree, it would have been better if the editor had added it. But "Improve pages wherever you can, and don't worry about leaving them imperfect. However, avoid deleting information wherever possible. (from Misplaced Pages:Editing policy)" I've added two references and rewritten that section in less time than it took us all to have this drawn-out discussion!!! --PaulWicks 19:13, 26 September 2006 (UTC)

What you have done, the Qijong editor should have been ready to do long ago. I did not know of "avoid deleting information wherever possible". If somebody has added that George W.Bush is Bulgarian I will leave it intact. Despite this suggestion/rule, I see a huge amount of information on the Parkinsons article that has previously been deleted. --Gerard Doyle 19:21, 26 September 2006 (UTC)

If I could offer one piece of advice, it would be to let that particular somnolent canine go about its theta waves. --PaulWicks 21:06, 26 September 2006 (UTC)

I was surprised to see a whole subsection on Qigong in this article. The text itself seems to have a biased point of view. The first study presented supports Qigong, and is followed by a sentence mentioning the authors' speculations about "energy". The second study presented shows no benefit from Qigong, and is followed by a dismissive sentence: "However, ... aerobic exercise had no benefit..." In exaggerated form, the text reads like this: "Hey, this one study supports Qigong! Isn't it awesome? Oh, there's this other study that said it didn't work, but it also said exercise didn't work, so forget about that one!" I would suggest removing the Qigong section and just including qigong in the list of physical exercise techniques. --Hyperqbe 18:18, 27 October 2006 (UTC)

Perhaps we could start a new wikiproject, "glib-o-pedia"? --PaulWicks 21:32, 27 October 2006 (UTC)

Temperature awareness

Is reduced awareness of temperature (i.e. too cold or too hot) a symptom of PD? - Kittybrewster 08:24, 28 September 2006 (UTC)

not that I'm aware of, Kitty, but perhaps someone who's more of a clinician than I could address it. Swallowing difficulties are a pretty good early sign; our PD clinic is getting referrals from the gastrointestinal guys who are checking people for GERD with that little gadget that blows air at the back of the throat - some of them have PD. --Dan 17:09, 29 September 2006 (UTC)

Hydrocephalus

Symptoms of Parkinson's Disease, most commonly gait disorders, can often occur simultaneously with Hydrocephalus , and can be due to the effects of Hydrocephalus . The Parkinson's Disease symptoms may be caused by increased intracranial pressure reducing blood flow to the basal ganglia where dopamine is produced .

Journal of neurology, neurosurgery and psychiatry 70 (3) : 289-297 (H.Stolze, J.P.Kuhtz-Buschbeck, H.Drucke, K.Johnk, M.Illert, G.Deuschl)

Movement Disorders 12 (1) : 52-60 (J.K.Krauss, J.P.Regel, D.W.Droste, M.Orszagh, J.J.Borremans, W.Vach)

Movement Disorders 9 (5) : 508-520 (T.Curran, A.E.Lang)

Movement Disorders 1 (1) : 59-64 (J.Jankovic, M.Newmark, P.Peter)

Canadian Journal of Neurological Science 12 (3) : 255-258 (L.Berger, S.Gauthier, R.Leblanc)

Pediatric Neurology 4 (2) : 117-119 (E.Shahar, R.Lambert, P.A.Hwang, H.J.Hoffman)

Unsigned by Gerard Doyle (talk · contribs), 30 September 2006, 20:00

If you use this approach you will need to include many more diseases. In practice, all these diseases are excluded almost instantly on the basis of clinical history alone. For instance, a lacunar infarct of the basal ganglia would also produce a movement disorder, but seldomly without other lateralising signs. It would also be sudden-onset rather than insidious. I think the hydrocephalus issue should be removed until you can prove that it is part of a neurologist's differential diagnosis for Parkinson's. The implications are obvious. Hydrocephalus is diagnosed by fundoscopy, CT scan and lumbar puncture. Are you suggesting all Parkinson's patients should undergo this? No, that is not supported by the evidence you have provided. Please try harder, Gerald. JFW | T@lk 19:36, 30 September 2006 (UTC)

1. "If you use this approach you will need to include many more diseases." This is incorrect as there are only about a dozen disorders that can cause Parkinson's Disease symptoms. You have only given one additional disorder. One is not "many more".

2. Am I suggesting that all people with PD should be diagnosed by Hydrocephalus methods ? No and it's not even implied or necessary according to the inclusion of Hydrocephalus. The implications are irrelevant anyway. What somebody doesin response to this information is up to them. Hydrocephalus occurs from an early age, whereas PD usually doesn't. So by the time of a PD diagnosis Hydrocephalus would usually be known. The practical relevance of this information is that if somebody showed the symptoms of PD and already had Hydrocephalus that the PD symptoms could be due to Hydrocephalus rather than PD.

3. The sole question is whether Hydrocephalus can cause symptoms of Parkinson's Disease. According to the published scientific literature it can occur quite frequently. What this implies is irrelevant. What some neurologists have previosuly thought about thisis irrelevant. The published scientific literature is overwhelming.

--Gerard Doyle 19:54, 30 September 2006 (UTC)

1. Don't cloud the issues. Demyelination, toxoplasmosis and AIDS encephalopathy will all produce movement disorders if the right area is targeted.
2. You give all the reasons why we should not list hydrocephalus, just as much as we should not list all the examples I've given in #1.
3. That is not the sole question. What we're trying to present here is a reasonable differential diagnosis for PD, and hydrocephalus is not amongst them according to most general sources. PMID 15489399 and PMID 7990846 suggest that this is a pretty rare clinical scenario; as the present article is aimed at the general public we should avoid "zebras" unless this is absolutely relevant (e.g. if that "zebra" led to elucidation of the pathophysiology, as sometimes has happened in other diseases). JFW | T@lk 20:54, 30 September 2006 (UTC)

1. Most movement disorders are not Parkinson's Disease. So examples of disorders that cause movement disorders are not examples of medical disorders that cause PD symptoms. So your examples are irrelevant. There is no number limitation anyway on the number of disorders.

2. "Hydrocephalus is not amongst them according to most general sources. PMID 15489399 and PMID 7990846 suggest that this is a pretty rare clinical scenario". You have cited irrelevant published scientific literature that only details isolated cases. They do not assess the frequency of hydrocephalus. The research I referred to shows that it is quite a common occurrence. There is also not a cut off point regarding frequency anyway.

--Gerard Doyle 21:37, 30 September 2006 (UTC)

1. Just look it up. Parkinsonism can be caused by all these. I can think of number of others, but I won't wear you out.
2. Irrelevant? One of them was cited by yourself! Could you give the PMID codes for your other references? Are you suggesting hydrocephalus-induced parkinsonism is common? JFW | T@lk 22:21, 30 September 2006 (UTC)

The full references are given and so should be easy to find on PubMed by typing hydrocephalus and the author surnames. The PD symptoms are proven in these studies (1) to occur as a result of the Hydrocephalus and not just simultaneously with it, and (2) to often occur as a result of it. Medical disorders are not Parkinsonism disorders if (1) they only cause symptoms of movement disorders rather than Parkinson's Disease, (2) and merely occur simultaneously with Parkinson's Disease rather than cause its symptoms. Hydroephalus fulfills any reasonable definition of Parkinsonism. --Gerard Doyle 12:38, 1 October 2006 (UTC)

Parkinsonism is when a medical disorder can cause symptoms of Parkinson's Disease. By reading the above references it is very obvious that Hydrocephalus fulfills this definition.

Parkinsonism is NOT when a medical disorder can cause symptoms of Movement Disorders rather than Parkinson's Disease. Parkinsonism does not have to inevitably cause symptoms of Parkinson's Disease in all cases. Parkinsonism is NOT when a medical disorder merely coincides with Parkinson's Disease without actually causing it.

There have been reverts of this fact by Ryulong and PaulWicks without prior discussion or reason. Further reverts that are made concerning this without first justifying them on the Discussion page will be considered as blocking.

--Gerard Doyle 13:17, 2 October 2006 (UTC)

You misunderstand "blocking". Blocking is when you're locked out of Misplaced Pages, like I did to you a little while ago.

You are pushing this hydrocephalus thing a bit too hard. Have you considered all my other examples?

I will not remove the hydrocephalus stuff again, unless several other editors agree with me here that it should be removed (also known as consensus). If that is the case, you will need to stop inserting it. Paul Wicks has already made his views clear by reverting you. Consensus means you sometimes need to move away from something you regard as important, because this is how Misplaced Pages works. JFW | T@lk 20:24, 2 October 2006 (UTC)

I don't see the point in having hydrocephalus in this article. As Bridgeman was fond of pointing out, the article needs to be concise and to the point, and including a disorder that can occassionally cause symptoms resembling PD isn't useful. The same applies for hemochromatosis. --Dan 20:30, 2 October 2006 (UTC)

Copied by Gerard Doyle from talk page :

If some textbook editors didn't know about it it should under no circumstance be in Misplaced Pages. Indeed, I was unaware of the link between hydrocephalus and PD, but a cursory examination of the relevant literature confirmed that this is a rare cause of Parkinsonism (not Parkinson's disease!) that need not be mentioned in a general purpose encyclopedia.

What people do you know that can judge this article? If they are truly qualified to do so, couldn't they help out a little? JFW | T@lk 20:31, 2 October 2006 (UTC)

Due to my past work and my contacts, I know many people involved or connected with Parkinson's Disease in different respects. I do not know of even one of them that has any regard for the Misplaced Pages Parkinson's article. It is too badly organised, inconsistent, contains too many errors and inadequacies, contains too many fanciful theories.

The major change that should be made to the article is what it appears PaulWicks has been proposing for quite some time, which is to have paragraph summaries on the Parkinson's Disease page, with links to sub articles on each of the subjects such as symptoms, epidemiology, treatments, pathology, causes (toxins, genetic, etc), history, etc.. PaulWicks appears keen to start up a sub-article on symptoms and also treatments. You have an epidemiologist who could link to and expand epidemiology in a sub article.

1. "If some textbook editors didn't know about it it should under no circumstance be in Misplaced Pages." - Unfortunately, most textbooks, and I have read many, are very badly written. They are usually full of horrendous omissions and inadequacies.

2. "I don't see the point in having hydrocephalus in this article. The article needs to be concise and to the point." - If Parkinsonism was merely summarised on the Parkinson's article and linked to a sub article on Parkinsonism, then Hydrocephalus would take up only one word.

3. "You are pushing this hydrocephalus thing a bit too hard. Have you considered all my other examples?" Rarer causes are ceratinly not unimportant to those that have them ! There are millionsof people with rare causes of medical disorders. I haven't carried out a detailed assessment of the entire scientific literature concerning the additional medical disorders you mentioned, but I may. If there is evidence that those disorders can CAUSE Parkinson's Disease symptoms rather than merely coincide with it, or merely cause other movement disorders, then they are forms of Parkinsonism and should be listed.

--Gerard Doyle 21:18, 2 October 2006 (UTC)

1. To restate my question: could you involve any of those past contacts to improve a vitally important public resource, the 14th most popular website in the world? Preferably someone with an academic background and practising neurology.
2. If we cannot believe the textbooks, then who are we to believe? Dr Gerald Doyle, recipient of the Nobel Prize for the first cure for Parkinson's? Honestly, what source are you expecting us to rely on apart from your personal judgement? Does everyone agree that whatever was left out amounted to "horrendous omissions and inadequacies", or is that your personal view?
3. Parkinsonism should list all causes of that constellation of symptoms. You can list your hydrocephalus there with appropriate references, as it does not cause Parkinson's disease and is rarely entertained as a differential diagnosis for PD (as opposed to Wilson's, which is, given the propensity of neurologists on ordering copper studies for young PD patients).
4. None of the causes I listed cause classical Parkinson's disease; they can cause Parkinsonism if the appropriate part of the basal ganglia is involved. The same goes for your hydrocephaus.
5. I register several other editors opposing the hydrocephalus info. Paul Wicks, Dan Snow, and myself now oppose it. We should have a few more days of discussion on this, but at the moment you seem to be a dissenter. Please respect consensus when we finally tally the votes. I'm happy for this to go to WP:RFC if you think this will improve matters. JFW | T@lk 22:41, 3 October 2006 (UTC)

1. I know a lot of people in many different countries of different scientific backgrounds, neurology, biochemistry, doctors, pharmacology, pharmacy, numerous people with Parkinson's Disease. Between them they have published thousands of studies. However, it is not that easy to get busy people to spend their time on something that somebody else may later wipe out based on a whim, or that may be objected to without valid reason.

2 If we cannot believe the textbooks, then who are we to believe ? The only really reliable source of information is to go to the original sources - the published research, because these are the building blocks of scientific knowledge. Given that the smallest of subjects can require checking hundreds or even thousands of abstracts, authors just don't do it. They instead often rely on hearsay or what they think is common knowledge, which often isn't even true. Even published research must be examined sceptically because : most medical research is useless, most conclusions don't match the results, many results are not reliable because of inadequate methods. My method for any issue is to go through all potentially related research on PubMed. Check the complete papers where it is needed. Ask if it is relevant. Ask if it is true, to what extent is it true, are the methods reliable, is it consistent with other known facts.

3 and 4. Hydrocephalus would be known long before somebody would be likely to get Parkinson's Disease symptoms. So in assessing PD somebody would not need to be assessed for Hydrocephalus. The practical significance of Hydrocephalus is that somebody would know that they had Hydrocephalus first and could later get the symptoms of Parkinson's Disease. They could of course happen to have both, but the research shows that the symptoms can be the result of Hydrocephalus and can be rid by treating it as Hydrocephalus rather than Parkinson's Disease.

5. If three editors believe that George W.Bush is Bulgarian and one editor believes that he isn't, does that make him Bulgarian ? Fully substantiated scientific fact is on my side. If somebody doesn't accept scientific fact then they are not being logical or scientific. I might not have all opinion on my side, but far more importantly, I certainly have all scientific evidence on my side. I'm still waiting to see any opposing evidence. If opposing opinions are maintained despite the complete lack of any opposing evidence, then as a matter of principle, I will take it through all the further assessment procedures.

--Gerard Doyle 11:29, 4 October 2006 (UTC)

1. I got a professor to review coeliac disease (or rather instruct one of his researchers to do so). That required two emails. Surely you could use your influence to mobilise someone useful? Serious recommendations with someone with verifiable scientific authority are usually not "wiped out on a whim" without a degree of consensus.
2. What original paper suggests that hydrocephalus should be considered in the differential diagnosis of classical Parkinson's disease? Full reference please. Has that paper, in turn, been cited and achieved acceptance?
3. You have answered your own question. If someone with hydrocephalus develops Parkinsonism, the diagnosis is less likely to be classic PD! Why are you still pushing for hydrocephalus to be mentioned here rather than on Parkinsonism, where it belongs according to your own logic?
4. Yes. If consensus emerges that GWB is Bulgarian, then the article will represent this, unless the minority then calls for RFC or other forms of dispute resolution. Scientific evidence yields to consensus on Misplaced Pages - get used to it. JFW | T@lk 22:49, 5 October 2006 (UTC)

I can get just about any information or input on Parkinson's Disease. However, there would inevitably be delays with some information because people such as the consultant neurologist I know are inundated with work. I know an internationally known pharmacologist who is called in as expert for many international authorites. However, he travels so much around the world that it is hard to keep track of him.

Hydrocephalus certainly isn't Parkinson's Disease. All the symptoms of Parkinson's Disease do not occur in most people with Hydrocephalus. However, in many people with Hydrocephalus Parkinson's symptoms can occur by indirectly affecting dopamine formation. It therefore has a place in a PD article, even if it is merely mentioned and is dealt with more fully in a Parkinsonism article.

--Gerard Doyle 13:00, 6 October 2006 (UTC)

I challenge you to get any of your influential friends to review this article. So far, you haven't as much as dropped a name.

You have not addressed my question: given that hydrocephalus is not a cause of PD and not really useful as a model for studying PD. What is it still doing in this article? JFW | T@lk 23:11, 8 October 2006 (UTC)

I don't really like to give out other people's personal details on the Internet because information is so readily available on the Internet to anyone. I would then have to specifically request their permission to openly quote them. People become a lot more inhibited if they know that what they write will be made public.

The standard of some of the people I know is very high. For example, Professor Beckett OBE who I know very well and for many years has published over 600 research papers. He has about six doctorates including DSc's. He was the chief scientific adviser for the International Olympic Committee, the IAAF (Athletics World governing body), the head of the Royal Pharmaceutical Society, and many more. He has taught more PhD students than anyone in the medical professions. I can't remember all his achievemnets as there are so many. There are others besides him that are nationally or internationally known in their areas.

However, one person reviewing this article is not appropriate. Parkinson's Disease as with most medical disorders is a wide range of subjects - anatomy, biochemistry, physiology, toxicology, pharmacology, pathology, epidemiology, medical history, etc. You will never get one expert opinion on all of it, but I can guess, given his standards and his straightforwardness how harshly Professor Beckett would criticise this article.

There is alo the problem of anyone adding even one single word to this article ends up with endless discussion, and investigations of the authors - everything short of referring it to the UN General Assembly !

"You have not addressed my question: given that hydrocephalus is not a cause of PD and not really useful as a model for studying PD. What is it still doing in this article?"

It is not Parkinson's but Hydrocephalus is often a cause of Parkinson's Disease symptoms. The references I have provided prove that. It is not a model for studying PD but it doesn't have to be. Forms of Parkinsonism should certainly at least be listed on a PD article. What is your criteria for a disorder being listed as a form of Parkinsonism ? I expect any reasonable criteria you give to either include Hydrocephalus or to exclude a disorder that you think should be listed.

I expect majority opposition to the inclusion of hydrocephalus, but I have yet to see any consistent scientific information at all that supports that view. --Gerard Doyle 01:27, 9 October 2006 (UTC)

I'm sure the UN General Assembly is too busy with Korea to worry about Gerard Doyle. Are you going to send that email to prof Beckett? You haven't actually told us whether he's see the article, so we cannot presuppose his response.

This article should not contain all causes of Parkinsonism. That includes your hobby horse hydrocephalus. The only causes that should be listed are the ones that are genuinely part of the "standard" differential diagnosis (such as Wilson's disease), or those that have served as useful models in the study of PD (e.g. lesion studies). Failing that, they're out. I hope this is clear enough. I have stated the same a couple of times now, if only you'd care to read what I wrote. JFW | T@lk 21:27, 12 October 2006 (UTC)

Useful source

Clinical evidence has a (2004) monograph on PD that may assist us in citing the right sources. JFW | T@lk 21:18, 30 September 2006 (UTC)

Hemochromatosis

While we're on the topic of "related diseases," I've noticed that hemochromatosis was recently added . I'm not sure if this entity is necessarily worth including, for more or less the same reasons that hydrocephalus should not be included. Andrew73 16:54, 1 October 2006 (UTC)

This claim is only based on one citation in which a few cases of haemochromatosis were merely found simultaneously with Parkinson's Disease. More extensive examination showed that haemochromatosis did not cause Parkinson's Disease. Many medical disorders can occur simultaneously without being responsible for their cause. --Gerard Doyle 13:21, 2 October 2006 (UTC)

That is not to say there are no theories about iron toxicity in PD. JFW | T@lk 20:26, 2 October 2006 (UTC)

There are several reasonably-credible reports of an association between hemochromatosis and Parkinson's disease. E.g., Concurrent hereditary haemochromatosis and idiopathic Parkinson’s disease: a case report series. I'd have to go back to get the earlier cites, but I have known about it since the early 1970's, as a graduate student. It may be one of those things that everybody knows about, so it is not "reportable". If memory serves, present work on the involvement of iron in PD comes from this source. Pproctor 00:11, 6 October 2006 (UTC)

Parkinsonism

At present, Parkinsonism is being duplicated by being spread out over the following five articles :

• ]
• Parkinson's disease mimics
• Parkinsonism
• Parkinson plus syndrome
• Parkinson plus

I suggest that the Parkinsonism disorders be listed on the Parkinson's Disease article, and linked to one Misplaced Pages Parkinsonism article that gave summary details of each of those disorders. --Gerard Doyle 19:46, 5 October 2006 (UTC)

Uhh, I agree that "PD mimics" should be merged with Parkinsonism. I feel the seperate article "Parkinson plus syndrome" should remain, as this is a container term that needs to be dealt with independently. Finally, Parkinson-plus is a redirect - I'm not sure why you included it. JFW | T@lk 22:52, 5 October 2006 (UTC)

If information is too spread out it will not get read. The Parkinsonism article could incorporate Parkinson Plus. When you examine the biological differences between them, I'm not sure what differences there that justifies them being kept completely apart. --Gerard Doyle 13:05, 6 October 2006 (UTC)

Based on recent attempts on James Parkinson to get a link into Viartis.net followed by a "mundane" edit by Gerard Doyle I am increasingly convinced of his GT-ness. I don´t want to enter into conversation with him until the checkuser comes back. --PaulWicks 08:36, 7 October 2006 (UTC)

Is a SP anyone who doesn't completely agree with you ? Isn't it merely a means of trying to overcome opposing views when you can not overcome them using reasoning and facts ? --Gerard Doyle 12:50, 7 October 2006 (UTC)

The activities have all of the stigmata of a GT sock puppet (though I'm surprised at the incredible restraint in not using boldface). I'm not sure how reliable the check user would be, given that GT has been using domains in the Middle East. Andrew73 17:38, 7 October 2006 (UTC)

Guys, I've been trying to WP:AGF with Gerard. Let's try to disagree on issues. Have you all given your opinion on whether hydrocephalus needs to be mentioned? JFW | T@lk 23:13, 8 October 2006 (UTC)

I already assume being outnumbered by at least 3 to 1 despite being scientifically correct. If a majority of Misplaced Pages editors believe George W.Bush to be Bulgarian, then Bulgarian he shall be. --Gerard Doyle 11:21, 9 October 2006 (UTC)

This 'x is Bulgarian' argument is one of GT's classic arguments. GD equals GT. So good faith is no longer assumed by me. --PaulWicks 10:07, 10 October 2006 (UTC)

Agree with Paul - banned users, especially one of Bridgeman's ilk, simply should not be posting. Hydrocephalus rarely can cause Parkinson's-like symptoms, and in that case, so what? It's obvious to the diagnosing clinician what's going on, and there's really no light shed on PD etiology or treatment thereby, since the tx is to treat the hydrocephalus. It's irrelevant, and the discussion has gone on way too long. But that's typical pointless Bridgeman argumentation. --Dan 15:14, 10 October 2006 (UTC)

I agree with Dan's reasoning that including hydrocephalus doesn't add that much to the article. Andrew73 00:31, 11 October 2006 (UTC)

Thank you, everyone. I have now removed the hydrocephalus stuff. JFW | T@lk 21:29, 12 October 2006 (UTC)

1. "Hydrocephalus rarely can cause Parkinson's-like symptoms" FALSE - It often causes PD symptoms, as is proven by the references provided.

2. "There's really no light shed on PD etiology or treatment" IRRELEVANT - There doesn't have to be in order to be considered as a form of Parkinsonism. None of the forms of Parkinsonism provide any more information about etiology and treatment than does Hydrocephalus. So are you going to remove all the rest ? Of course you won't despite the blatant inconsistency of the objection.

2. "Hydrocephalus doesn't add that much to the article" INCONSISTENT - It doesn't have to add much in order to be added. Most elements of the article do not in themselves add much. Qijong certainly does't add much if anything at all, yet it gets two paragraphs ! Obvious inconsistency there.

I see negative conclusions but nothing at all to back it up. The response has been very unscientific. So I will take the assessment of this issue further before more qualified people, so that a logical and scientific conclusion is reached.

All of the forms of Parkinsonism should be dealt with under Parkinsonism. However, they should all at leat receive a mention on the Parkinson's Disease article, even if it is just one word, otherwise people wouldn't even be aware of them in order to get more information on the Parkinsonism article.

The Parkinson's Disease article is probably at present the worst medical article on Misplaced Pages. Anything beyond trivial is reverted or falsely described as vandalism. Significant improvements are never made. It is very badly organised. Most of it is not susbtantiated, and never could be. Much of it is worse than it was months ago. Amongst people I know that have or are involved in Parkinson's Disease it is completely discredited due to its numerous fallacies, inadequacies and inconsistencies. Nobody I know thinks it even worth using it. Until there is a fundamental change in attitudes amongst those people that have chosen themselves as editors that is exactly how it will remain.

--Gerard Doyle 21:51, 12 October 2006 (UTC)

I would suggest, therefore, "Gerard", that you go and do your own site, so you can do it to your own satisfaction and standards, and leave us to our collective incompentence. --Dan 22:18, 12 October 2006 (UTC)

Well "Dan", I don't think it fair of you to describe your own efforts as "incompetence" because when added up you have hardly added anything in order to be incompetent. On most articles people make their contributions and move on. Instead, you don't make contributions yet still linger. If you have something to add, why haven't you added it. If you don't have anything to add, why are you still hanging around ? I am really baffled by this. --Gerard Doyle 23:59, 12 October 2006 (UTC)

More on hydrocephalus

I think Dan, Paul, Andrew and some others are waiting for the evidence that you are not a Tojo sock, so they will find it a tad easier to WP:AGF, like I have attempted to do without much positivity from you (e.g. I unblocked you despite strong negative vibes).

To respond to your above further hydrocephalus rant:

1. Be honest: how many cases of hydrocephalus are complicated by parkinsonism (don't refer us to the sources, I want a figure straight from you).
2. Can you cite us one scenario where the pathogenesis of Parkinson's disease (not "parkinsonism") has been elucidated significantly due to findings related to hydrocephalus?
3. Hydrocephalus doesn't add that much to the article. I stand behind that statement; it adds less to the article than MPTP. I have already outlined above that hydrocephalus requires no mention if it is not part of the "general" differential diagnosis of PD and doesn't shed light on its pathogenesis. These are simple principles that other editors will agree with. I fail to understand why you're pushing so hard in the absence of really good grounds for inclusion.

As stated, good articles grow by consensus. Please propose further significant changes here on the talkpage, and honour consensus when it emerges. Even the thorniest articles have been featured when opposing groups of editors managed to produce a consensus. JFW | T@lk 00:18, 13 October 2006 (UTC)

1. "Hydocephalus resulting in Parkinson's symptoms ?" - The references have already been provided.

2. "Hydrocephalus showing how Parkinson's is caused" - It doesn't have to show how Parkinson's is caused in order to be a form of Parkinsonism. Wilson's Disease doesn't yet you still list it.

3. "Hydrocephalus doesn't add much." - It doesn't have to in order to be included. Two paragraphs for Qijong !!! That doesn't add anything at all.

This isn't a discussion. All this involves is people trying to maintain the view they started out with regardless of how false or inconsistent it is. Opposing evidence is ignored. When one objection fails another is tried.

The article has not grown at all due to consensus. It hasn't grown, it has gotten worse. At present there are four persistent editors, none of whom have any expertise in Parkinson's Disease. None of them are neurologists, PD sepcialists, or have Parkinson's. They never add anything of any significance. They all agree with whatever each other suggests regardless of how blatantly false it is. They obstruct or revert any significant changes, all of which they spuriously describe as vandalism. Absolutely anyone who makes any significant changes is labelled a Sock Puppet- claimsthat often have to be subsequently reversed. In some cases you would really have to stretch the imagination to work out why. I was recently part of a thorough checkuser assessment. So I don't have to prove anything. Anyone who disagrees is described as negative or obstructive. The sum result of this is that the article is presently awful, full of errors, inconsistencies, inadequacies, and fanciful theories.

The reason why I persist with Hydrocephalus is that persistence is the only way any improvements will be made to this article. There are so many improvement that are needed, but it is obvious that every single one of them will be objected to without good reason.

It is now time to bring in people with more expertise in this subject in order to overcome the constant obstruction by this small majority of obviously allied editors, all of whom lack expertise in this subject. It is also time to bring to the attention of other Administrators how much obstruction is taking place.

--Gerard Doyle 12:29, 13 October 2006 (UTC)

I do have to begrudgingly agree with Doyle's point about the inclusion of qijong in previous edits. I can see his point that if qijong is going to be included, why not hydrocephalus? On the other hand, both qijong and hydrocephalus have the flair of "pet topics" favored by individual users rather than consensus.

Ultimately, the reason why this has been a difficult discussion is that, alas, any contribution by a Tojo sock puppet is viewed with extreme prejudice, and why would it not be, given his previous antics and drama.

(Incidentally, contrary to Doyle has been suggesting , I don't think that check user has actually exonerated Doyle from being a sock puppet. Now whether or not all Tojo sock puppets should be categorically barred from contributing is a separate matter.) Andrew73 13:23, 13 October 2006 (UTC)

"I don't think that check user has actually exonerated Doyle from being a sock puppet." It hasn't exonerated you either !

The following is the rational, consistent, concise and comprehensive approach :

Physical exercise

Regular physical exercise and/or therapy, including in forms such as yoga, tai chi, Qijong and dance can be beneficial to the patient for maintaining and improving mobility, flexibility, balance and a range of motion.

Parkinsonism

Other medical disorders can sometimes cause some or all of the symptoms of Parkinson's Disease. These include Wilson's Disease, Vascular Parkinsonis, Essential Tremor, Hydrocephalus, etc, ect. For full article see .

--Gerard Doyle 13:35, 13 October 2006 (UTC)

The reason why there is two paragraphs on qiqong is not because it is a pet theory of mine. The reason is that you (or whichever account you were using, my mind grows weary) deleted it out of hand because you said it was unsourced. So I went and found some recent, relatively sound studies stating what the evidence was. If only you would act like this instead of reverting, deleting, wikilawyering, and being abusive, perhaps you would have been taken more seriously in the past. But the truth is this: as GT and his various incarnations you were disruptive, abusive, and made physical threats against editors. You are banned. So feel free to say whatever you want on viartis.net or dopavite.com, heck even Braintalk 2. But on Misplaced Pages there are rules. You violated them, so you're not welcome. --PaulWicks 16:02, 13 October 2006 (UTC)

It was good to have found the evidence concerning Qijong. However, it is excessive to include two paragraphs on something like Qijong. References (for example ) are appropriate. That is what is done throughout the rest of the article when providing evidence, but with Qijong has not been done.

Jfdwolff asked "Please propose further significant changes here on the talkpage" yet has just made changes without adhereing to his own request. That is solely the reason for the recent revert. Rules and customs should apply equally to everyone.

Due to the investigation that has been initiated, you will soon be finding out from Administrators that you are breaching the very rules you claim should be adhered to. Besides risking sanctions yourself, it will not look good if you intend to apply to be an Administrator again. --Gerard Doyle 16:22, 13 October 2006 (UTC)

EDIT HISTORY : PaulWicks for three months, from July to October

Reverts and deletes : 22

Contributions : two paragraphs on Qijong !

The record shows that you don't actually contribute anything. If you have something to contribute, why don't you add it ? If you have nothing to contribute, why are you lingering endlessly ? Most genuine editors make their contributions and then move on to the next article. --Gerard Doyle 16:11, 14 October 2006 (UTC)

I think this troll-feeding has gone on long enough. Bye Keith. --PaulWicks 21:48, 14 October 2006 (UTC)

I'm really baffled. Why do you always linger around a site that you never contribute to ? --Gerard Doyle 22:31, 14 October 2006 (UTC)

Vascular Parkinsonism

Vascular parkinsonism is produced by one or more small strokes that affect the basal ganglia. A stroke is the loss of activity of a discreet brain area (lesion) because of blockage of the blood supply to that brain region. Vascular diseases are associated with a higher prevalence of Parkinson's Disease . There are three different pathologic states that produce Vascular Parkinsonism (VP), including multiple lacunar infarctions in the basal ganglia area , subcortical arteriosclerotic changes (Binswanger's disease) and a single vascular lesion that present a clinical picture indistinguishable from Parkinson's disease . Parkinson's Disease symptoms occur in Vascular Parkinsonism . However, resting tremor is either reduced , or absent . Only a minority, but a large minority, of people with Vascular Parkinsonism respond to L-dopa .

Archives of Neurology 63 (5) : 717-722 (E.D.Louis, J.A.Luchsinger)

Journal of Neurology 253 (Supplement 3) : iii16-iii21 (K.Fukimoto)

Journal of Neurology 251 (5) : 513-524 (I.Sibon, G.Fenelon, N.P.Quinn, F.Tison)

Journal of Clinical Neuroscience 8 (3) : 268-271 (S.Peters, E.G.Eising, H.Przuntek, T.Muller)

Di Yi Jun Yi Da Xue Xue Bao 25 (7) : 868-870 (D.Q.Zhao)

Archives of Neurology 56 (1) : 98-102 (J.Winikates, J.Jankovic)

Acta Neurologica Scandinavica 86 (6) : 588-592 (C.M.Chang, Y.L.Yu, H.K.Ng, S.Y.Leung, K.Y.Fong)

Stroke 28 (5) : 965-969 (H.Yamanouchi, H.Nagura)

Journal of Neurology 252 (9) : 1045-1049 (LRampello, A.Alvano, G.Battaglia, R.Raffaele, I.Vecchio, M.Malaguarnera)

Journal of Neurological and Neurosurgical Psychiatry 75 (4) : 545-547 (J.C.Zijlmans, R.Katzenschlager, S.E.Daniel, A.J.Lees)

Acta Neurologica Scandinavica 104 (2) : 63-67 (M.Demirkiran M, Bozdemir H, Sarica Y.)

Movement Disorders 11 (5) : 501-508 (J.C.Zijlmans, P.J.Poels, J.Duysens, J.van der Straaten, T.Thien, M.A.van't Hof, H.O.Thijssen, M.W.Horstink)

--Gerard Doyle 21:12, 14 October 2006 (UTC)

You have already been informed that causes of parkinsonism should not be listed here unless part of the GENUINE differential diagnosis of Parkinson's disease. Just listing papers will not help you - this shows that you are good at copying & pasting from an inexhaustible list of articles. You can't even be bothered to list the names of papers or their PMID code. All other editors manage (or at least try) to do that. JFW | T@lk 19:33, 15 October 2006 (UTC)

Manganese and Pproctor

Gerard is right, I should have explained here why I removed the section about manganese poisoning. It's for the same reason his own work gets reverted: it is not common, does not normally form part of the differential diagnosis of PD, and furthermore it is the work of an editor who likes to link to his own website to support his edits. There were no objections when I removed it earlier (apart from Gerard), so I suspect my repeated removal will be accepted without much problems. JFW | T@lk 19:33, 15 October 2006 (UTC)

Sprotection

AjaxAmsterdam (talk · contribs) deleted a paragraph in the "toxic causes" section with no explanation. I have reverted for now. If we get further new/red user vandalism I suspect we'll need to get the article semiprotected again. JFW | T@lk 22:37, 16 October 2006 (UTC)

External links review

Just checking up on the article and I noticed that the External links section has grown out of control. I've removed all of the following links:

• European Parkinson's Disease Association
• Parkinson Society Canada
• Parkinson's Disease Foundation
• Parkinson's Action Network
• Hope For A Cure Foundation for Parkinson's Research
• Dr. Abe Lieberman's Ask the Doctor Parkinson Forum
• National Parkinson Foundation, Inc.
• American Parkinson's Disease Association
• Michael J. Fox Foundation for Parkinson's Research
• Parkinson's Disease Society (UK)
• Parkinson's NSW (In AUS)
• 'Investigating Parkinson's Disease' Dr Brigit Liss Freeview 'Snapshots' video by the Vega Science Trust and the BBC/OU.
• MyParkinsonsInfo.com
• The PD Webring
• WEMOVE: Worldwide education and awareness for movement disorders
• NETRP Web site
• Northwest Parkinson's Foundation
• Parkinson's Resources on the WWWeb
• Parkinson's Disease Pictures
• Parkinson's Drug Comparison Chart (PDF)
• International Society for Posture and Gait Research (ISPGR)
• HollyRod Foundation
• Lee Silverman Voice Therapy

and replaced them with a link to the Open Directory Project (formerly Dmoz) which suggests editors submit their links there and {{NoMoreLinks}} to force new editors to post new links here for review first. So what links should this article contain as an encyclopedia article and not a web directory per the Misplaced Pages:External links policy? --  Netsnipe  ►  20:01, 23 October 2006 (UTC)

Interesting question. This is not an advocacy site, of course, but laypeople may well come here for further information, and might appreciate having links to further information. I suspect that's the thinking behind the lists of links, but I agree with your point that this is an encyclopedia, and there are plenty of link farms out there on the net. So as an encyclopedia, what would be best? I dunno, maybe a link to current review articles such as the extanisve UK government review on toxins & PD (don't have the URL handy, sorry - it's in VOLUME 114 | NUMBER 2 | February 2006 • Environmental Health Perspectives, and is about 170 pages long. Or a research consortium site, like CCPDER? Links make me uneasy - it's altogether too easy to get into spamming problems. --Dan 22:39, 23 October 2006 (UTC)

Web sites can serve two purposes : practical assistnce for patients, or more extensive information on Parkinson's Disease.

Practical information is offered by the national or international Parkinson's Disease organisations. Most countries have one and are listed on either the World or European sites. The USA has four, some of which are not affiliated to the World organisation. The following therefore covers by at least one means all of the national and international organisations :

• World Parkinson's Disease Association
• European Parkinson's Disease Association
• Parkinson Society Canada
• Parkinson's Disease Society (UK)
• American Parkinson's Disease Association
• Parkinson's Disease Foundation
• Parkinsons Research Foundation
• National Parkinson Foundation, Inc.

The following is accounted for by the Parkinsons Research Foundation and so need not be included :

• Dr. Abe Lieberman's Ask the Doctor Parkinson Forum

The Michael J.Fox site is not one of these organisations, but due to its renown some people may consider it worth including :

• Michael J. Fox Foundation for Parkinson's Research

The following adds more information on Parkinson's Disease drugs than exists in the article :

• Parkinson's Drug Comparison Chart (PDF)

The rest add nothing to the article, as they are either for fundraising, dead links, lesser sources of information on Parkinson's Disease, only regional organisations or odd treatments :

• Parkinson's Action Network
• Hope For A Cure Foundation for Parkinson's Research
• Parkinson's NSW (In AUS)
• 'Investigating Parkinson's Disease' Dr Brigit Liss Freeview 'Snapshots' video by the Vega Science Trust and the BBC/OU.
• MyParkinsonsInfo.com
• The PD Webring
• WEMOVE: Worldwide education and awareness for movement disorders
• NETRP Web site
• Northwest Parkinson's Foundation
• Parkinson's Resources on the WWWeb
• Parkinson's Disease Pictures
• International Society for Posture and Gait Research (ISPGR)asking
• HollyRod Foundation
• Lee Silverman Voice Therapy

--Professor Rizzo Naudi 23:57, 23 October 2006 (UTC)

Thanks for reviewing the links Naudi. The only one I haven't restored to the page is Michael J. Fox's Foundation. I have some reservations that including it will introduce a slippery slope with other advocacy groups arguing that it's unfair to exclude them while MJF's Foundation is listed. Thoughts? --  Netsnipe  ►  10:34, 24 October 2006 (UTC)

Personally I wouldn't include it because (1) it does not add further information that is not contained in the article, and (2) is not one of the national organisations. Some people will have a different opinion, and at some point other people will inevitably propose adding it, largely because it is well known. --Professor Rizzo Naudi 12:02, 24 October 2006 (UTC)

Then again it can easily be found through MJF's own entry on Misplaced Pages, and is eminently Googlable. So I don't think we detracting from anything here, and as you say there is the risk of a slippery slope. In something like ALS it's not such a big deal as there are only a handful of organisations worldwide. --PaulWicks 17:46, 24 October 2006 (UTC)

Hitler's PD

Media anthro (talk · contribs) removed mention of Adolf Hitler. Unfortunately media anthro is a new user, and was reverted by the VoAbot II (which watches this article). I think there is no concensus amongst "paleo-physicians" (doctors who like to diagnose illness in dead white men) that Hitler had PD, but some evidence is definitely present.

We have a whole article discussing Hitler's health at Adolf Hitler's medical health, which is a bit low on evidence. However, PMID 10053222 and PMID 1484538 go quite a way into strengthening the case. Perhaps we should indeed make the wording a bit more tentative. JFW | T@lk 09:44, 26 October 2006 (UTC)

Adolf Hitler definitely had Parkinson's Disease. His personal physician Dr Theo Morell kept diaries in which he kept full details all of Hitler's symptoms and treatments. Amongst a variety of illnesses and treatments, he had the symptoms of well progressed Parkinson's Disease, and was taking medicines that were used at the time for Parkinson's Disease. The diaries were published as "Adolf Hitler : The medical diaries" (Theo Morell). A documentary concerning Hitler's health called "Hitler : Dead men talking" shows film of Hitler's progressing Parkinson's Disease that first becomes apparent in 1933. Hitler's Parkinson's Disease was never disclosed publicly, and film that exists showing his symptoms was never used publicly. However, there is still a lot of film showing his symptoms. The last piece of film of HItler was when he inspected Hitler Youth outside his bunker just before he comitted suicide. There are actually two versions of this film - one that was made public that did not show his tremor, and another that was not made public that did show his tremor. --Professor Rizzo Naudi 13:44, 26 October 2006 (UTC)

Side Effects Of Drugs

Following the L-DOPA section, there is a section on dopamine agonists with the following line:

These have their own side effects including those listed above in addition to somnolence...

There is nothing listed "above" in that section or, as far as I can tell, in the L-DOPA section. I presume the general side effects would include hyperkinesias, and this should probably be stated. I'm not adding myself because I have no reference available. SJS1971 13:16, 1 November 2006 (UTC)

Tardive dyskinesias, hallucinations, and possibly dopamine dysregulation syndrome would be obvious ones to start with. Also there is a feeling that the sooner one starts dopaminergic medications the sooner their benefits will wear off. I'm a bit stretched for time at the moment, anyone else feel like having a crack at these? --PaulWicks 13:32, 1 November 2006 (UTC)

Surgery

When I found the article today, the surgery section seemed to underplay the research in this area. My own sense (but as an academic, not a medical professional) is that there is increasing excitement about pallidotomy and other surgical interventions. I have added just a small bit to the surgery section and provided references but would be happy to have someone else look over and add to it if justified. SJS1971 13:37, 1 November 2006 (UTC)

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