Talk:Parkinson's disease/Archive 1

message: This is the next section in need of a major overhaul.  Subsections probably need to be something like:
*Pharmacotherapy
**Motor symptoms (including levodopa, dopamine agonists, amantadine, rasagiline, etc.)
**Non-motor symptoms (antidepressants, atypical antipsychotics) 
*Rehabilitation therapies
*Surgical therapies
AFGriffithMD 07:40, 27 February 2006 (UTC)
thread_title:  Treatment for Parkinson Disease 

message: "microheteroplasmic mutations in one of the mitochondrial complex I genes, ND5, were found to be sufficient to diagnose sporadic PD correctly in 27 out of 28 cases. While additional studies are needed, mitochondrial microheteroplasmic mutations may be the cause of the majority of PD cases."
I believe this passage from the Toxins section strongly overstates the relative importance of ND5 mutations in particular, and microheteroplasmic mutations in general with respect to the pathophysiology of Parkinson disease.  The only PubMed article I could find on ND5 mutations being used to classify PD cases versus controls is this one , and it mentioned correct classification of 15 of 16 samples, not the 27 out of 28 cited above.  This means there were only 8 cases and 8 controls, which is a pretty small sample size, certainly not enough to make the sweeping statement, "mitochondrial microheteroplasmic mutations may be the cause of the majority of PD cases." AFGriffithMD 01:05, 16 February 2006 (UTC)
thread_title:  Role of ND5 in pathophysiology of Parkinson disease 

message: I think it is more than worthwhile to mention amphetamines as a possible cause.
(Minor comment reg. your last statement: the epidemic was in 1919-20 and the movie appears to play in the early fifties...which fits to the CV of Oliver Saks :-)
I'm sorry I edited the page.  I was trying to prove to someone it doesn't actually edit it in real-time.  Boy was I wrong.  I did fix it though.  Sorry again.
it's worth noting that ritalin is quite useful for the ADD like deficits in attention in PD.Bldavids 05:46, 10 January 2006 (UTC)
thread_title:  Amphetamines 

message: The first name seems to be the more popular and proper one, being referenced more often in recent literature and on Google. taion 11:10, 23 Nov 2004 (UTC)
replies: text: Disagree - Kittybrewster 22:28, 9 July 2006 (UTC)
thread_title:  "Parkinson Disease" or "Parkinson's Disease" 

message: Katharine Hepburn did not have Parkinson's Disease. She had a condition called Essential tremor.
Hitler's Parkinson's Disease was not caused by a gas attack. He did not have even his first noticeable symptom of Parkinson's Disease until 15 years after the gas attack in 1918. At the time, in 1918, he exhbited no symptoms that were Parkinson's Disease. The gas used in the attack was not one of those known to cause Parkinson's Disease.
:Hitler's PD is believed to have been consequential to encephalitis lethargica (a kind of sleeping sickness). There was an epidemic in the 1910's and a lot of people who suffered from the disease later developed PD. These are people Oliver Sacks wrote about in Awakenings. Balok 00:32, 10 July 2006 (UTC)
thread_title:  removed Katharine Hepburn 

message: One of the symptoms mentioned is "micrographia (small handwriting)" — is this accurate? Is small handwriting symptomatic of disease? Either way, the link currently goes to an article about a popular science book, which I don't think was the author's intention. -- 213.122.16.164 20:04, 17 August 2005 (UTC)
replies: text: Well, micrographia alone is not particularly indicative of PD. In the context of other symptoms, though, it is an informative symptom. JFW | T@lk 00:48, 18 August 2005 (UTC)
thread_title:  Micrographia 

message: Parkinson disease is used in American scientific literature.  There has been a move away from the apostrophe (e.g. Alzheimer disease vs. Alzheimer's disease).  The British and the rest of the world use "Parkinson's disease" (preferred term).
219.95.213.43 00:40, 20 October 2005 (UTC)
thread_title:  Terminology depends on which side of the Atlantic you are on 

message: Depression, anxiety, and executive dysfunction have been estimated to account for up to 70 percent of the disability associated with Parkinson disease. Dementia and psychosis may ultimately effect more than a third of all Parkinson patients. There is a movement among researchers and patients to weaken the emphasis on "movement disorder" and strengthen the emphasis on "neuropsychiatric disease".Bldavids 06:35, 16 January 2006 (UTC)
replies: text: If you have documentary support for this shift in paradigm it would make a very important point in the article. JFW | T@lk 12:17, 16 January 2006 (UTC)
thread_title:  neuropsychiatric aspects of parkinson's disease

message: The lists as constituted are poor vehicles for certain symptom sets: for example, speech-language problems. In PD, there are defects in articulation and breath support and voicing, but there are also problems with comprehension of complex syntax, with word finding, and with both expression and reception of prosody. Likewise vision and visual processing: the defects in vision are quite complex, seemingly a function of the combined effect of impaired attending, impaired gating of response, and slowed reaction time.  The physical and cognitive and affective components of the disease are all snarled together, because the job of the pre-frontal cortex is precisely the integration of these kinds of inputs and outputs. The dysfunction observed in the prefrontal cortex when deprived of dopamine is subtle but radical: disconnects between physical stimulae and perception, between intention and action, between feelings and responses. At some point, these lists will not serve. Bldavids 23:18, 17 January 2006 (UTC)
thread_title:  Symptoms that cross over the physical into the cognitive and affective realms

message: I didn't see anything about Parkinson's speech in this article. That isn't my speciality but I regularly get calls from PD patients whose speech has been affected. Judging from these individuals, speech symptoms are one of the most devastating effects of PD, so this article should say something about Parkinson's speech. I've written a short article about Parkinson's speech in WikiBooks. What I wrote is too short to be a WikiBook, but the subject is too big for a Wikipedia article. I'm hoping that someone with more expertise will expand my WikiBook article. I also added a link at the bottom of the Wikipedia article to my WikiBooks article, and a link to LSVT.Tdkehoe 18:11, 1 March 2006 (UTC)
thread_title: Parkinson's speech

message: I'm going to add to the mix my (probably) unwanted request to have in the pathology section something about the physiology of the diseas e.g. how the degenration of dopaminergic neurons causes the motor disorders. (Basal ganglia, anyone?).
Yeah, and to ensure the universal hatred of me, four times the exact same link about the already well (perhaps even too) detailed biochemistry is definitely an overkill... --80.221.29.185 17:08, 10 May 2006 (UTC)
replies: text: Please refer to the Wikipedia help page on links.  The only aspect that this doesn't fully give the "how to" for is that the part of the URL after the # is the bookmark in the HTML code of the target page.  The "clever" changes made by user:80.221.29.185 are just implementations of this general wiki format for external links.  In his/her wisdom, he/she obviously grasped that in their original format, because all your citations looked identical, they gave an appearance of being something you had not intended, and which I had the temerity to question.  Now that he/she has amended these citations such that they now all appear as different "link names", this has had the benefit of being an incremental improvement to the pathology section.  To obtain each #bookmark simply required him/her to follow the original links, find the part of the page you were referring to, examine the HTML code, and constuct the external link complete with the bookmark accordingly.  One might almost say that this could have been done without more than a rudimentary knowledge of biochemistry, as long as each bookmark name matched the topic you had described. DFH 19:36, 13 May 2006 (UTC)
thread_title:  Pathology section 

message: You know just reading this page again, I think it's insane that there's a whole page about these utterly unfounded theories about "toxins" before you get to a brief mention of the frontline, highly effective treatment for PD, being the Dopamine agonists! I might even go so far as to suggest there is a new page called "hypotheses for the pathogenesis of Parkinson's Disease" in which these theories can be vaguely alluded to, but for now I think there is far too much emphasis placed on these scatty paragraphs. If the majority of other editors are in agreement I will begin the pruning. --PaulWicks 18:09, 19 June 2006 (UTC)
replies: text: Agreed. Go. Good luck not getting reverted. --Dan 18:19, 19 June 2006 (UTC)
thread_title:  Toxins 

message: This article is currently too long. There is some very useful stuff in here but it's not the sort of thing that's directly relevant to someone looking it up for the first time. There are also glaring omissions such as the diagnostic process. I am trying my best to chunk off new articles in as rational a fashion as possible in accordance with these two guidelines:
Wikipedia:Article size
Wikipedia:Summary style
I am acting in good faith to make this a better article to read as I worry that a newly diagnosed patient would come across this and be utterly flummoxed! 
I would appreciate the input of ALL the other editors on this article to help improve this article. 
--PaulWicks 14:53, 20 June 2006 (UTC)
thread_title: Major revision

message: Right, that's better. OK what do you say we take up JFDWolff's suggestion about evidence? We could for instance start with adding and updating lines with the best evidence e.g. Cochrane reviews, then lit reviews, then big studies (esp RCTs), then small studies, then case series and then case reports. 
Everyone might find it useful to read this section if they haven't already: 
WP:REF
Wikipedia:Reliable sources#Finding a good source may require some effort
What do you reckon?
--PaulWicks 08:22, 23 June 2006 (UTC)
replies: text: This is a useful way of presenting this information, especially if reliable sources are brought. Alternatively, we can start by simply presenting basic treatment algorhythms and leave in-depth comparison between the drugs for a separate page, such as antiparkinsonistic drug (compare anti-diabetic drug). JFW | T@lk 10:58, 23 June 2006 (UTC)
replies: text: I really like teh succinctness of this table, teh article can discuss at greater length each treatment group, but as a quick aid this is well thoughtout. The risk is that too much info gets inserted over time - shorter is better. Also standardise/shorten method descriptions as  'COMT inhibitor: decreases dopamine metabolism' & 'MAOB inhibitor: decreases dopamine metabolism' and reverse word-order Levodopa method of action to 'Dpopamine precursor'. David Ruben  Talk  18:27, 15 July 2006 (UTC)
thread_title: Once more unto the breach...

message: Paul, [here are a couple of points] - first, because PD is a disease with a long latency and development, with patients able to ignore symptoms or ascribe them to old age, presentation is highly variable and the collection of symptoms people will have through the course of their disease is likewise variable. Second, in nosology in western medicine we define diseases by three main ways: by the cause (eg. Tuberculosis or asbestosis), by the anatomic site affected (almost any cancer, or by the symptoms (Parkinson's, Depression, and tuberculosis before we knew about the bug). People can be sickened by a rhinovirus, and have differing constellations of symptoms - it does not negate the concept of 'common cold'. Just so, varying symptoms of Parkinson's patients does not negate that disease concept. One could argue that more successfully with something like "fibromyalgia" or "chronic fatigue syndrome", though. --Dan 19:42, 30 June 2006 (UTC)
thread_title: Cardinal symptoms

message: I've made a first early attempts to start citing material from Pubmed. I've also paved the way for the non-motor symptoms of Parkinson's disease article as I think this could turn into a disproportinately large part of the article.
Sorry I wasn't logged in, I'm away from home and clearly failing to have my wikibreak
--PaulWicks 15:48, 23 June 2006 (UTC)
thread_title: Non-motor symptoms

message: from my talk page, massive thanks to Chris_73, all round legend:
:On a side note, :Image:Parkinson surgery.jpg may be interesting to you -- Chris 73 | Talk 09:49, 25 June 2006 (UTC)
replies: text: Just uploaded :Image:PET scan Parkinson's Disease.jpg from a NASA (and hence free) site. CHeck also :commons:Category:Parkinson's disease -- Chris 73 | Talk 09:56, 25 June 2006 (UTC)
replies: text: One more: uploaded :Image:Sir William Richard Gowers Parkinson Disease sketch 1886.jpg. Also Picture of Parkinson is here, which is PD due to its age. The image is not very good, however, and I do not know the painter or other source. Ok, hope this helps, best wishes, -- Chris 73 | Talk 10:08, 25 June 2006 (UTC)

text: Sure can. See Wikipedia:Picture tutorial on how to do it yourself, and Wikipedia:Finding images tutorial for image needs -- Chris 73 | Talk 10:41, 25 June 2006 (UTC)
thread_title: Images

message: Essential tremor and Wilson's disease have been included as part of the Parkinson-plus diseases.  However, while they may be associated with parkinsonism, my (naive) sense is that these are distinct clinical entities and would not be considered a Parkinson-plus disease like Shy-Drager syndrome.  Andrew73 12:16, 27 June 2006 (UTC)
replies: text: I think we're on the same page.  These disorders which have similar symptoms like Wilson's disease, etc. would probably be better off included under parkinsonism rather than under Parkinson's disease.  Or alternatively, perhaps a section about differential diagnosis, so that the distinction can be more explicit.  Andrew73 13:02, 27 June 2006 (UTC)
replies: text: I like the differential diagnosis section with pointers very much, Andrew. Familial tremor is, of course, far and away the most common miss, probably simply because it's common. So perhaps we should think in terms of rate of misdiagnosis for a given disease, thereby correcting for the rarity. When you have diseases such as PD that are defined and diagnosed solely by symptoms that vary from person to person and even for hour to hour, both clinical diagnosis and research can be tricky. --Dan 15:24, 27 June 2006 (UTC)
replies: text: I like the idea of a "differential diagnosis" section too. The "diagnosis" section does need plumping up too, maybe on average time to diagnosis or average symptom duration? Other things to include or link off to new articles might be dopamine challenge, DAT-scan, and of course progression. i.e. Although many people may be misdiagnosed at any one particular timepoint, diagnoses can be revised if a period of time has past in which progression is at an unusual rate (either too fast or too slow). --PaulWicks 16:42, 27 June 2006 (UTC)

text: The time to diagnosis question is a good one. I've done some work on that and on time from initial diagnosis to final, correct  diagnosis assuming the initial dx wasn't right. PD patients typically do not attach much significance to their initial symptoms at the time, but once diagnosed they realize that that symptom on that day was the (clinical) start. I don't recall details, but the work I did showed that time to dx was shorter for women, of course. --Dan 19:49, 30 June 2006 (UTC)
thread_title:  Related disease section 

message: An RCT [...] is a Randomized Clinical Trial. A comprehensive summary of current knowledge would be here:
or here:
and a website indicating current questions is here:
. --Dan 17:51, 28 June 2006 (UTC)
thread_title:  Toxins 

message: Recently a colleague coincidentally emailed me an article from Neurology about PD.  It was one of four reports on Parkinson's disease this year by the Quality Standards Subcommittee of the American Academy of Neurology. They were made through systematic review of the current literature by a committee of movement disorder specialists and general neurologists.
See Neurology 66(7):966-1002 ... it's free to download at http://www.neurology.org/content/vol66/issue7/
Anyway, I think the 4 articles outline quite well the important questions and the answers currently known regarding diagnosis and treatment of PD, so I'm copying the conclusions from their abstracts:
"Diagnosis and prognosis of new onset Parkinson disease" (Neurology 66:968-975)
1. Early falls, poor response to levodopa, symmetry of motor manifestations, lack of tremor, and early autonomic dysfunction are probably useful in distinguishing other parkinsonian syndromes from Parkinson disease (PD).
2. Levodopa or apomorphine challenge and olfactory testing are probably useful in distinguishing PD from other parkinsonian syndromes.
3. Predictive factors for faster disease progression (more rapid motor progression, nursing home placement, and shorter survival time) include older age at onset of PD, associated comorbidities, presentation with rigidity and bradykinesia, and decreased dopamine responsiveness.
"Neuroprotective strategies and alternative therapies for Parkinson disease" (Neurology 66:976-982)
1. Levodopa does not appear to accelerate disease progression.
2. No treatment has been shown to be neuroprotective.
3. There is no evidence that vitamin or food additives can improve motor function in PD.
4. Exercise may be helpful in improving motor function.
5. Speech therapy may be helpful in improving speech volume.
6. No manual therapy has been shown to be helpful in the treatment of motor symptoms, although studies in this area are limited.
"Treatment of Parkinson disease with motor fluctuations and dyskinesia" (Neurology 66:983-995)
1. Entacapone and rasagiline should be offered to reduce off time (Level A). Pergolide, pramipexole, ropinirole, and tolcapone should be considered to reduce off time (Level B). Apomorphine, cabergoline, and selegiline may be considered to reduce off time (Level C).
2. The available evidence does not establish superiority of one medicine over another in reducing off time (Level B). Sustained release carbidopa/levodopa and bromocriptine may be disregarded to reduce off time (Level C).
3. Amantadine may be considered to reduce dyskinesia (Level C).
4. Deep brain stimulation of the subthalamic nucleus (STN) may be considered to improve motor function and reduce off time, dyskinesia, and medication usage (Level C). There is insufficient evidence to support or refute the efficacy of deep brain stimulation (DBS) of the globus pallidus interna (GPi) or ventral intermediate (VIM) nucleus of the thalamus in reducing off time, dyskinesia, or medication usage, or to improve motor function.
5. Preoperative response to levodopa predicts better outcome after DBS of the STN (Level B).
"Evaluation and treatment of depression, psychosis, and dementia in Parkinson disease" (Neurology 66:996-1002)
Screening tools are available for depression and dementia in patients with PD, but more specific validated tools are needed. There are no widely used, validated tools for psychosis screening in Parkinson disease (PD).
The Beck Depression Inventory-I, Hamilton Depression Rating Scale, and Montgomery Asberg Depression Rating Scale should be considered to screen for depression in PD (Level B). The Mini-Mental State Examination and the Cambridge Cognitive Examination should be considered to screen for dementia in PD (Level B).
Amitriptyline may be considered to treat depression in PD without dementia (Level C).
Cholinesterase inhibitors are effective treatments for dementia in PD, but improvement is modest and motor side effects may occur.
For psychosis in PD, clozapine should be considered (Level B), quetiapine may be considered (Level C), but olanzapine should not be considered (Level B).
Hope that's of interest (despite the length).  I think it may help with cleaning up the PD article.
--GeekPhilosopher 03:09, 29 June 2006 (UTC)
replies: text: Very nice; thank you. To my mind, we need a good study of the incidence of dementia in PD patients compared with general population of that age. I put in a proposal to the feds a coupla years back to do that, and included stuff about developing a dementia instrument specific to PD. The reviewers thought we were biting off too much. I should go back in on that, though - I think it still hasn't been done, and I have the credibility in the field. What do you guys think? The underlying alternate hypothesis is that dementia is diagnosed more often in PD patients because they're seen more often by docs and because docs are keyed to look for it. --Dan 04:31, 29 June 2006 (UTC)
thread_title:  American Academy of Neurology 

message: Some of the other common disease have lists of afflicted famous people, such as List_of_people_with_multiple_sclerosis. Would it be worth consideration for this page set as well? Bdelisle 00:38, 4 July 2006 (UTC)
replies: text: While we're at it, I also restored the "see also" section. This one, however, may need some population. -- Chris 73 | Talk 16:27, 5 July 2006 (UTC)
replies: text: They are now at :Category:Parkinson's disease sufferers which incorporates people said to have died from it, or complications around it- Kittybrewster 22:33, 9 July 2006 (UTC)
thread_title:  People? 

message: Just to clarify, my understanding is that reactions to toxins like cyanide produce an acute onset syndrome resembling Parkinson's disease. But they do not produce Parkinson's. Is that correct? So should these toxins be listed under Parkinsonism rather than Parkinson's disease? --PaulWicks 17:31, 10 July 2006 (UTC)
replies: text: Agreed.  I tried clarifying that with a sentence in the beginning, but perhaps this needs to be stated more explicitly.  Andrew73 17:40, 10 July 2006 (UTC)

text: Parkinson Plus is clinically highly relevant, e.g. when there is a need to treat autonomic phenomena in MSA with autonomic features (formerly Shy-Drager). Toxins are certainly relevant, and if there has been rapid clinical deterioration a clinician may suspect carbon monoxide poisoning. Other toxicities are not generally suspected unless there are obvious clues (e.g. plethora and/or polycythemia in chronic HbCO). This is one of the reasons why in the UK the diagnosis of PD is now left to neurologists rather than general physicians. JFW | T@lk 20:38, 10 July 2006 (UTC)
thread_title:  Toxins 

message: Just ideas to cut down on article size and varying levels of detail, let's discuss before doing anything.
* http://en.wikipedia.org/wiki/Parkinson%27s_disease#Symptoms - These could be summarised more briefly on the PD page with the main articles being Motor symptoms of Parkinson's disease and Non-motor symptoms of Parkinson's disease which would allow more space for explanation
* http://en.wikipedia.org/wiki/Parkinson%27s_disease#Pathology - The level of detail here might be too much for the overview article. Suggest creating new article for full biochemistry. 
* http://en.wikipedia.org/wiki/Parkinson%27s_disease#Toxins - A version of this that cited original references could be useful.
Interested in views. --PaulWicks 17:01, 11 July 2006 (UTC)
replies: text: This is a useful way of presenting this information, especially if reliable sources are brought. Alternatively, we can start by simply presenting basic treatment algorhythms and leave in-depth comparison between the drugs for a separate page, such as antiparkinsonistic drug (compare anti-diabetic drug). JFW | T@lk 10:58, 23 June 2006 (UTC)
thread_title:  Some ideas for parts that could be split off into new pages 

message: I wasn't sure why the link to the experimental model of rotenone toxicity was deleted, so I restored the text.  The speculation here is grounded in a published article, so I think it's worthwhile including the reference.  Andrew73 02:50, 12 July 2006 (UTC)
thread_title:  Rotenone 

message: Is there a guideline on what order to put external links in? It's a bit higgledypiggledy. First it's GT's forum, then one for Europe, then Canada... Alphabetical? By size of organisation? --PaulWicks 07:27, 12 July 2006 (UTC)
thread_title:  External links 

message: I removed this list of differential diagnoses:
:Diseases that are in the differential for Parkinson's disease include:
:* Cerebellar thoracic outlet syndrome
:* Antiphospholipid syndrome
:* Vascular parkinsonism
:* Encephalitis lethargica
:* Hydrocephalus
:* Essential tremor
:* Wilson's disease
It is unreferenced, it has come from nowhere, and doesn't explain the relationship. Antiphospholipid syndrome is not associated with any extrapyramidal phenomena in the vast majority of cases. Essential tremor is usually ruled out early-on on clinical grounds. Wilson's disease should be mentioned, but not in such a random fashion (young PD patients should have copper studies, though).
Can we get a list from a reliable medical textbook, instead of someone's personal preferences? JFW | T@lk 07:33, 12 July 2006 (UTC)
replies: text: I agree with JFW that a laundry list of diseases that may resemble Parkinson's disease is not necessarily that useful (e.g. echoing again antiphospholipid antibody syndrome, which is quite distinct diagnostically and clinically).  Andrew73 12:13, 12 July 2006 (UTC)

text: I just read the article describing three patients with movement disorders.  All of these patients underwent intensive investigation, since their symptoms were more than just parkinsonism (apraxia, etc.).  It doesn't seem like these patients were given a primary diagnosis of Parkinson's disease, the concern that you raised.  It seems a bit of an overcall then to include APA in the differential.  Andrew73 12:58, 12 July 2006 (UTC)
thread_title:  Differential 

message: I've included the comment about tyramine-containing foods being okay with MAO-B inhibitors in order to distinguish it from other MAO inhibitors that are used for depression, e.g. phenelzine.  I imagine this is practically relevant information that should be kept in the article.  (I'm not saying that tyramine-containing foods are a treatment for Parkinson's disease!)  Andrew73 12:17, 13 July 2006 (UTC)
thread_title:  Tyramine containing foods 

message: True Parkinson's disease is global and Wikipedia is global.  However, I think it's worthwhile to include the incidence rates, even if it's specific to one area.  The information is factual and referenced.  Instead of not including it at all, why not add information about incidence rates globally?  Andrew73 18:33, 13 July 2006 (UTC)
replies: text: See, David, here's the thing. What you're really after with descriptive epi is etiological hypotheses. As you know, prevalence studies are limited in their value for that because they're too prone to bias. Incidence studies are sounder methodologically, but tougher to do (ie expensive) because you have to count all new cases in a defined population over time. And after you've done the study, what do you have? Well, some interesting rates and maybe some ideas on who gets more/less of the diease. But with Parkinson's, we think we've already got some pretty good ideas and what might be causing it, i.e. the farming chemicals, so why bother with the incidence studies - makes much more sense (and more likely to be funded) to jump right into the hypothesis testing studies, case-control design (if you're Karen Semchuk or Walter Rocca) or even cohort studies (if you're Alberto Ascherio and have access to the Nurses' Health Study). Which means the next section I oughta write up is the risk factor epidemiology section. I'm not convinced farming chemicals are going to be the big payoff everyone thought after Bill Langston found that MPTP outbreak back in what, 1986? I think there might be something else about farming. But we shall see. --Dan 14:44, 14 July 2006 (UTC)
replies: text:  Thanks for the points raised. My posting was mainly counter-arguement to DiamondPlus objecting to any such incidence info, if not a complete world-picture. You make some good points, but if "I'm not convinced farming chemicals are going to be the big payoff everyone thought " then perhaps "we think we've already got some pretty good ideas and what might be causing it" is not the case (hence a need appropriate studies). Even if hypothesis testing studies prove the cause, the cause might not be eliminatable: if it proved (for sake of discussion) due to nitrogenous toxins from meat-eating, then are people really going to fully stop eating meat (issues also of risks iron deficiency) - and I still would like to know the incidence rates (clearly 100% of meat eaters do not go on to get PD, if 10% risk it might affect my dietary habits, but at 0.1% I might decide to ignore the risk). Similarly incidence rates are useful in health planning. Leaving aside reduced incidence rates if the causative factors are identified and eliminated, if 2% of the current population have already been exposed to a causative factor and will inevitably now get PD at some point, then this will be a major health care service requirement, yet if incidence rates are just 0.1% then provision needs are relatively small compared to other diseases. Even if cause of PD is found and 100% prevention ensues, I would still like to know how much of a historical imposition this was to healthcare/social-services/individuals (in increasing importance) :-) David Ruben  Talk  15:39, 14 July 2006 (UTC)
replies: text:  Yup, good counter-points. Being an etiologic epidemiologist, the health services/public health impact tends to be something that occurs to me later rather than earlier, but of course for someplace like Nebraska, with a proportinally large old population, it's a serious matter. The town of Grand Island, for instance, in the late 90s underwent a boom in old people because some very nice supported living and nursing homes were built, drawing lots of people from the surrounding counties (nobody lives in those counties anyway), so of course the Nebrasks Parkinson's registry observed a rise in prevalence in Grand Island. At the same time, however, an obnoxious neurologist in north-eastern Nebraska steadfastly refuses to report his PD patients to the registry, so of course prevalence seems low there. --Dan 16:01, 14 July 2006 (UTC)
thread_title:  Incidence rates 

message: While the article is protected (which is likely to last a few weeks), we should discuss which sections of this important article need improvements, and in what way. I think the "toxins" section, despite General Tojo's insistence, occupies way too much space and should be reduced to the most established toxic causes (e.g. MTPT, HbCO). There may be room for a subarticle if all material is found to be highly-relevant (toxic causes of Parkinson's disease). JFW | T@lk 09:50, 14 July 2006 (UTC)
replies: text: Agree, it needs to be debulked or spun off into a subarticle.  Right now, it reads like a laundry list.  I'm surprised that H2O or O2 aren't listed.  Andrew73 12:27, 14 July 2006 (UTC)

text: You know what? I was looking through the older versions of the article, and up till Feb 2006 or so, as Barb Davids finished up her contributions, this was a pretty darn good page. Needed some epidemiology, of course, but it was pretty good. --Dan 19:00, 14 July 2006 (UTC)

text: Agreed. Please note that I created two other subpages, Motor symptoms of Parkinson's disease and Non-motor symptoms of Parkinson's disease that we can use to go into more detail. A postdoc just started in our team who specialises in hallucinations and I'd really like her to add more on non-motor symptoms. There simply isn't need for such detail on the main page though. If everyone's happy with the drug table I've put on the talk page (or would like to add to it) then I think we should have a drugs used in the treatment of parkinson's disease as Jfdwolff has suggested in the past. --PaulWicks 21:18, 14 July 2006 (UTC)
replies: text: Removed --GW_Simulations|User Page | Talk | Contribs | E-mail 12:13, 16 July 2006 (UTC)

text: Looking the material over, those are almost certainly posted by Bridgeman, aka General Tojo  and over 150 sockpuppets. --Dan 21:22, 18 July 2006 (UTC)

text: Certainly look that way to me. Admins can you nominate for deletion please? --PaulWicks 21:46, 18 July 2006 (UTC)
replies: text: The AfD for both articles is at Wikipedia:Articles for deletion/The symptoms of Parkinson's Disease. --Allen3 talk 22:13, 18 July 2006 (UTC)

text: I'm inclined to think with what we've got from the pre-Bridgeman days (before Feb 2006) and what the rest of can contribute, we have plenty of solid, accurate material. --Dan 23:03, 18 July 2006 (UTC)
thread_title: Protection?

message: I have noticed two new articles that are possible forks of this article have recently been created by a new user: The symptoms of Parkinson's Disease and Biochemistry of Parkinson's Disease.  As I am not familiar enough with the topic to determine if these are valid content spin-offs or POV forks, and given the current protection status of the main article, I am bringing attention to the articles here so that appropriate actions may be taken by others if needed. --Allen3 talk 21:10, 18 July 2006 (UTC)
replies: text: Looking the material over, those are almost certainly posted by Bridgeman, aka General Tojo  and over 150 sockpuppets. --Dan 21:22, 18 July 2006 (UTC)

text: Certainly look that way to me. Admins can you nominate for deletion please? --PaulWicks 21:46, 18 July 2006 (UTC)
replies: text: The AfD for both articles is at Wikipedia:Articles for deletion/The symptoms of Parkinson's Disease. --Allen3 talk 22:13, 18 July 2006 (UTC)

text: I'm inclined to think with what we've got from the pre-Bridgeman days (before Feb 2006) and what the rest of can contribute, we have plenty of solid, accurate material. --Dan 23:03, 18 July 2006 (UTC)
thread_title: Possible forks created

message: I'd like to archive the older parts of this talk page. Is there a date before which the discussions are no longer active? Tom Harrison Talk 18:06, 14 July 2006 (UTC)
replies: text: It's not so long as to be a problem, if it's useful to keep it. I'll leave it alone for now. Tom Harrison Talk 19:52, 14 July 2006 (UTC)
replies: text: Why not just archive all that is GT-related and leave the actual discussions up? Also please leave my drug table there! --PaulWicks 21:20, 14 July 2006 (UTC)

text: If you want I'll try to refactor the page, removing GT's remarks and all the replies to them. They'll still be in the history if anyone wants to refer to them. I'll be sure and leave the drug table. I'll try to do it tomorrow if no one objects. Tom Harrison Talk 21:29, 14 July 2006 (UTC)
replies: text:  I wouldn't mind. --Dan 21:30, 14 July 2006 (UTC)
replies: text: Some form of archiving is required - this page takes ages to load on my slow dial-up connection (almost makes me dread the boredom of waiting to view the latest postings here)- I agree in first instance archive off GTs trolling and then lets see if/where we wish to archive older historical discussion threads. David Ruben  Talk  23:47, 14 July 2006 (UTC)

text: Thanks, Tom - good work. Hope this helps you, David. Alternatively I hope Santa Claus (or maybe your Hallowe'en bag) brings you a fast connection. --Dan 15:31, 15 July 2006 (UTC)
replies: text: Talk page now a pleasure to visit it loads so fast :-) Suspect will need wish hard, as would need faster computer to cope with broadband... David Ruben  Talk  13:34, 16 July 2006 (UTC)
thread_title: Archive?

message: unprotected the page, and within hours Tojo is all over it again. I see no other option but to protect it again. JFW | T@lk 22:31, 2 August 2006 (UTC)
thread_title:  Reprotected 

message: I'd like to thank DocRogers for removing a lot of the irrelevant info that has been clogging up that article for a while. Please don't anybody revert his improvements. --PaulWicks 12:51, 4 August 2006 (UTC)
replies: text: Not to mention he directed us yet again to his private PD pages. And reminded us that there was some sort of copyright violation somewhere. Maybe we copied his copies. --Dan 16:09, 4 August 2006 (UTC)
replies: text:  I'm not sure what the copyright violation is specifically.  Perhaps it's just a ruse.  Andrew73 17:30, 4 August 2006 (UTC)

text: Perhaps you could provide more specifics about which linked sites?  Andrew73 18:09, 4 August 2006 (UTC)

text: If I recall correctly, I think you may have been the one who originally incorporated this information in the Wikipedia article!  Isn't this sort of like the pot calling the kettle black?  Andrew73 18:36, 4 August 2006 (UTC)

text: Okay, I restored an earlier version of the toxins section that does not incorporate material from the viartis.net site.  Andrew73 19:22, 4 August 2006 (UTC)
replies: text: *chuckle* Great minds think alike, eh Andrew? --Dan 19:43, 4 August 2006 (UTC)
replies: text:  That's a given.  Andrew73 19:49, 4 August 2006 (UTC)

text: I ended up including a later version (I don't remember the exact one), before it morphed into something like the viartis.net entry.  Andrew73 19:53, 4 August 2006 (UTC)
thread_title: Copyright vios

message: Why exactly did Mwanner revert Npang's link ? To describe it as spam is either due to deceit or not actually reading it. Too often editors revert what they describe as spam that is not spam at all. Spam is blatant advertising, but the link goes to a non commercial site that is plainly a very good Parkinson's Disease information site. --Leilania 12:05, 12 August 2006 (UTC)
replies: text: Err, because the site is bursting at the seams with banner ads? Because the information adds nothing to what is on the article already? Spam doesn't have to be "blatant advertising" to be spam. If the intention of adding content to Wikipedia is to drive traffic to a site, I'd say that's a pretty good reason to take it down. --PaulWicks 14:46, 12 August 2006 (UTC)

text: Barb, it's good to see you back - you and Griffith had a pretty good page put together before the tojo makeover. Having said that, I truly don't see why conversations about having expertise on tap would be offensive. I regard it as a valuable resource, a groups of people who are plugged into various specialty areas and are aware of what current conversations are happening. For instance, I was just looking over some old data of mine, and found a mild association between PD and heptachlor, a now-banned (mostly) insecticide that was used a lot by termite exterminators. Looking to see what's out there about heptachlor, I came across a hypothesis that it acts as a first blow to the dopamine producing areas, softening them up as it were, and making them vulnerable to damage from other factors that would not ordinarily cause problems. Interesting, eh? Anyway, before I went off on that digression, I want to ask you to please not take wrongly our valuing particular expertise.  With one notable exception, we have not engaged in disparaging people based upon perceptions about qualifications. So don't take offense at us who do have higher degrees. --Dan 20:39, 7 September 2006 (UTC)

text: Barb, I'm going to offer some unsolicited (maybe) advice - "higher degree", "advanced degree" and the like are common usage; there's no implication that the bearer thereof is of greater value. The education likely is of greater value - PhDs are qualitatively different from Masters, but you're repeatedly making a point of our usage and implying thereby that Paul and I are making a class distinction of some sort. Would you say that if we were talking about "high" school (well, I would use that term, anyway, Paul's in England where they have some totally incomprehensible system involving forms). Anyway, it appears to me that you are being overly sensitive about class distinctions. This is a not uncommon problem in the States where we pretend to have an egalitarian, classless society. You and I both know this to be a deception. Railing against it, however, and claiming that we are all equal, only puts dents in your forehead from banging it against that particular brick wall. We would be better off, I feel, to acknowledge that there are inequalities in the world - in our country - and that to some extent they're inavoidable, a fact of nature. Where we should pick our fights, though, is where the inequalities are enforced, say by birth, where the classes are not open regardless of effort or merit. I've found, through being married into a Confucian society, that acknowledging class differences should bear with it reciprocal responsibilites, one to another. We in the US live in a place where we place highest value on the individual, with the result that we aren't very good at bearing those responsibilities toward each other. We tend to blame those lower on society's ladder for their weakness, and resent those higher on the ladder for their ruthlessness, venality, what-have-you. And, getting political here, this is a situation encouraged by those who profit from society being divided. I suspect I've gone on altogether too long, but there it is. Do you know how to pick through the history of the page, so you can find the bits you liked and clip those in? If not, whistle & I'll give you a hand with it. --Dan 05:20, 11 September 2006 (UTC)
thread_title:  Spam what spam ??? 

message: It has been suggested that the Non-motor symptoms of Parkinson's disease page I created be merged into the main article. I originally created the page so that I could expand it beyond the scope of a main article. My intention was to add more about depression in PD, and our new postdoc who did her PhD on hallucinations in PD could expand the rest. However the GT incident put me off editing for a bit. If we leave the link there for now I will expand it in the coming months. But if other editors want to delete it for now that's fine too and I can always reinitialise it once some new content has been written. --PaulWicks 20:14, 26 August 2006 (UTC)
thread_title: Merge of non-motor symptoms page

message: I don't think this article is complete without at least a cursory mention of the UK Royal College of Physicians national guideline - it recommends (amongst other things) that all patients with Parkinsonian symptoms are referred to a specialist for adequate diagnosis, rather than management by generalists. JFW | T@lk 13:07, 21 September 2006 (UTC)
thread_title:  RCP guideline 

message: Mr. Doyle - it's customary to talk things over on this page before deleting material from the article with no more than a statement of "no evidence". One could, for example, ask the editor to provide evidence that supports the assertion. I am not aware of evidence speficiclly for Qigong, but I am aware of ongoing clinical trials that support a beneficial effect of a variety of exercise programs. --Dan 16:15, 26 September 2006 (UTC)
replies: text: I'd suggest you peruse the discussion page a bit more carefully. Many of changes made over the past month were more in the way of improving readibility and flow. MMoneyPenny, for instance, did quite a bit of editting, and where he'she did change something substantive, we corresponded and changed it back. If I remember correctly, the user who added the Qigong piece was Barb Davidson, and as you can see sh'e not a daily visitor or even a weekly visitor. I'd suggesting restoring what you deleted and being a bit more patient. Or perhaps adding a reference that says "we ran a trial of Qigong on PD patients & it didn't work." The attitude of "everybody else misbehaves" really doesn't hold water, and in any case is not a valid reason for acting badly. --Dan 17:53, 26 September 2006 (UTC)

text: Yes, you did - you said "a custom that nobody else complies with". Literally, you didn't say "everybody else misbehaves" but that was certainly the meaning of your statement. Second, your point that "no alterationshave been made as a sresult of discussing them" is also incorrect, as you would see readily by perusing this page. Just an example, the section on Risk Factor Epidemiology above is currently under discussion for inclusion. --Dan 16:33, 27 September 2006 (UTC)
replies: text: I did not claim that "everybody else misbehaves", and my statement did not imply it. My statement is entirely correct, and means nothing more than it states. Of the numerous edits over the months I see virtually no prior discussion. Your one counter example (Risk Factor Epidemiology) is not even under discussion as you have suggested. You added it over two months ago and nobody has discussed it. It is a blunt fact on this article that alterations are rarely justified after prior discussion. I think anyway that apart from really major changes that it is better to make alterations and to enter into disussions only if somebody disagrees with them, because most alterations are not objected to anyway. --Gerard Doyle 17:06, 27 September 2006 (UTC)
thread_title:  Qigong 

message: Is reduced awareness of temperature (i.e. too cold or too hot) a symptom of PD? - Kittybrewster 08:24, 28 September 2006 (UTC)
replies: text: not that I'm aware of, Kitty, but perhaps someone who's more of a clinician than I could address it. Swallowing difficulties are a pretty good early sign; our PD clinic is getting referrals from the gastrointestinal guys who are checking people for GERD with that little gadget that blows air at the back of the throat - some of them have PD. --Dan 17:09, 29 September 2006 (UTC)
thread_title: Temperature awareness