Rajesh Pahwa

Prognostic significance of the onset mode in parkinsonism

Early recognition of the prognosis in parkinsonism is important for both the management and studies aimed at preventing progression of disease. Less favorable prognosis is reported in early-onset postural instability and gait difficulty (PIGD) than in the tremor-onset cases, but the reasons for this are unknown. In 70 autopsy-verified cases, 11 (15.7%) had PIGD, and 34 (49%) had tremor onset. Improvement on levodopa was more common in the tremor- than the PIGD-onset cases (p < 0.05). The majority of tremor-onset cases had Lewy body disease, while the majority of PIGD-onset cases had other forms of pathology. Survival was shorter in the PIGD- than the tremor-onset cases (p < 0.05).

Handbook of Parkinson's Disease, Fourth Edition

The new edition of this book is a comprehensive update on one of the most common and complex neurodegenerative diseases. The handbook comprises an extensive list of chapters, addressing all elements of Parkinson disease. Each chapter is sufficiently detailed with an extensive list of references for further reading. The chronology of chapters is well arranged from history to epidemiology, followed by pathophysiology, diverse clinical manifestations and comorbidities, neuroimaging techniques, animal models, genetics, and, last but not least, comprehensive medical and surgical management along with ancillary therapies for Parkinson disease. The list of contributors is a “Who’s Who” in movement disorders composed of authoritative experts, extensively published in their respective areas of expertise, which is reflected in the state-of-the-art reviews. The chapters on neuropathology, neurochemistry of nigral degeneration, neurophysiology, and neuron circuitry along with animal models offer insight into basic science aspects of Parkinson disease. A clinician looking for practical insight into therapies and new advances will be enthralled by the chapters addressing medical and surgical management. The chapter on investigational pharmacologic treatments provides insight into new drugs being studied in clinical trials which should be of great interest both to practicing neurologists as well as fellows in training. The section on deep brain stimulation provides a systematic approach for patient selection criteria; advantages and disadvantages of each deep brain stimuation lead location are discussed along with complications of surgery, hardware, and programming. To summarize, this is a comprehensive manual written by excellent authors in an organized, readable format that should provide updated basic science and clinical information for both general neurologists as well specialists in movement disorders. Prose Illustrations Science Usefulness