2017 Volume 34 Issue 3 Pages 182-187
As the clarification of the nature of Parkinson's disease progresses, many drugs have been developed, and clinicians have been asked to make judgments as to their proper use. Until now, various dopaminergic drugs have been developed against the motor symptoms such as tremor, rigidity, akinesia and postural reflex disturbance as the main therapeutic targets. Recently, due to aging and prolonged disease duration of Parkinson's disease patients, it has become problematic and can not be ignored as a treatment target that includes autonomic symptoms such as constipation and orthostatic hypotension, REM sleep behavioral disorder (RBD), mental disorders such as depression, apathy, delusion/hallucination, performance impairment and cognitive disorders. Moreover, the manifestation of non–motor symptoms such as pain, fatigue, camptocormia, dropped head are focused as the cardinal symptom of Parkinson's complex. Further, these symptoms correlate well with the progression of α–synuclein pathological stage of Parkinson's disease reported by Braak et al. It is awaited to develop disease modifying drugs that suppress not only symptoms but also pathological progress itself. At the same time, it is also required to develop biomarkers that can be accurately used in the preclinical phase from the viewpoint of early detection and early prevention as well as risk factor analysis. In addition, intestinal microbiota dysbiosis and gut–brain axis via the vagus nerve are attracting attention as a new pathogenic mechanism of Parkinson's disease. In this presentation, I will present my personal opinion of various anti–Parkinson's disease treatment based on clinical evidences and its current use, as well as the molecular mechanisms concerning α–synuclein's pathology. Recent trial of immunotherapy targeting α–synuclein proteins and the suppression of the protein aggregation will also be outlined.
