Medical Management of Parkinson's Disease in the Early, Mid and Advanced Stages

In 1817, 200 years ago James Parkinson’s published an essay on “shaking palsy” - the first scientific description of this disease. 1 Today, Parkinson’s disease (PD) is the second most common neurodegenerative disorder with a natural history of gradual but relentless progression. The basic pathophysiology of the disease is of dopamine depletion, which explains the major motor manifestations. So a simple solution would be to replenish dopamine. Levodopa, a synthetic precursor of dopamine, was discovered 140 years later. 2 It got converted to dopamine in the brain and helped in dramatic improvement in symptoms of PD. But, not all apparently simple looking problems have simple solutions. Some have deep rooted enigmas which unfold with time, and it so happened with PD. We discovered gradually that Levodopa had its own set of complications, and following Braak’s staging, it was revealed that PD actually begins in non-dopaminergic cells opening other treatment targets.