Pharmacological treatment of Parkinson's disease.

Parkinson’s disease is a neurodegenerative disorder of unknown cause. Age is the most consistent risk factor and incidence in the general population over 75 years of age is 254:100 000. With an aging population the management of Parkinson’s disease is likely to prove an increasingly important and challenging aspect of medical practice. Classically Parkinson’s disease presents with resting tremor, rigidity, and akinesia often in an asymmetric fashion, but later usually bilateral. However, initial symptoms may be subtle and vague, for example discomfort or mild stiVness in the limbs, and may be misinterpreted. Moreover clinical features are variable with some patients presenting with akinesia and rigidity only and others with a tremor dominant type. About 10%–20% of autopsy cases with a diagnosis of Parkinson’s disease were not considered to suffer from it in life. On the other hand, approximately 25% of patients with a diagnosis of Parkinson’s disease in life are shown to have a diVerent diagnosis when postmortem examination is carried out. 4 Diagnosis may thus be diYcult particularly as there are no biological markers that unequivocally confirm the diagnosis of Parkinson’s disease. The most common diVerential diagnoses are essential tremor, arteriosclerotic pseudoparkinsonism, drug induced parkinsonism, and the so-called Parkinson plus syndromes namely multiple system atrophy, 7 progressive supranuclear palsy, 9 and corticobasal degeneration.