Continuum : lifelong learning in neurology
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Dopaminergic agents remain the principal treatments for patients with Parkinson disease (PD). In many patients, however, a combination of relatively resistant motor symptoms, motor complications such as dyskinesias, or nonmotor symptoms such as dysautonomia may lead to substantial disability in spite of dopaminergic therapy. This chapter will review both dopaminergic and nondopaminergic therapies for motor and nonmotor symptoms in PD. ⋯ In addition, there has been an increasing interest in agents targeting nonmotor symptoms, such as dementia and sleepiness. As patients with PD live longer and acquire additional comorbidities, addressing these nonmotor symptoms has become increasingly important. In this chapter, the major antiparkinsonian dopaminergic compounds will be reviewed, followed by a patient-focused guide to implementation of these treatments as part of an overall management plan.
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The significant contribution of genetic research has resulted in substantial progress in our understanding of the pathophysiology of movement disorders. This will allow for earlier diagnosis of patients with the potential to influence future therapeutics. However, given the complicated patterns of inheritance and consequences for successive generations, a review of the current state of knowledge as well as basic genetic principles is important. In this review we will discuss current classification systems, and clinical and neuropathologic features of the major genetic etiologies for Parkinson disease, dystonia, chorea, and ataxia.