Enhancing Diagnosis and Seeking Disease-Modifying Treatments

In the nearly 5 years since we celebrated the 50-year anniversary of the introduction of levodopa therapy, much progress in movement disorders has been made. This is particularly true in the diagnostic realm as advanced technology such as dopamine transporter (DaT) scanning and genetic studies have become more widely available in the clinical realm.

For treatment for Parkinson disease (PD), new ancillary pharmacologic agents and formulations have been developed to address the motor fluctuations that eventually arise with levodopa treatment. People with late-stage PD now have a specific treatment available for troublesome symptoms of psychosis. However, more detailed, granular diagnosis is needed to make optimal use of such treatments as discussed by Dashtipour et al. in Parkinson Disease ICD-10-CM Coding.

Although levodopa is among the most successful and cost-effective neurologic treatments, it does not reduce or prevent the loss of dopaminergic neurons that is the hallmark of PD. The etiology of PD remains an area of intensive investigation from many perspectives. The potential role of inflammatory and immunologic mechanisms for the development of PD are ably reviewed in Neuroinflammation in Parkinson Disease, authored by Witek, Keshavarzian, and Hall, who also discuss the potential of Immunomodulators for Parkinson Disease, which have been evaluated or are being evaluated in myriad clinical trials.

Other movement disorders also lack disease-modifying treatments, particularly with the disappointing termination of studies of antisense oligonucleotide therapy for Huntington disease. Where causative genetic mechanisms are known, such as in Wilson Disease, covered by Brooker, Mishra, and Bega, new therapeutic approaches continue to develop and studies addressing how to definitively correct the causative mutations may yet bear fruit.

We thank the contributing authors for bringing light to some of the pressing issues in the field and hope you will find value in these reviews.