2017 saw the 200-year celebration of the description of Parkinson’s disease by James Parkinson, making this year is the first year of the third century to watch for more advances in this field.

In 1817 James Parkinson, an astute observer, described clinical features of Parkinson’s disease such as resting tremor (shaking), flexed posture, postural instability and festination (quicker and shorter steps when walking) in “an Essay on the Shaking Palsy”. Jean Martin Charcot, a French neurologist, later added more description on two other important features, namely rigidity and bradykinesia (slowness of movements).

Diagnosis

上面描述的这些特征对于当前临床实践中帕金森氏病的诊断仍然至关重要。Bradykinesia加上休息震颤，僵化和/或姿势构成英国帕金森氏病协会脑库临床诊断标准的核心特征。Bradykinesia是其中最重要的临床特征，尽管诊断帕金森氏病的诊断并不需要误解，因为大约1/5患者没有震颤。弯曲的姿势和姿势不稳定通常发生在疾病的后期。

While motor symptoms are the typically predominant features, and prompt most patients to seek medical attention, there are also non-motor features that are not less important. These include a wide variety of symptoms such as neuropsychiatric and cognitive features (e.g. depression, anxiety, memory impairment), olfactory dysfunction, sleep disturbances including REM sleep behavior disorder (acting out dreams during the REM sleep), gastrointestinal, urinary, sexual and autonomic dysfunction, among others.

Some of these features, especially olfactory dysfunction, constipation and RBD can even predate the motor symptoms of Parkinson’s disease, making them “premotor” or “prodromal” symptoms. Study of prodromal symptoms or early identification of Parkinson’s disease in the premotor stage has drawn a lot of attention to researchers to seek news to identify Parkinson’s disease as early as possible.

早期诊断的主要原因甚至在患者出现运动症状之前就要研究或采用改良疾病的疗法（可以延迟疾病进展的药物）早期干预。

如今，帕金森氏病仍然是临床诊断，这意味着该诊断主要基于临床评估，而不是详尽的研究。已经尝试使用其他方法来利用其他方法，例如神经影像（例如MRI或PET扫描）或其他生物标志物（例如血液，脑脊液，其他体液或组织）来增加诊断产量。但是，生物标志物研究仅在研究环境中进行，而不是在临床实践中进行的。

治疗

The landmark discoveries in treatment are the role of dopamine as a major responsible neurotransmitter and subsequent development of levodopa (Figure 3) therapy in the early 20^thcentury and its successful clinical application in 1967. While there are also other classes of medications in Parkinson’s disease treatment, for example, dopamine agonists, selective monoamine oxidase-B inhibitors, amantadine, and others, levodopa is still respected as the most effective symptomatic therapy for Parkinson’s disease.

Wide use of levodopa after 1967 led to emergence of additional clinical features in Parkinson’s disease, known as motor fluctuations. Two common forms of motor fluctuations include levodopa-induced dyskinesias (excessive involuntary writhing movements typically during the peak dose of levodopa) and wearing-off phenomenon (when levodopa does not work until the next dose).

尽管尚无治疗帕金森氏病的治疗方法，但该领域的基础科学研究非常活跃。

It is important to emphasize that this does不是意味着左旋多巴是有毒的，应该避免被某些人误解。取而代之的是，应将运动波动视为为患者工作的药物，但反应不如疾病的早期阶段那么光滑。该领域随后尝试通过连续的多巴胺能刺激（例如左旋多巴核肠凝胶）和深脑刺激来弥补这些运动并发症（例如which was already discussed in the blog by Dr. Ramdhani in 2016).

帕金森氏病的毒品正在进行中。几项进行的试验和新药物批准归因于先前已知的有效药物，尤其是Levodopa的新递送系统或配方。由于左旋多巴仍然是帕金森氏病运动症状的最有效的症状治疗，因此正在进行的一些试验集中在其不同的药物输送系统上，例如吸入的左旋多巴。

尽管尚无治疗帕金森氏病的治疗方法，但该领域的基础科学研究非常活跃。在发现路易体作为病理标志和α-突触核蛋白作为其主要成分以及发现帕金森氏病的几种遗传形式的主要成分之后，我们对帕金森氏病的发病机理有了很大的提高。

However, the most important question that remains to be answered, as in all neurodegenerative disorders including Alzheimer’s disease, is “what is the major cause or trigger of neurodegeneration in Parkinson’s disease?” I strongly believe that the closer we are to the answer to this question, the closer we are to the curative treatment of Parkinson’s disease. This is our goal in this third century!