Medical Malpractice. A Preventive Approach

receptors, the in vivo imaging of dopamine and its receptors, the discovery of new dopamine agonists, the surprise revelation that the relatively simple neurotoxin 1-methyl-4-phenyl-1,2,5,6-tetrahydropyridine (MPTP) is an etiologic factor of parkinsonism in humans, and the development of novel approaches to bromocriptine therapy. The volume is divided into six main sections: anatomy, biochemistry, and pathology; imaging of dopamine and receptors; MPTP-induced Parkinsonism; pharmacology and long-term treatment; use of bromocriptine in Parkinson's disease; and use of other dopamine agonists in Parkinson's disease. The first section covers the heterogeneities of the dopaminergic mechanisms in the striatum, the anatomy of the dopamine subsystems, and recent discoveries in the neuropathology and neurochemistry of parkinsonism. The next section may very well represent the first publication of progress in using the most up-to-date imaging techniques, such as positron emission tomography (PET) scanning, to examine dopamine metabolism, uptake, and receptor binding in the living brain of patients with Parkinson's disease. The third section assesses the relevance of MPTP-induced parkinsonism as a model for the human disease, reviews novel animal models under investigation, and suggests feasible mechanisms of MPTP neurotoxicity. The last three sections should stimulate fresh clinical approaches to the therapy of Parkinson's disease. Chronic levodopa therapy often results in complications in many patients. Featured are animal studies that are furthering our understanding of the consequences of the long-term use of levodopa and dopamine agonists. The pharmacokinetics of short-term intraveneous levodopa and dopamine agonists are covered, as well as guidelines on the use of bromocriptine in Parkinson's disease, and clinical results of newer dopamine agonists, including pergolide, mesulergine, and lisuride. The editors can be applauded for their successful attempt in compiling a muchneeded, informative, comprehensive, and up-to-date publication of the major breakthroughs in the understanding and therapy of Parkinson's disease. The figures, tables, and color plates of imaging studies are well-designed and help to clarify the concepts and findings. The references are extensive and useful. Since the articles are rigorous in their scientific detail, the volume may not be appropriate for the layperson; instead, it may be best appreciated by readers who are familiar with basic neuroanatomy and neuroscience and are interested in Parkinson's disease, movement disorders, and dopamine neurotransmission. The many, many pressing questions that remain unanswered will undoubtedly stimulate further research and improvements in the therapy of Parkinson's disease.