Parkinson's Disease: Current and Future Therapeutics and Clinical Trials

Parkinson's disease is no longer considered only a motor disorder. It has become evident that the pathological changes are broad, the progression seems to follow a pattern suggesting transynaptic transmission via templation of proteins in a prion-like fashion, and that these pathological changes usually antedate the motor symptoms by decades. This book emphasizes treatment options for Parkinson's disease, critically assessing pharmacologic and surgical interventions for all aspects of the disease. Evidence from randomized controlled clinical trials is highlighted to develop practical recommendations for clinical practice. Lessons learnt from clinical trials – and controversies and future challenges – are all addressed. Readers will find the necessary clinical and scientific foundations for the understanding of the disease, the underpinnings of the pathological processes, the identification of disease biomarkers, and the basis for solid therapeutics. Chapters are authored by an international team of specialists who bring their expertise to improving the management of this disease.

    Covers the full range of therapeutic options for Parkinson's disease - medical and surgical - and compares their effectiveness
    Treatment advice based on evidence from clinical trials rather than expert opinion
    Also looks at areas of controversy where therapeutic options are less clear-cut, making it useful for patients unsuitable for traditional therapies

Table of Contents

Part I. The Pharmacological Basis for Parkinson's Disease Treatment:
1. The pharmacological basis of Parkinson's disease therapy: an overview
2. Anticholinergic agents in the management of Parkinson's disease
3. Amantadine and antiglutamatergic drugs in the management of Parkinson's disease
4. Monoamine oxidase inhibitors in the management of Parkinson's disease
5. Oral dopamine agonists in the anagement of Parkinson's disease
6. Subcutaneous, intranasal and transdermal dopamine agonists in the management of Parkinson's disease
7. Oral and infusion levodopa therapy in the management of Parkinson's disease
8. Catechol-O-methyltransferase inhibitors in the management of Parkinson's disease
9. Experimental pharmacological agents in the management of Parkinson's disease
Part II. Management of Non-Motor Symptoms of Parkinson's Disease:
10. Management of autonomic dysfunction in Parkinson's disease
11. Management of cognitive impairment in Parkinson's disease
12. A neurobehavioralist approach to the management of cognitive impairment in Parkinson's disease
13. Management of disease-related behavioral disturbances in Parkinson's disease
14. Management of treatment-related behavioral disturbances in Parkinson's disease
15. Management of sleep disorders in Parkinson's disease
16. Management of pain and euromuscular complications in Parkinson's disease
Part III. Surgical Management of Parkinson's Disease:
17. Thalamotomy, pallidotomy and subthalamotomy in the management of Parkinson's disease
18. Deep brain stimulation of the globus pallidus internus in the management of Parkinson's disease
19. Deep brain stimulation of the subthalamic nucleus in the management of Parkinson's disease
20. Deep brain stimulation of the thalamic ventral intermediate nucleus in the management of Parkinson's disease
21. Emerging targets and other stimulation-related procedures in the management of Parkinson's disease
Part IV. Clinical Trials in Parkinson's Disease: Lessons, Controversies and Challenges:
22. Rating scales and clinical outcome measures in the evaluation of patients with Parkinson's disease
23. Functional imaging markers as outcome measures in clinical trials for Parkinson's disease
24. Cerebrospinal fluid and blood biomarkers as outcome measures in clinical trials for Parkinson's disease
25. Lessons learned: neuroprotective trials in Parkinson's disease
26. Lessons learned: symptomatic trials in early Parkinson's disease
27. Controversy: GPi vs STN deep brain stimulation in the management of Parkinson's disease
28. Controversy: ablative surgery vs deep brain stimulation in the management of Parkinson's disease
29. Controversy: mid-stage vs advanced stage deep brain stimulation in the management of Parkinson's disease
30. Lessons and challenges of trials for cognitive and behavioral complications of Parkinson's disease
31. Lessons and challenges of trials for other non-motor complications of Parkinson's disease
32. Lessons and challenges of trials involving ancillary therapies for the management of Parkinson's disease
Index.

Nestor Galvez-Jimenez, Cleveland Clinic, Weston
Nestor Galvez-Jimenez MD is Professor of Medicine (Neurology-Florida) at Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, and Pauline M. Braathen Endowed Chair, Director of the Neurological Center, Chief of the Movement Disorders Unit, and Chairman of the Department of Neurology, at Cleveland Clinic Florida, Weston, FL, USA.

Hubert H. Fernandez, Cleveland Clinic, Cleveland
Hubert H. Fernandez is Head of the Division of Movement Disorders at the Department of Neurology, Cleveland Clinic, Cleveland, OH, USA.

Alberto J. Espay, University of Cincinnati
Alberto J. Espay is Associate Professor of Neurology, Director, and Endowed Chair at the James J. and Joan A. Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati Academic Health Center, Cincinnati, OH, USA.

Susan H. Fox, Toronto Western Hospital
Susan H. Fox is Associate Professor of Neurology at the University of Toronto, Associate Director of the Movement Disorders Clinic at Toronto Western Hospital, and Staff Neurologist in the Division of Neurology, Department of Medicine, University Health Network, Toronto, Canada.
Contributors

Néstor Gálvez-Jiménez, Hubert H. Fernandez, Alberto J. Espay, Susan H. Fox, Juan Carlos Giugni, Ramon L. Rodriguez-Cruz, Marco Onofrj, Valerio Frazzini, Laura Bonanni, Astrid Thomas, Sven-Eric Pålhagen, Javier Pagonabarraga, Juan Marín-Lahoz, Jaime Kulisevsky, Antoniya Todorova, K. Ray Chaudhuri, M. Angela Cenci-Nilsson, Per Odin, Ilana Schlesinger, Amos D. Korczyn, Krishe Menezes, Lawrence W. Elmer, Robert A. Hauser, Shen-Yang Lim, Ai Huey Tan, Dawn M. Schiehser, Eva Pirogovsky-Turk, Irene Litvan, Po-Heng Tsai, Joseph H. Friedman, Mayur Pandya, Dimitrios A. Nacopoulos, Naveed Khokhar, Daniela Calandrella, Alberto Albanese, John A. Morren, Malco Rossi, Daniel Cerquetti, Jorge Mandolesi, Marcelo Merello, Lilia C. Lovera, Andrew P. Duker, David A. Schmerler, Diana Apetauerova, Jay L. Shils, Peter K. Dempsey, Tiago A. Mestre, Elena Moro, Pablo Martinez-Martin, Carmen Rodriguez-Blazquez, Ryan R. Walsh, Thomas F. Tropea, Claire Henchcliffe, Isabelle Beaulieu-Boire, Anthony E. Lang, Ramon Lugo-Sanchez, Sarah K. Bourne, Sean J. Nagel, Darlene A. Lobel, Gian D. Pal, Leo Verhagen Metman, David Mallory L. Hacker, David Charles, Daniel Weintraub, Lama M. Chahine, Federico E. Micheli, Carlos Zúñiga-Ramírez, Chris J. Hass, Elizabeth L. Stegemöller, Madeleine E. Hackney, Joe R. Nocera