Talk:Management of Parkinson's disease

Wiki Education Foundation-supported course assignment
This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): Jessica Kurf.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 03:13, 17 January 2022 (UTC)

Comment
What about gene therapy for parkinson's disease? 75.16.79.22 00:32, 30 June 2007 (UTC)aceboy22275.16.79.22 00:32, 30 June 2007 (UTC)

Major revamping
I have done a major revamping of the article copying info from the main article, since in general it was more complete and referenced.

The section on nutrients was really poor, with unbalanced, unreferenced content. Nevertheless since some items could be of use in the future if properly sourced and balanced with secondary sources I move the whole section here:


 * Nutrients have been used in clinical studies and are widely used by people with Parkinson's disease in order to partially treat Parkinson's disease or slow down its deterioration. The L-dopa precursor L-tyrosine was shown to relieve an average of 70% of symptoms. Ferrous iron, the essential cofactor for L-dopa biosynthesis was shown to relieve between 10% and 60% of symptoms in 110 out of 110 patients.  More limited efficacy has been obtained with the use of THFA, NADH, and pyridoxine—coenzymes and coenzyme precursors involved in dopamine biosynthesis. They now constitute largely experimental methods and former treatments rather than common medical practice. Vitamin C and vitamin E in large doses are commonly used by patients in order to theoretically lessen the cell damage that occurs in Parkinson's disease. This is because the enzymes superoxide dismutase and catalase require these vitamins in order to nullify the superoxide anion, a toxin commonly produced in damaged cells. However, in the randomized controlled trial, DATATOP of patients with early PD, no beneficial effect for vitamin E compared to placebo was seen Coenzyme Q10 has more recently been used for similar reasons. MitoQ is a newly developed synthetic substance that is similar in structure and function to coenzyme Q10. However, proof of benefit has not been demonstrated yet.

--Garrondo (talk) 20:03, 5 January 2011 (UTC)

Levodopa paragraph
The second to last paragraph here is copied directly from a 1989 paper's abstract - "the on off phenomenon" found here. This doesn't provide the reader with much useful information and is likely out of date. Can a specialist provide any more useful (pathogenesis etc.) information? Medi1101 (talk) 17:46, 23 May 2012 (UTC)

ref names
in this dif away back in 2011 the ref name "Nice-pharma" got trashed by providing two different versions of the citations under the same name. This dif, changed just one of the already-existing multiple citations. Both the versions of the citation in 2011 used this URL: http://guidance.nice.org.uk/CG35/Guidance/pdf/English which now redirects to something different, namely https://www.nice.org.uk/guidance/CG35. The original URL is archived at the internet archive at https://web.archive.org/web/20110807071956/http://guidance.nice.org.uk/CG35/Guidance/pdf/English -- it is a landing page where you can find the full pdf. The current similar page at the NICE site is here: https://www.nice.org.uk/guidance/cg35/evidence - the link to the full pdf is there.

The recent dif attempted to replace the URL with https://www.ncbi.nlm.nih.gov/books/NBK48513. The full pdf is what is cited in the ref, and is here at the NICE site; there is no reason not to use that URL. I have done that, and add a note that it was reviewed in 2011 and that it is in the process of being updated. This is a really old ref per WP:MEDDATE... Jytdog (talk) 19:35, 30 November 2016 (UTC)

Edits yesterday
So about this massive set of diffs, and responding to this note....

That was a big bunch of changes, added all at once.

In general, refs are very OK (with some exceptions) - you clearly tried to start with good MEDRS sources. So good there. Good effort was made at fully citing sources, adding wikilinks etc.

Some general problems:
 * refs don't all include PMID
 * refs come after punctuation, not before
 * overall the writing is poor - it is often unnecessarily complicated, is convoluted in spots, there is lots of repetition and a tendency to try to sell, or say how great something is, (what we call WP:PROMO) rather than simply describe.


 * First bit of content on personalized medicine.

Deep brain stimulation (DBS) can also be categorized as personalized medicine because it requires a personal-tailored surgery for individual PD patient’s anatomy. There are different DBS approaches such as subthalamic nucleus DBS (STN-DBS), globus pallidus DBS (GPi-DBS), ventralis intermedius DBS (Vim-DBS) and pedunculopontine nucleus DBS (PPN-DBS). The challenges for STN or GPi-DBS is the deficiency of the battery-life. As for Vim or PPN-DBS, the efficacy varies for different PD patients. However, these adaptive DBS offer an accurate and individualized treatment for PD patients through automatically adjusting parameters based on the real-time brain/body response. Moreover, an advanced option by adopting spontaneous stimulation parameters can be used to meet further needs for each PD patient in the near future.

OK, almost this whole section depends on.
 * This is not classified by pubmed as a review. I am not quite sure what it is, but the authors are an ethicist and a public policy person, and in the article they are making an argument as to why DBS should be considered as personalized medicine.  Looking in pubmed, there is five recent reviews that discuss DBS as a form of personalized or precision medicine.  So i guess that is enough so that including some content about this - no WP:UNDUE problem.  But the content isn't correct.  Brain region isn't selected based on anatomy but rather key symptoms; different regions address different problems and have different side effects.
 * the content about the various targeted brain regions is sourced to the first ref but it doesn't mention any of those regions, nor the efficacy of targeting them, nor batteries.  it is sourced to the 2nd ref   just a simple mistake. it happens.
 * These two sentences are unfortunately nonsense: "However, these adaptive DBS offer an accurate and individualized treatment for PD patients through automatically adjusting parameters based on the real-time brain/body response. Moreover, an advanced option by adopting spontaneous stimulation parameters can be used to meet further needs for each PD patient in the near future"  You seem to be mashing together the concepts of Open-loop and closed-loop (feedback) control (the field currently does open loop; closed loop is something long-sought after) and the personalized medicine notions.  These are separate.
 * The last sentence is promotional and also violates [{WP:CRYSTALBALL]]. we have no way of knowing when closed-loop systems will be viable.

moving on..


 * OK for some reason you did this in subsections - General Rehabilitation -- but we don't do that.   Just let the subsectioning with equal signs do its thing.


 * OK you added a subsection on neurorehab as follows

Neurohabilitation is a non-pharmaceutical treatment for PD and the core of it is to help PD patients control their motor and non-motor symptoms by the training of behavioral adaptations. There are four relatively new fields in neurohabilitation, which are visual rehabilitation because optimal vision is crucial to PD patients, cueing delivered by wearable devices in an on-demand manner because it can be used to objectively, continuously and quantitatively detect PD patients’ mobility difficulties, exergamin which combines physical exercise with cognitive games, and telemedicine that can deliver the professional neurohabilitation advice to PD patients directly. Even though collecting robust scientific evidence on the cost-effectiveness for these four new neurohabilitation approaches has been challenging, positive results and good clinical trials show that these new developments of neurohabilitation can potentially improve PD patients’ quality of life.

So this is all sourced from the title of which is "Neurorehabilitation for Parkinson's disease: Future perspectives for behavioural adaptation". The title gives you a big clue that the article is focused on stuff that is emerging, and the abstract alone tells you that the authors are advocating. here is the pubmed search for MEDRS sources. Looking through those i would have started with which seems more ... measured, describing what is and what currently problems are, rather than advocating for some happier future. But probably more importantly, nothing you added here is really distinct from the content already in the rehab section - it isn't more "neuro" in any way. It is about bringing new technologies to bear on that existing stuff. This should have just been blended in with the existing content instead of making a standalone section. The last sentence is also terribly WP:PROMO and [{WP:CRYSTALBALL]]. Jytdog (talk) 07:33, 6 December 2016 (UTC)


 * finally, the biomarkers section


 * Biomarkers

In the modern time, large amounts of biomarkers could be used in various neurological practices to provide better decision for patient prognosis or in prediction of treatment affects. Although future validation of these biomarkers is needed before utilizing them into standard clinical diagnose algorithms, the importance of personalized medicine will be considered significantly to achieve more effective, cheaper and better-tailored treatment for different neurological diseases in the future. In Parkinson’s disease, there is no validated diagnostic biomarker for PD yet. However, like Alzheimer’s disease, perspective biomarkers are such as dopamine metabolism, oxidative stress, α-synuclein, auto antibodies against α synuclein and inflammatory markers. The reliable results are obtained from studies of α synuclein, the major component of lewy bodies, and it can be found in saliva, serum, plasma and cerebrospinal fluid (CSF). In addition, inflammatory markers such as higher level of interleukin 6 (IL-6) and soluble tumor necrosis factor (TNF) receptor-1 are associated with PD or early onset of disease. More than 25 genetic factors have been reported to affect the risk factor for PD and the major risk factor is shown to be homozygous and heterozygous mutations of the glucocerebrosidase gene. For PD, one biomarker and a single measure are not efficient to provide useful information. The combination of different biomarkers with clinical relevant patient’s characteristics can be considered to offer better and integrated information on disease.

This is terribly written, full of repetition and convolution and just plain bad grammar. The concepts here are not that hard. And really importantly, none of these are clinical (-- you included the really important fact that "In Parkinson’s disease, there is no validated diagnostic biomarker for PD yet." (ouch, grammar).   But in other words, none of this has anything to do with actually managing Parkinson's.  Why is this even here?  This section overall is far the most promotional and CRYSTALBALL of all of them.

None of this is useable as it stands. Jytdog (talk) 07:33, 6 December 2016 (UTC)


 * Hi, Jytdog, thank you for your work and time on verifying all the references I used before. Also, thank you for your suggestions for how to revise the writing about DBS, neurohabilitation and biomarker paragraphs. I would like to take you advice and try to rewrite the DBS paragraph with correct, appropriate and professional terms. As for neurohabilitation section, I agree that I can add information I think the original part is missing piece by piece back to the whole paragraph instead of starting a new sub-section. However, I do think biomarker studies are important for future PD researches. The edits should be incontrovertible. But, I will carefully work on the grammars and syntax, and I will also add things slowly to make sure each edit makes sense and is a correct fact. Moreover, in the future, I will post revised material on the talk page here first. Please feel free to leave a comment or give a feedback to the new writings. If other users agree on what I write, I will move to the encyclopaedia page later then.
 * Jessica Kurf (talk) 06:26, 7 December 2016 (UTC)Jessica Kurf
 * great, thanks. about biomarkers, this article is called "Management of Parkinsons"  It is about how people who have PD are actually treated.  There is a section in the parkinsons article about research, here and content about biomarker research could go in a subsection there. It is really important to keep reality separate from speculation -- actual management separate from possible future ways to manage.  Jytdog (talk) 06:39, 7 December 2016 (UTC)

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Alternative medicine
I would very carefully like to introduce a section on alternative medicine, strictly limited to review articles and meta analyses as it is quite a rabbit hole. Has this been attempted already or is there a reason it hasn't been done already? I enjoy sandwiches (talk) 00:41, 17 February 2019 (UTC)

External devices
Perhaps there should be a section on external devices which reduce tremors or reduce the impact of tremors as per these? Aoziwe (talk) 08:46, 5 March 2019 (UTC)