Movement Disorders Aims for Precision

Movement disorders continues to be an exciting dynamic area as reflected by ongoing pharmaceutical refinements and more sophisticated neuroimaging approaches. These advances further improve our ability to maximize precision of diagnoses and clinical outcomes for people with Parkinson’s disease, atypical parkinsonisms, Huntington’s disease, and tardive dyskinesia. Even more exciting, is the potential actualization of true disease-modifying treatment through the application of advanced molecular genetic technologies.

In this issue, Zehra Farzal, Guillaume Lamotte, and Laxman Bahroo highlight a panoply of pharmaceutical options we now have in our armamentarium to alleviate various manifestations of Parkinson’s disease, Huntington’s disease and tardive dyskinesia. The pharmacologic mechanisms of many of these strategies are well understood so our readers will readily appreciate the applicability of information contained in these pharmacologic articles.

Catherine Gallagher surveys the various neuroimaging approaches at our disposal for refinement of movement disorder diagnosis. Imaging reflective of underlying biochemical, cellular, and structural changes induced by movement disorders reveals clues for diagnosis. Although imaging generally cannot render a specific diagnosis of a movement disorder, the imaging findings coupled with clinical features can improve the precision of diagnosis.

The exciting potential of new technologies for gene therapy is covered by Amber Van Laar and Victor Van Laar for mRNA-directed therapy, and Frederick Hitti provides an update on advances in DNA-targeted gene therapy for movement disorders. Drs. Van Laar’s extensive discussion of antisense oligonucleotide approaches to neurologic disorders provides a roadmap for this rapidly evolving therapeutic space. Hopefully, it will not be very long before we begin to see the direct clinical application for treatment of some of the most difficult neurodegenerative movement disorder space, such as Huntington’s disease.

Dr. Hitti’s article provides a detailed review of molecular genetic approaches, specifically applicable to Parkinson’s disease. Although these approaches have been studied for more than a decade, furthering application of this technology has been challenging on many fronts. Nonetheless, the field continues to advance, and it is expected that all physicians treating these disorders will need to become conversant in the promise that gene therapy holds.

We believe the areas we have highlighted in this issue will be of great interest to the general neurologist as well as those with a specific interest in movement disorders. Many of the technologies we discuss in this issue have been or are about to be more widely applied in other subspecialties in neurology. It behooves all neurologists to continue to learn as much as possible about all these evolving therapies. We are pleased to continue to participate in disseminating this information to our readers.