Parkinson's Disease: Diagnosis & Clinical Management : Second Edition (Google eBook)

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Demos Medical Publishing, Dec 15, 2007 - Medical - 819 pages
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Parkinson's disease (PD) is the second most common neurodegenerative disease in the world. Still the only major text on the subject, the completely revised and updated second edition of Parkinson's Disease: Diagnosis and Clinical Management comes at a time when specialists have made important advances in our understanding of the etiology, pathogenesis, investigation, and management of Parkinson's disease.

The book includes 23 completely new chapters, and has updated information on:

  • Genetics
  • Pathology
  • Biomarkers
  • Pathogenesis
  • Impulse control disorders in Parkinson's disease
  • Updated outcome measures
  • Complementary and alternative medicine for the treatment of Parkinson's disease

Together the chapters form a comprehensive review of the many issues facing PD physicians today. Lucid and easily readable from beginning to end, each chapter may also stand on its own as a scholarly review of the individual subject. Each one is concisely written and heavily referenced for this purpose.

The second edition of Parkinson's Disease: Diagnosis and Clinical Management provides a state-of-the-art review of where we've been, where we are now, and where we are going in treating this disease.

  

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Contents

SPECIES SUSCEPTIBILITY
INTRANIGRAL SELECTIVE VULNERABILITY
EPIDEMIOLOGIC INVESTIGATIONS
CONCLUSIONS
References
NATURE AND COURSE OF PARKINSONS DISEASE
Environment and Parkinsons Disease
THE ROTENONE MODEL IN RATS

Parkinsons Disease
CHARCOT AND PARKINSONS DISEASE
CHARCOT AND PARKINSONS DISEASE
Etiology and Natural Progression
Treatment
CHARCOT AND PARKINSONS DISEASE
References
References
II
SELECTION OF LOCATION AND POPULATION
INCIDENCE OF PARKINSONS DISEASE
PREVALENCE OF PARKINSONS DISEASE
References
EARLY NONSPECIFIC FEATURES
CORRELATION BETWEEN SYMPTOMS AND PATHOLOGIC STAGES OF PARKINSONS DISEASE
CARDINAL MOTOR FEATURES OF EARLY PARKINSON DISEASE
Rigidity
Bradykinesia
Postural Instability and Gait Disturbance
THE DIFFERENTIAL DIAGNOSIS OF PARKINSONS DISEASE
MultipleSystem Atrophy
NEUROIMAGING IN THE DIAGNOSIS OF EARLY PD
References
GAIT DISTURBANCE AS PART OF THE CLINICAL SYNDROME
ASSESSMENT OF GAIT
Locomotion
Festinating Gait
TREATMENT OF PARKINSONIAN GAIT
REHABILITATION OF GAIT DISTURBANCES
FUNCTIONAL NEUROSURGERY FOR GAIT DISTURBANCES
FREQUENCY LOCATION AND QUALITY OF SOMATOSENSORY SYMPTOMS
PATHOPHYSIOLOGY OF SENSORY DYSFUNCTION
DOPAMINERGIC MODULATION OF NOCICEPTION AND PARKINSONS DISEASE
OLFACTORY SYMPTOMS IN PARKINSONS DISEASE
TREATMENT OF SENSORY SYMPTOMS IN PARKINSONS DISEASE
References
SPEECH AND VOICE CHARACTERISTICS IN PARKINSONS DISEASE
Physiologic Studies of Respiratory Dysfunction in Parkinsons Disease
Articulatory and Velopharyngeal Disorders
IMPAIRED SENSORY AND HIGHLEVEL FUNCTIONS AS CAUSES OF HYPOKINETIC DYSARTHRIA
SWALLOWING DISORDERS
Physiologic Mechanisms Underlying Swallowing Disorders in Parkinsons Disease
TREATMENT
Brain Stimulation
Effects on Speech
Effects of Peripheral Surgery on Speech and Swallowing
Behavioral Speech Voice and Swallowing Treatment
CONCLUSION
Acknowledgment
OVERVIEW OF GASTROINTESTINAL MOTOR FUNCTION
HISTORIC BACKGROUND AND PRINCIPAL FEATURES
DYSPHAGIA IN PARKINSONS DISEASE
NAUSEA VOMITING DYSPEPSIA AND GASTRIC FUNCTION IN PARKINSONS DISEASE
AVAILABLE EVIDENCE AND FUTURE PROSPECTS
MANAGEMENT OF GASTOINTESTINAL COMPLICATIONS IN PARKINSONS DISEASE
CONCLUSION
IS DYSAUTONOMIA COMMON IN PARKINSONS DISEASE?
WHAT IS THE ETIOLOGY OF DYSAUTONOMIA IN PARKINSONS DISEASE?
WHY OBTAIN AUTONOMIC TESTING?
TREATMENT OF AUTONOMIC DYSFUNCTION
Management of Bladder Dysfunction
Bowel Issues
NOCTURNAL SLEEP DISTURBANCES IN PARKINSON DISEASE
Sleep Fragmentation Due to Sleep Apnea
HALLUCINATIONS SYNDROME IN PARKINSONS DISEASE PATIENTS ON CHRONIC DOPAMINERGIC THERAPY
REM SLEEP BEHAVIOR DISORDER IN PARKINSONS DISEASE
EXCESSIVE DAYTIME SLEEPINESS IN PARKINSONS DISEASE
References
PRECLINICAL PERIOD
Neuroimaging Studies
CLINICAL PRESENTATION
Neuroimaging Studies
Clinical Predictors of Progression
Effects of Therapy
CONCLUSION
EARLY STANDARDIZED RATINGS
Administration and Content
SYMPTOM RATINGS
ADVANTAGES AND DISADVANTAGES
DIARY RATINGS
Activities of Daily Living Determine for onoff
Motor Examination
Complications of Therapy in the past week
MODIFIED SCHWAB AND ENGLAND ACTIVITIES OF DAILY LIVING SCALE
III
DEFINING DEMENTIA IN PARKINSONS DISEASE
NEUROPSYCHOLOGICAL CHARACTERISTICS OF DEMENTIA IN PARKINSONS DISEASE
ROLE OF DOPAMINE IN COGNITIVE DYSFUNCTION
PROGRESSION OF COGNITIVE IMPAIRMENT IN PARKINSONS DISEASE
INCIDENCE OF DEMENTIA
RISK FACTORS FOR DEMENTIA IN PARKINSONS DISEASE
NEUROPATHOLOGY
NEROIMAGING
References
EPIDEMIOLOGY
ETIOLOGY
RISK FACTORS
NONMOTOR SYMPTOMS
Cognitive Impairment
RECOGNITION OF DEPRESSION
INCLUSIVE CRITERIA
Rating Scales
Evaluation of Depression
TREATMENT OF DEPRESSION
Antidepressant Medication
Electroconvulsive Therapy
A Treatment Algorithm
Treatment of Comorbid Psychosis
CONCLUSION
ANXIETY IN PARKINSONS DISEASE
Clinical Features of Anxiety Disorders
Relationship of Anxiety to Antiparkinsonian Medications
Epidemiology of Anxiety
Relationship Between Anxiety and Depression
Neurobiology of Anxiety as It Relates to Parkinsons Disease
Treatment of Anxiety in Parkinsons Disease
CONCLUSION
References
CLINICAL CORRELATES OF APATHY IN PARKINSONS DISEASE
NEUROANATOMY AND NEUROCHEMISTRY
APATHY AND PERSONALITY
APATHY VERSUS DEPRESSION
APATHY AND COGNITIVE DYSFUNCTION
APATHY IN MEDICAL NEUROLOGIC AND PSYCHIATRIC DISORDERS
THE MANAGEMENT OF APATHY AND AMOTIVATION
APATHY AND LIVING WITH CHRONIC ILLNESS
References
DEFINITION AND CLASSIFICATIONS
PREVALENCE
PATHOPHYSIOLOGY
Associations with Dopaminergic Medications
Susceptibility
Subgroups
INDIVIDUAL SUSCEPTIBILITY
SUBTHALAMIC STIMULATION
CONCLUSION
IV
NEUROPATHOLOGY OF PARKINSONS DISEASE
Microscopic Pathology
Composition of Lewy Bodies and the Role of αSynuclein in Parkinsons Disease
Other Microscopic Features of Parkinsons Disease
Clinical Features of Various Stages of Parkinsons Disease
Pure Autonomic Failure
Neuropathology of Familial Parkinsons Disease
Neuropathology of Parkinsons Disease Associated with Neurotoxins
OTHER PARKINSONIAN DISORDERS
Progressive Supranuclear Palsy
Corticobasal Degeneration
Guamanian ParkinsonDementia Complex
ACKNOWLEDGMENTS
References
ANATOMY OF THE BASAL GANGLIA AND RELATED CIRCUITS
DOPAMINERGIC SYSTEMS
DOPAMINE METABOLISM
PROTEIN SYNTHESIS
DOPAMINE METABOLITES
LEVODOPA AND HOMOCYSTEINE
DOPAMINE RECEPTORS
DOPAMINE TRANSPORTER
NIGROSTRIATAL DOPAMINE SYSTEM AND PARKINSONIAN SYMPTOMS
Serotonergic Systems
Gabaergic Systems
Neuropeptides
THE EFFECT OF GENES ON THE DEVELOPMENT AND SURVIVAL OF DOPAMINERGIC CELLS
STRUCTURE OF BASAL GANGLIA CIRCUITS
SOURCES OF INPUTS TO THE BASAL GANGLIA
The Thalamostriatal Projection
The Corticoand Thalamosubthalamic Projections
INTRINSIC BASAL GANGLIA CONNECTIONS
Dopaminergic Projections
STN Projections
Pallidofugal Pathways
FUNCTIONAL CONSIDERATIONS
The Role of the Basal Ganglia in Motor Control
PATHOPHYSIOLOGY OF PARKINSONS DISEASE
The Rate Model
Changes in Discharge Patterns
Pathophysiology of Parkinsonian Motor Signs
CONCLUSIONS
MOLECULAR CHARACTERIZATION OF DOPAMINE RECEPTORS
NEUROANATOMIC LOCALIZATION OF DOPAMINE RECEPTOR PROTEIN AND mRNA
SecondMessenger Pathways
PHARMACOLOGIC SELECTIVITY
References
V
CLINICAL TESTS
Pharmacologic Challenges
IMAGING STUDIES
Cardiac Radiotracer Imaging
Transcranial Sonography
BLOOD AND CEREBROSPINAL FLUID TESTS
GENETIC TESTING
HISTORICAL BACKGROUND
BIOMARKERS AND SURROGATE ENDPOINTS
MONITORING DISEASE PROGRESSION OR EFFICACY OF TREATMENT
Evidence Supporting a DAT Tracer as a Biomarker
Evidence Supporting DTBZ as a Biomarker
ACKNOWLEDGMENTS
IMAGING IN THE DIFFERENTIAL DIAGNOSIS OF PARKINSONIAN DISORDERS
LONGITUDINAL IMAGING STUDIES IN PARKINSONIAN DISORDERS
IMAGING IN THE PATHOGENESIS OF PARKINSONS DISEASE
IMAGING IN THE SURGICAL TREATMENT OF PARKINSONS DISEASE
IMAGING OF NONDOPAMINERGIC NEURONS IN PARKINSONS DISEASE
FUTURE DIRECTIONS
STRUCTURAL MRI
MAGNETIC RESONANCE SPECTROSCOPY
MAGNETIC RESONANCE IMAGINGBASED VOLUMETRY
DIFFUSIONWEIGHTED IMAGING
MAGNETIZATION TRANSFER IMAGING
FUNCTIONAL MAGNETIC RESONANCE IMAGING
SUMMARY
THE CONTROVERSIES AND THE EVIDENCE
What Happens to DopaPET and DATSPECT Results With Normal Aging?
Can DATSPECT and DopaPET Reliably Discriminate Normal From PD at Symptom Onset and Can They Usefully Detect Preclinical PD?
What Are SWEDDs Other Than Symptomatic Without Evidence of Dopaminergic Deficit?
What Is the Latency of PD? What Is the Rate of Progression? What Is the Pattern of Progression?
How Do We Interpret the 3 Longitudinal Neuroprotection Imaging Studies?
AN ALTERNATIVE VIEW OF THE CONTRIBUTION OF DOPAPET AND DATSPECT DATA
References
VI
TOXIN MODELS OF PARKINSONS DISEASE
MPTP
Rotenone
Proteasomal Inhibitors
GENETIC MODELS
Transgenic Mice
Viral Vector Gene Delivery
MITOCHONDRIAL DYSFUNCTION IN PARKINSONS DISEASE
Mitochondrial Complex I Impairment in Parkinsons Disease
OXIDATIVE STRESS IN PARKINSONS DISEASE
Markers of Oxidative Damage in Parkinsons Disease
Parkinsons Disease Genes Affecting Mitochondrial Function and the Oxidative Stress Response
EXCITOTOXICITY
THERAPEUTIC IMPLICATIONS
CONCLUSIONS
References
HISTORY OF THE CONCEPT
APOPTOSIS AND OTHER MORPHOLOGIES OF PROGRAMMED CELL DEATH
A Primer
THE INTRINSIC PATHWAY OF PROGRAMMED CELL DEATH
PROGRAMMED CELL DEATH IN DOPAMINE NEURONS OF THE SUBSTANTIA NIGRA DURING DEVELOPMENT
RELEVANCE TO HUMAN PARKINSONS DISEASE
Programmed Cell Death and Genetic Causes of Parkinsons Disease
Evidence for Programmed Cell Death in Human Postmortem Parkinsons Disease Brain
CONCLUSIONS
References
PROTEINACEOUS DEPOSITS IN PARKINSONS DISEASE
Association of Lewy Bodies with Brain Diseases Other Than Parkinsons Disease
THE PATHOGENIC CONCEPT OF PROTEIN MISFOLDING AND AGGREGATION
THE UBIQUITIN PROTEASOME SYSTEM
The Status of the UbiquitinProteasome System in Sporadic Parkinsons Disease
Types of Autophagy
AUTOPHAGY AND PROTEIN MISFOLDING
IMPAIRED AUTOPHAGY AND PARKINSONS DISEASE
ACKNOWLEDGMENTS
References
CHALLENGES IN INVESTIGATING PARKINSONS DISEASE
PARKINSONISM OF KNOWN CAUSE
Parkinsonism Resulting from Genetic Mutations
CLUES TO THE CAUSE OF PARKINSONS DISEASE FROM EPIDEMIOLOGIC STUDIES
RISK FACTORS FROM ANALYTIC STUDIES
Environmental Risk Factors
CONCLUSION
THE DISCOVERY OF THE BIOLOGIC EFFECTS OF MPTP
WHAT HAVE WE LEARNED FROM MPTPINDUCED PARKINSONISM IN HUMANS?
An Animal Model for Parkinsons Disease
The Beginning of the Age of Neuroprotection
Exacerbation of MPTP Toxicity
AGING AND MPTP
Variability in the Rotenone Model
The ParaquatManeb Model in Mice
ParaquatManebInduced Toxicity
CONCLUSIONS
INFLAMMATION IN THE BRAIN
Astrocytes in Neuroinflammation
Microglia in Parkinsons Disease
POTENTIAL THERAPEUTIC IMPLICATIONS
CONCLUSION
ENVIRONMENT VERSUS GENES
Evidence for a Genetic Component in Typical Parkinsons Disease
PARKINSONS DISEASE GENES
Parkin parkin
PARK3
Phosphatase and TensinInduced Putative Kinase 1 PINK1
DJ1
PARK9
PARK11
NACPRep1
WholeGenome Association Study
Glucocerebrosidase
References
VII
HISTORICAL REVIEW
Dopamine and the Rational Treatment of Parkinsons Disease
Levodopa Therapy
THE BIOCHEMISTRY AND METABOLISM OF LEVODOPA
COMPLICATIONS OF LEVODOPA THERAPY
IS LEVODOPA TOXIC?
Is Levodopa Neurotoxic in Vitro?
Is Levodopa Toxic in Normal Animals?
Is Levodopa Toxic in Animals with a Lesioned Nigrostriatal System?
REFINEMENT OF LEVODOPA THERAPY
ENZYME INHIBITION
Dopamine Agonists
Continuous Levodopa Administration
CONCLUSIONS
References
AMANTADINE
Clinical Use in Early Parkinsons Disease
Clinical Use in Advanced Parkinsons Disease
Side Effects
Pharmacology
Individual Agents
Side Effects
BIOCHEMISTRY AND MECHANISM OF ACTION
ANATOMY AND LOCALIZATION
REVERSIBLE AND IRREVERSIBLE
PRECLINICAL NEUROPROTECTIVE EFFECTS
SELEGILINE
Side Effects
Selegiline and Mortality
Selegiline Use by Alternate Routes
RASAGILINE
Clinical Trials of Rasagiline
OTHER MAO INHIBITORS
NEUROPROTECTION
ADVERSE EFFECTS OF DOPAMINE AGONISTS
Depression
Fibrosis
Bromocriptine in Early Parkinsons Disease
PERGOLIDE
LISURIDE
CABERGOLINE
ROPINIROLE
PRAMIPEXOLE
Pramipexole in Advanced Parkinsons Disease
PIRIBEDIL
DIHYDROERGOCRIPTINE
DOPAMINE AGONISTS AS ADJUVANT THERAPY
References
LIMITATIONS OF LEVODOPA
CLINICAL STUDIES WITH COMT INHIBITORS
Comparison to Dopamine Agonists
Patients With Nonfluctuating Parkinsons Disease
Entacapone
SAFETY OF COMT INHIBITORS
DIFFERENCES BETWEEN TOLCAPONE AND ENTACAPONE
Pharmacokinetics
Dosing Regimens
CONCLUSION
EXCITATORY AMINO ACID NEUROTRANSMISSION
Excitotoxicity
Functional Changes of Excitatory Transmission by Parkinsons Disease
EXCITATORY AMINO ACID ANTAGONISTS AS THERAPY FOR PARKINSONS DISEASE
Animal Studies
Human Experience
CONCLUSION
MECHANISM OF ACTION
A2AReceptors and Motor Control
A2A Receptors and Neuroprotection
EVIDENCE FROM CLINICAL TRIALS
CONCLUSIONS
CAM and the Health Care Industry
CAM and Regulatory Agencies
INTEREST IN CAM AMONG PATIENTS WITH PARKINSONS DISEASE
Body Work and Exercise
Chinese Martial Arts
MindBody Modalities
Nutraceuticals and Multivitamins
Instrumental Interventions
CAM and the Role of Placebo
Acknowledgment
VIII
PREVALENCE OF FLUCTUATIONS AND DYSKINESIA
DEVELOPMENT OF MOTOR FLUCTUATIONS
DEVELOPMENT OF LEVODOPAINDUCED DYSKINESIA
TREATMENT OF FLUCTUATIONS AND DYSKINESIA
Making Responses Predictable
Reducing Off Disability
Reducing Off Dystonia
ACKNOWLEDGMENTS
NONMOTOR PHENOMENA ASSOCIATED WITH THE ON STATE TABLE 471
Pain Associated with Dystonia
Cognitive or Psychiatric
Internal Tremor
Autonomic Dysfunction
Cognitive or Psychiatric
TREATMENT
TERMINOLOGY AND HISTORY
CURRENT EPIDEMIOLOGY AND RISK FACTORS
CLINICAL FEATURES
MECHANISMS OF PSYCHOSIS
TREATMENT OF PSYCHOSIS
Treatment with Clozapine
Treatment with Other Atypical Antipsychotics
Nonneuroleptic Therapies
Treatment Summary
MANIA
HYPERSEXUALITY
ACKNOWLEDGMENTS
TREATMENT OPTIONS
Glutamatergic Antagonists
Neuroprotective Agents
Noradrenergic Agents
Cognitive Rehabilitation
DEFINITION OF NEUROPROTECTION AND RELEVANCE TO PARKINSONS DISEASE
MECHANISMS OF NEURONAL INJURY IN PD SEE CHAPTERS 29 TO 31
NEUROPROTECTIVE THERAPY FOR PD
Selegiline
Other MAOB Inhibitors
Potential Protective Effects of Stereotactic Surgery
Glutamatergic Agents
Coenzyme Q10
Issues in the Design of Neuroprotective Trials
CONCLUSION
WHEN TO START TREATMENT
Primary Medications for Early Parkinsons Disease
IS LEVODOPA TOXIC?
Early Levodopa Trials
LEVODOPA VS DOPAMINE AGONIST THERAPY
Possible Neuroprotective Effect With Dopamine Agonist Therapy
INITIATING TREATMENT WITH LEVODOPA
What Dosage of Initial CarbidopaLevodopa?
Common Side Effects in Initiating CarbidopaLevodopa
Which Agonist to Choose for Initial Therapy?
Rotigotine Neupro
METHODS OF GENE TRANSFER TO THE BRAIN
CELL VEHICLES FOR EX VIVO GENE TRANSFER FOR PARKINSONS DISEASE
CANDIDATE THERAPEUTIC GENES FOR PARKINSONS DISEASE
Symptomatic Gene Products
Genes for the Inhibition of Overactive Neurons
Neurorestorative Genes
Other Neuroprotective Genes
DEALING WITH PROBLEMS RELATED TO GENE THERAPY
PARK1
PARK6
THE IMPLICATIONS OF THESE FINDINGS FOR CLINICAL PRACTICE
CONCLUSION
IX
HISTORY OF DBS FOR PARKINSONS DISEASE
THE SECRET OF SUCCESS
SURGICAL TECHNIQUE
Neuroimaging Techniques
Intraoperative Procedures
Frame vs Frameless
Selecting the Optimal Contact
Refining Stimulation Parameters
RESULTS
Subthalamic Nucleus
Globus Pallidum Pars Interna
COMPLICATIONS OF DBS
HardwareRelated Adverse Events
StimulationRelated Adverse Events
MECHANISMS OF ACTION
CONTROVERSIAL ISSUES
Dyskinesias
The Role of Age
Effects of Deep Brain Stimulation on Nonmotor Symptoms
Patients with Previous Ablative Procedures
FUTURE DIRECTIONS
ACKNOWLEDGMENTS
ADRENAL MEDULLARY TRANSPLANTS
Controlled Trials
Can the Problems Be Fixed?
DIRECTIONS FOR THE FUTURE
Use of Genetically Modified Cells
References
HISTORICAL BACKGROUND
RATIONALE OF SURGERY
INDICATIONS AND PATIENT SELECTION FOR SURGERY
Thalamotomy
CLINICAL RESULTS
Thalamotomy
Bilateral Thalamotomy
Subthalamotomy
CONCLUSION
References
X
PROGRESSIVE SUPRANUCLEAR PALSY
Epidemiology and Genetics
Pathology
MULTIPLE SYSTEM ATROPHY
Epidemiology and Genetics
Pathology
CORTICALBASAL GANGLIONIC DEGENERATION
Pathology
Clinical Findings
Epidemiology and Genetics
Management
CONCLUSION
INFECTION
Other Infectious Etiologies
Other Medications Associated with Parkinsonism
MPTP
Carbon Disulfide
Vascular Disease
Posttraumatic Parkinsonism
XI
Impairment Disability and Quality of Life in Parkinsons Disease
The Impact of Parkinsons Disease Impairment on Disability and Quality of Life
Impediments to Accuracy of Outcomes Measurement
References
DEMOGRAPHIC TRENDS IN FAMILY CAREGIVING FOR THE TWENTYFIRST CENTURY
THE RISKS ASSOCIATED WITH FAMILY CAREGIVING
Caregiver Role Strain
Economic Status
Personality
The Caregiving Situation
Direct Care
Caregiver Strain
Social Support and Interpersonal Relations
INTERVENTIONS
Respite Care and Adult Day Care
InHome Interventions
CONCLUSION
GLOBAL ECONOMIC BURDEN
DIRECT AND INDIRECT COSTS
INFLUENCE OF CLINICAL FEATURES ON RESOURCE USE
COST OF MEDICATIONS AND SURGERY
COSTEFFECTIVENESS OF SURGERY
SUMMARY
DRIVING AND THE ELDERLY
DRIVING AND PARKINSONS DISEASE
Incidents of Motor Vehicle Accidents or Moving Violations
Clinical Features Impairing Driving Ability
Excessive Daytime Somnolence and Sleep Attacks
The Patients Perspective
Assessing Driver Competence
CONCLUSION
DOCTOR AND PATIENT
DIFFICULTIES IN TREATMENT
What about Getting Deep Brain Stimulation Earlier Rather than Later?
DIFFICULTIES IN SOCIAL ADJUSTMENT
THE PARKINSONS PYRAMID
Focused Nutrition
Exercise
Index
Copyright

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About the author (2007)

Stewart A. Factor, DO, Professor and Director Movement Disorder Program, Department of Neurology, Emory University, Atlanta, Georgia

William Weiner, MD, Professor and Chairman, Department of Neurology, University of Maryland, Baltimore, Maryland

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