Talk:Parkinson's disease: Difference between revisions

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Role of L-tyrosine and neurodegeneration in PD

Recent edits have been inaccurate and misleading. The L-tyrosine study mentioned was an open-label, uncontrolled study that followed only 10 patients, and no follow-up studies have been done since. Dopaminergic cell loss as well as dysfunction is well-documented on pathologic studies. The Parkinson's forum recently added to the external links section contains highly questionable information, and belongs at the very end of the section, if it belongs there at all. Hence the revert. AFGriffithMD 01:10, 28 February 2006 (UTC)[reply]

What is written above is itself misleading and unscientific.

1. Not a single piece of scientific evidence contradicts the fact that : (1) L-tyrosine has been known for decades from biochemical studies to be the precursor of L-dopa and is therefore relevant to Parkinson's Disease, (2) L-tyrosine is known, from biochemical studies, to increase dopamine levels in Parkinson's Disease, (3) the two studies in which L-tyrosine has been used in Parkinson's Disease have shown a reduction in symptoms. There is no opposing evidence whatsoever. Can you provide any ?????

2. "Dopaminergic cell loss is well-documented on pathologic studies." Not a single study has ever demonstrated this. If this is "well documented" then provide the references for a study that proves it. Studies using the f-Dopa PET scan and enzyme studies do not measure cell death.If you can not provide a reference, then you are adding information that is scientifically baseless. Below is written : "Content....must be verifiable", but your claim of massive cell loss has not been verified and nor could it be because no such studies exist.

3. What information on the Parkinson's Disease Forum is questionable ? Virtually all of it consists of newly published scientific studies, and is fully referenced, unlike most of what appears on Wikipedia's Parkinson's Disease page which is not. It is the only site wolrdwide tat provides daily updatyes of newly published research in Parkionson's Disease. Are all newly published scientific studies concerning Parkinson's Disease questionable as you claim ? If they are why have you not substantiated what you have written.

In response to what you have stated above:

1. Lack of opposing evidence does not constitute proof of efficacy. A small, open-label, uncontrolled, ten-patient study is not sufficient proof of efficacy.

2. For references, see the section I added recently entitled "Pathology." Heiko Braak's work systematically details the pattern of neuron death and degeneration throughout the stages of Parkinson disease. Also, see any medical textbook on pathology or neurology, including Adams and Victor's Principles of Neurology or Watts & Koller's Movement Disorders. Or go to your local medical school and ask to see pathologic specimens of brains from people who had Parkinson's. The neuron loss is very visible.

3. Your website contains the same sorts of inaccurate and misleading statements that you have posted above. AFGriffithMD 02:32, 2 March 2006 (UTC)[reply]

Criticisms of the response :

1. If every method of treatment that had not conclusively proven long term efficacy without side effects were eliminated from the section on Treatments, there would be nothing there. That would be what you call a "cure". The web site should include the variety of medical treatments that are either used, or have demonstrated a degree of clinical efficacy. None of the drugs listed get rid of Parkinson's Disease. They are proven to be only transient relief accompanied by widespread side effects. Both L-dopa and dopamine agonists contribute to the symptoms. L-dopa via feedback inhibition eventually elminates a person's capacity to produce their own L-dopa. Dopamine agonists greatly reduce the sensitivity of the very same receptors they are attempting to stimulate.

2. I have read all of the more than eighty books published on Parkinsons' Disease. I have read more than ten thousand studies on the biochemistry of Parkinson's Disease. I have been referred to books and studies of the kind you refer to. However, I have yet to see any evdience of a considerable loss of dopaminergic neurons in Parkinson's Disease. I have, however, seen plenty of evidence of a considerable loss of activity of the dopaminergic neurons

There are more than twenty cell types in the nervous system. They are intermingled and distributed throughout different regions of the brain. No one area of the brain is restricted to one type of cell such as the dopaminergic neurons. So you can not possibly see the selective loss of dopaminergic neurons as opposed to the loss of part of the brain. The claims of massive cell loss in Parkinson's Disease originated from autopsy studies carried out on people that had had severe Parkinson's Disease. Their supposed method of demonstrating cell loss was based on an examination of the activity of tyrosine 3-monooxygenase (known at the time as tyrosine hydroxylase)as this enzyme is responsible for L-dopa formation. However, the activity of tyrosine hydroxylase does not measure cell loss at all. It is the primary means of measuring cell activity in the dopaminergic neurons.They concluded massive cell loss, but what they actually proved was a considerable loss of cell activity.

More recent claims have been made of massive loss of cells based on the use of f-Dopa PET scans. This is the method you have based your (false) assumptions on. You, or whoever added it to this web site, have written "More recent data based on PET scans suggests that symptoms may occur when 50-60% of dopaminergic neurons are lost." However, of course, f-Dopa PET scans do measure the loss of cells. They measure the emission of positrons from flouro-Dopa. That is an indication of cell activity - not cell loss. The conclusions of massive cell loss simply do not match the methods used. There is no evidence of a massive loss of dopaminergic neurons rather than a massive reduction in the activity of those cells. It is one of the biggest fallacies in medicine.

3. You do not give any substantiation of your criticims of what I assume is part of what appears on "The Parkinson's Disease Forum" but my guess is that it only concerns the fallacy of massive cell loss in Parkinson's Disease. That has been answered above. The site includes more new research and is more scientifically substantiated with scientific references than any other web site concerning Parkinson's Disease, including this one !

Treatment

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)[reply]

There is also note of the following: Due to feedback inhibition, L-dopa causes a reduction in the body's own formation of L-dopa. So a point is reached where the drugs only work for periods of a few hours ("on" periods) which are sandwiched between longer interval during which the drugs are partially or completely ineffective ("off periods").

While I am familiar with feedback inhibition in situations such as steroids and testosterone, I have not seen a study that addresses nor suggests that there is feedback inhibition. It may be premature to suggest that feeback inhibition is a problem.

Carlwfbird 12:43, 7 March 2006 (EST)

Role of ND5 in pathophysiology of Parkinson disease

"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 [1], 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)[reply]

Awakenings

Awakenings deals with Parkinson's? I thought it was encephalitis. - Montréalais

The patients in Awakenings were suffering from post-encephalitic Parkinsonism. The encephalitis had occurred 50 years earlier and the infection was over. However it had left damage, causing their Parkinsonism. RTC 06:06 Nov 2, 2002 (UTC)

Amphetamines

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)[reply]

I think it is worthwhile to mention that the drug Selegiline (Eldepryl) which appears to inhibit disease progression is broken down into amphetamine and methamphetamine.

Ozzy?

Does Ozzy Ozbourne really have Parkinsons Disease? I know he has Parkinsonian symptoms, but I thought it was due to drug-induced damage to the dopaminergic system rather than actual PD. - Sayeth 22:24, Nov 18, 2004 (UTC

"Parkinson Disease" or "Parkinson's Disease"

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)

"inclinations towards Catholicism"

Is this a bogus edit?

It's a jibe at John Paul II. JFW | T@lk 00:49, 18 August 2005 (UTC)[reply]

You don't have to be Catholic to have PD!

No, you can convert to Islam and get it too.

removed Katharine Hepburn

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.

Micrographia

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)[reply]

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)[reply]

The statement is accurate; it's a classic symptom. So, its presence is definitely informative but not diagnostic. sensitive but not specific. Bldavids 05:48, 10 January 2006 (UTC)[reply]

Exercise neuroprotective

I am dubious about the alleged "neuroprotective effect" of exercise. I'd like to see a reference please. --Dubbin 23:23, 23 September 2005 (UTC)[reply]

See: “Parkinson's Disease” an on-line summary @http://www.bcm.edu/neurol/jankovic/educ_pd.htm, by Joseph Jankovic, M.D., an internationally recognized expert on Parkinson disease, and the medical director of the Udall Parkinson Disease Research and Treatment Center in Houston (Note: “Udall Center” is a federal designation denoting excellence in PD treatment and research):

“Recent animal research has provided strong evidence that exercise can increase brain levels of neurotrophic factors, increase resistance to brain insult or injury, and improve learning and mental as well as motor performance.” Dr. Jankovic is a highly credible sourcer.Bldavids 05:50, 10 January 2006 (UTC)[reply]

Here's a good place to start: PMID 15214505. (Then click on "Related Articles" and you'll see many studies on the topic.) --Arcadian 18:08, 3 January 2006 (UTC)[reply]

Terminology depends on which side of the Atlantic you are on

Parkinson disease is used in American scientific literature. There has bee 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)M K Lee[reply]

I see 22.7 million for "Parkinson Disease" and 23.3 million for "Parkinson's Disease". The apostrophes have it. --PaulWicks 21:32, 19 June 2006 (UTC)[reply]

neuropsychiatric aspects of parkinson's disease

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)[reply]

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)[reply]

Gladly:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15043801&query_hl=3&itool=pubmed_docsum

Symptoms that cross over the physical into the cognitive and affective realms

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)[reply]

I agree, the symptom section needs to be reorganized. I did a bit of minor cleanup in one section, but it should be something like:

Symptoms:

Cardinal Symptoms
Other Motor Symptoms
Non-Motor Symptoms
- Sensory
- Visual
- Neuropsychiatric
- Cognitive

AFGriffithMD 23:31, 14 February 2006 (UTC)[reply]

dear afgriffith; you really did a super job. it's much clearer, more logical, and internally consistent. it also reads better. i appreciate that you left the language about patient rights and relationships, as that section above all others that i've contributed matters to me. i would like to ask you a question re: pd data, since i looked up your professional affiliation, and am very pleased to have someone with a connection to booth gardner contributing as you are: what is your best sense of both incidence and prevalence of dementia, by subpopulations, and also across the broadest historical study that you're aware of? i have found radically divergent estimations--30%, 40%, 40-80%. it strikes me that there mu[st be some real bias in the data, because people who are doing badly are more frequently lost to follow-up than are indvidiausl who are doing well. barb

Thanks, Barb. I'm working on this article section by section, mostly trying to reorganize without completely overwriting what has gone before, unless it's inaccurate or outdated. With respect to your question about dementia, I think Heiko Braak's work on Parkinson disease pathology is most illuminating. He published an article in Neurology linking incidence of dementia to severity of pathology. [2] I'm going to be working on the pathology/pathophysiology section next, and will have more to say on that subject. AFGriffithMD 19:26, 20 February 2006 (UTC)[reply]

Dear A: I'd like to use your first name some variant of it, but don't wish to be presumtuous. may i use your your/ first initial? i'd also ask if you'd take a look at both this article and the wikipedia dementia article, in light of a citation i just came across: (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12567332&query_hl=21&itool=pubmed_docsum) "making it the most common cause of degenerative dementia after AD" and also: (http://jnnp.bmjjournals.com/cgi/content/extract/76/7/903) Patients with Parkinson’s disease (PD) have a significant risk of developing dementia in the course of their illness. Cross sectional studies suggest a dementia prevalence rate of 30% to 40%.1 Longitudinal studies indicate that the cumulative frequency of dementia in patients with PD is 60% to 80%.1 The risk of dementia for individuals with PD is approximately six fold greater than that of age matched controls.

80 percent is a looooong ways from 30 percent.

thanks for your thoughts.

I assume you know bill bell?

barb

Parkinson's speech

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)[reply]

Opening summary

the opening summary contains no mention of effects or symptoms of the disease, which might make more sense than a "sciencey" explanation of its causes.

This has now been added. --General Tojo 12:05, 13 April 2006 (UTC)[reply]

Revert to Boonukem : Reordering the introduction means that there are two separate and therefore duplicatory sections in the introduction dealing with symptoms. The alteration also uses the phrase "neurodegenerative disease" which effectively asserts that cell loss as the cause of Parkinson's Disease. Despite that widely being claimed, no such study has ever demonstrated cell loss as a widespread cause in idiopathic Parkinson's Disease.Content must be verifiable with in this case scientific studies as evidence --General Tojo 14:14, 23 April 2006 (UTC)[reply]

I reordered the introduction to reveal the most important information first. I imagine that external descriptions are more relevant than internal causes to someone who has no experience with the disease. I agree that using neurodegenerative disease may be unfounded, but it should at least be mentioned that it's a movement disorder. Even if this is obvious from the information about muscle contraction, the term itself is more immediately descriptive and recognizeable.

If by "duplicatory sections" you mean the mention of "primary symptoms" in my edit, the sentence could be shortened to "As dopamine can reduce muscle contraction, its deficiency can cause excessive muscle contraction." I assume you aren't referring to the mention of symptoms, as the previous version also contained their description (in a slightly awkward grammatical form).

I'll leave the decision to you as you seem to have more expertise in the subject and interest invested in the article. -- 70.81.118.123 07:47, 28 April 2006 (UTC)[reply]

Pathology section

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)[reply]

Understood the idea and actually fixed the links to point straight to the correspondings posts rather than the first one. Maybe that way it does not seem so repetitive. Still think it's overkill though.--80.221.29.185 18:07, 10 May 2006 (UTC)[reply]

Parkinson's Disease isn't physiologically caused. The faults resulting in the symptoms are biochemical. The reason why in most books on PD that you see anatomical or physiological rather than biochemical explanations is that medical graduates rarely study biochemistry and so instead wrongly try to interpret and understand it in terms of what they do know which is anatomy and physiology. The Parkinson's Disease page on Wikipedia was previously riddled with errors as a result of this.

The biochemistry provided really is the briefest amount. Just the information available concerning one dopamine receptor could fill up the entire page on its own. This information concerning the biochemistry of PD is not available anywhere else apart from Wikipedia and the link.

The biochemistry of PD is new to Wikipedia. There was nothing previously concerning it. Ther was little on toxic PD as well until recently. Due to the prolific turnover of information on Wikipedia, more information will inevitably come in concerning it. When that occurs, the links will start changing or being added to for each part of the biochemistry and toxicity sections. Biochemistry and toxicity are certainly not individual subjects for which one link will always suffice. I suspect that somebody will come in with more information concerning subjects such as Lewy Bodies or Ubiquitin. The present PDF biochemistry links do not cover them at all, and so there will have to be separate links for each section, rather than just one PD biochemistry link for everything.

You very cleverly amended the two links, or at least it looks clever to me. I'd do the other two biochemistry links myself if it wasn't for the fact that I don't have a clue how to do it.

--General Tojo 21:37, 10 May 2006 (UTC)[reply]

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)[reply]

Incidence

This Wikipedia article is already 50% lengthier than it is supposed to be. There is therefore not the scope for analysis and detail of all research referred to, despite its posssible significance. They way around this is to provide links to other web sites (such as PubMed) where the full abstract or further information can be provided. This is what has been done with other subjects on the Parkinson's Disease page. Wikipedia is worldwide, so the information should concern what occurs internationally rather than only in one or two countries, or parts of countries. Just one county in the U.S. (Copiah County) is clearly not representitive of the occurence of Parkinson's Disease internationally. Incidence rates differ enormously from one country to another. This is why the present range of incidence rates are given (Nebraska possibly the highest and Ethiopia possibly the lowest) rather than giving generalised incidence rates as if the occurence of Parkinson's Disease is almost uniform internationally when it very definitely isn't. The wide spread of figures given for sex ratio (2.55, nearly double, 1.55) shows how even sex ratio differs so much according to each region. In other countries there is even less consistency with the three figures given.--General Tojo 13:29, 19 June 2006 (UTC)[reply]

First, I find the tone implied by the bold type face offensive. Second, this is not your private web page, this is a wiki. One wonders what you are doing here if you're so unwilling to be part of a cooperative venture. Third, if you're concerned about length, your sections on dopamine synthesis, toxins, and nutrients could be shortened considerably. Fourth, you have demonstrated total lack of understanding of basic epidemiology and you therefore have no business cavalierly removing my contributions. To speak to the questions you raise: Copiah County is a classic study with methods that have been used in most descriptive epidemiology studies since - I did not mention the prevalence rates they found nor did I state that those rated reflected the US rates. Prevalence rates vary tremendously because of differences in diagnosis, awareness and ascertainment. Because incidence studies are performed using less biased methods, ie they count new cases rather than all cases, the rates vary much less. Nebraska and Ethiopia are not incidence rates; they are prevalence rates. Comparisons across countries are close to meaningless because so many factors can influence prevalence besides the underlying occurrence of disease. The sex ratio difference is not enough to make any kind of point. I have not deleted your lengthy and overdetailed pathophysio and toxin sections; please show me that same respect and do not delete mine. I shall otherwise report you. -- Dan 15:03, 19 June 2006 (UTC)[reply]

To find bold type offensive is ludicrous, as is describing this as a private web page. I am very happy to see different people contribute to Wikipedia, and have accepted without amendment the contributions of many people. Unfortunately, what you have added has been done without giving it any real thought. It is frequently false, irrelevant or inconsistent. Other people are more careful and consequently make amendments that are long lasting. As you don't critically evaluate what you add, other people have to do it for you. It appears that you want everyone to be happy with what you add regardless of how counterproductive it might be. The sections on toxicity and biochemistry are already vey short versions of what they link to, which are the most comprehensive source of information on both subjects. Other people have frequently defended what I have added against arbitrary alteration. Copiah County having used good methods is irrelevant, as it deals with only one single county. Wikipedia deals with the whole world. Try telling people in Japan, Africa or Russia that one single county is of great relevance to them. None of what you have written defends that obvious weakness. You have not managed to rebut even one of my criticisms of what you have added. You have instead just merely tried to distract attention by raising irrelevant or erroneous issues. This isn't the academic world where what you publish remains published. Everything is up for scrutiny and potential amendment. If I delete what you add you will report me ! You don't seem to realise how Wikipedia operates.Wikipedia gives a warning that contributors must be prepared to have their contributions altered. If you can't accept Wikipedia's way of doing things then you shouldn't contribute to Wikipedia.--General Tojo 16:06, 19 June 2006 (UTC)[reply]

Vanity links?

I observe that there are multiple instances of Toxic causes of Parkinson's Disease and The biochemistry of Parkinson's Disease, which look much to me as if they are all vanity links. As there is already a link to this forum at the top of the External links section, it is my view that these multiple instances could be removed from all earlier sections with no detriment to the article. Does everyone agree? DFH 16:50, 5 May 2006 (UTC)

To describe the links as "vanity links" is remarkably stupid and dishonest and demonstrates a total lack of attention to the information that is being provided. Information that is added must be verifiable. The links under "Toxic causes" and "Bicochemistry of Parkinson's Disease" are to fully referenced sources of information concering the subject they refer to. They are the most comprehensive Online source of information concerning these two subjects, and provide far more detail for those that want it. It is very clear that you have not even checked in detail or carefully considered the information it is linked to. Before attempting to resort to vandalism of the site, you should discuss it fully on the Talk pages as Wikepedia rules require. Noen of the alterations you made acutually provided any information at all, and instead attempted to reduce the availaibility of informaton for those that want verifiable references or far more detail than is possible on the Wikepedia site. --General Tojo 14:40, 6 May 2006 (UTC)

Please refer to Wikipedia:Etiquette and Wikipedia:External links. It was the multiple instances of the same links that I was calling into question, not the content of either. It's a pity that you didn't assume good faith on my part. I was certainly not being dishonest. Possibly my use of the word "vanity" was incorrect here in the talk page, yet to describe my edits to the main page as "vandalism" was equally so. If you believe that each separate "toxic cause" and/or each separate "biochemistry point" all require identical citations to the same forum, rather than a single reference to a relevant link in the references section, then please explain why. DFH 19:39, 8 May 2006 (UTC) You are an electrical engineer. I doubt if you even understand the scientific information on the Parkinson's Disease site. You should not even be considering altering a Parkinson's Disease site. That should be left to the Parkinson's Disease specialists. It is a pity that throughout Wikipedia there are some people that make arbitrary, useless or conterproductive alterations even when they know little about the subject they are dealing with. --General Tojo 14:52, 6 May 2006 (UTC)

I already know that I am but a humble electrical engineer, and not a Nobel prizewinner, yet you shouldn't generally presume that a person is unable to understand information outside his or her chosen speciality. The fact is that electrical engineering requires a good scientific education, which I have. Nowadays to become a Chartered Engineer requires a four year M.Eng degree or equivalent. The minor edits I made the other day were intended to improve the readability of the page. I was not seeking to reduce the availability of further information. Even so, I shall refrain from making any further edits to the Parkinson's Disease page main article. DFH 19:39, 8 May 2006 (UTC) "Possibly" your use of "vanity was incorrect". It could not have been more incorrect. Vandalism due to carelessness is correct, as you readily and unjustifiably removed links that would provide people with the most comprehensive online references and information concerning these subjects. People can opnly respond to what you write, not what you might have thought. I don't presume that a person is unable to understand information that is outside their area. We all know something about everything, and nobody knows everything about something. Sometimes somebody who is a bit detached from a subject can see things more clearly that those that are engrossed in the subject. Leonardo Da Vinci wasn't a bad engineer even though he was an artist. However, before making assertions and alterations outside their area, people should be extra careful by checking their facts first, or discuss it beforehand. You didn't do that. If I made suggestions about electrical engineering, about which I do not know much, no matter how good I thought my proposed alterations were I would check them out first on the talk page. Engineering may require a "good scientific education". However, it certainly does't cover advanced biochemistry. Medical degrees don't even cover basic biochemistry.

You obviousy hadn't considered how the links would be used in practice. For somebody to rely solely on the Parkinson's Disease Forum link near the bottom of the page would have led them solely to a discussion Forum. They would not have readily known from that lnk that there was fully referenced and far more substantial information concerning toxic causes of PD and the biochemistry of PD. The links to that information are each different from the general link to the Parkinson's Disease Forum that you would have had people rely on. As you admit to having a limited knowing little about the subject, it would have been better if you'd read the information on those links. You would then have been more knowledgeable about the subject and would have seen in practice how useful the links (that you removed) were. There are different subjects within the toxic causes and the biochemistry of PD. If there was only one link for all of toxic causes, and one link for all of PD biochemistry, then further amendments may may be made that contain better sources to some of the subjects of both. For example, somebody may add a better link to maneb toxicity (within toxic causes) or dopamine receptors (within PD biochemistry). Consequently, circumstances may arise where the present links are the best available for only some of the present subjects of toxic causes and PD bochemistry. Each area of toxicity and PD biochemistry is researched separately. So the links will be separate for each subject with toxicity and PD biochemistry. --General Tojo 20:57, 8 May 2006 (UTC)

Quick toxicology question: General Tojo, I assume you wrote the toxin remarks? If so, I'm feeling uncomfortable with the statement about rotenone. Granted, there's some strong findings, but saying it causes PD is a bit too far, no? And to whoever prepared the incidence section, from this neuroepidemiologist, not a bad effort, but you might want to add citations and perhaps a comment about how ascertation bias can affect _apparent_ differences in incidence.(dan strickland) --Dan 23:14, 1 June 2006 (UTC)

I think they're vanity links and later on I will attempt to find some recent reviews from PubMed that I can use to replace them with. General Tojo -> Viartis -> Keith Bridgeman. Look him up on Braintalk. --86.133.112.238 08:37, 2 June 2006 (UTC)

Toxins

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)[reply]

Agreed. Go. Good luck not getting reverted. --Dan 18:19, 19 June 2006 (UTC)[reply]

PaulWicks, there are some obvious fallacies in what you have written. 1. You have falsely assumed that the mention of toxic causes of Parkinson's Disease means that toxicity is the primary cause of Parkinson's Disease. I doubt that toxicity amounts to more than 10% of cases of Parkinson's Disease. The order of the subjects does not determine its relative merits or prominence. 2. You describe toxic causes of Parkinson's Disease as unfounded. You have obviously not checked the links attached to toxins. Every one of them is fully substantiated and based on a comprehensive assessment of the entire scientific literature.Every part of it is well documented and scientifically accurate. 3. Describing dopamine agonists as highly effective is ridiculous. Besides widespread side effects, in response to dopamine agonists, the dopamine receptors that they are supposed to stimulate become progressively less sensitive. Dopamine agonists consequently end up causing the very same symptoms that they initially relieve. I certainly do not agree with your factually baseless suggestions, as they are based on obvious errors. I will consequently revert them interminably. Profsnow would obviously want to alter anything I have added solely out of resentment that his amendments of the page have all been shown to be useless. It's a pity that some people prefer to act out of resentment rather than any genuine aim at being informative. --General Tojo 18:41, 19 June 2006 (UTC)[reply]

Don't "fallacy" me mate. --PaulWicks 21:23, 19 June 2006 (UTC)[reply]

You'll be fallacied when you write fallacies, such as the recent amendments. "Often" is correct because 30% of people do not have tremor. Muscular symptoms are the primary symptoms because many people with PD have only limited if any emotional disturbances.Excessive muscle contraction does cause muscle rigidity. Muscle rigidity does lead to walking difficulties, as can be readily seen by the walking difficulties increasing or decreasing in response to the level of muscle rigidity. --General Tojo 08:55, 20 June 2006 (UTC)[reply]

'Diagnosis is performed clinically on the basis of at least two of the following three signs: bradykinesia (slow movement), resting tremor, rigidity. Therefore Parkinson's is not "often" characterised by these signs, it "is". --PaulWicks 14:19, 20 June 2006 (UTC)[reply]

MAJOR REVISION

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:

http://en.wikipedia.org/wiki/Wikipedia:Article_size http://en.wikipedia.org/wiki/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)[reply]

http://en.wikipedia.org/wiki/WP:3RR

They would be far more flummoxed by the obviously detrimental alterations that you are trying to make. --General Tojo 18:28, 20 June 2006 (UTC)[reply]

I will wait until the admins have adjudicated on this revert war before doing any further revisions, I would recommend all others do the same. --PaulWicks 18:54, 20 June 2006 (UTC)[reply]

As PaulWicks current attempts at decimating the Parkinson's Disease page constitute a blatant breach of Wikipedia rules, there are no restrictions on anyone reverting his vandalism or in improving the page by other means. --General Tojo 19:26, 20 June 2006 (UTC)[reply]

I wasn't deleting them I was moving them into new articles so there'd be enough space for people like you to drill in more detail without making the main article too long. See:

http://en.wikipedia.org/wiki/Parkinson%27s_disease_pathology http://en.wikipedia.org/wiki/Striatonigral_degeneration http://en.wikipedia.org/wiki/Parkinson%27s_disease_mimics http://en.wikipedia.org/wiki/Non-motor_symptoms_of_Parkinson%27s_disease http://en.wikipedia.org/wiki/Motor_symptoms_of_Parkinson%27s_disease

And why take down the picture of Michael J Fox???

--PaulWicks 20:26, 20 June 2006 (UTC)[reply]

There is nothing more to add apart from Lewy bodies. The pages don't need spreading around. It is only symptoms that are comprehensive but far too ill organised. Nobody needs a picture of MJFox. We all know what he looks like anyway. --General Tojo 21:33, 20 June 2006 (UTC)[reply]

Well maybe you do but not everyone knows he has PD. I was going to add some more pix too, I'm trying to source a good image of a DAT scan. And I disagree, there's tons to add. My original aim was to add the contents of this conference (http://www.mdpdamsterdam.nl/) which I just attended to the non-motor symptoms section but I quickly realised it would need a whole article. --PaulWicks 21:38, 20 June 2006 (UTC)[reply]

MJFox is already on the site twice - his foundation web site and on the list of famous PDers. He also has his own page on Wikipedia that details his PD. It doesn't matter if people know he has it anyway. It's not going to get rid of their symptoms. How about a picture of Adolf Hitler on the site. I don't suppose most people know he had it either !!! --General Tojo 22:27, 20 June 2006 (UTC)[reply]

RFC

I was asked by Paul to have a look at the strange edit war here. I really do not understand General Tojo's reasons for reverting. Using capitals or boldface on talk pages and violating Godwin's law is also unlikely to achieve a resolution. Please be mindful of WP:CIVIL and WP:NPA.

I would propose that Paul announces every major edit before committing it. The reason is that we should be attempting to gain consensus of major edits. I don't think we should be forking content at the moment. Rather, all material that looks doubtful and is unsourced should be moved to the talkpage for discussion.

This article needs a lot of work, and I would like to encourage General Tojo and Paul Wicks to work together on this. Do we agree that this article should offer a reliable, neutral, basic overview of a very common medical condition, along with reliable sources for further information? Shall we try to implement this? JFW | T@lk 23:41, 20 June 2006 (UTC)[reply]

Thanks JFD, I'm in agreement with that. --PaulWicks 09:10, 21 June 2006 (UTC)[reply]

Major Revision - Principles

I'm going to try to outline my rationale for a major revision of the article Parkinson's disease.

1. The article is too long. (http://en.wikipedia.org/wiki/Wikipedia:Article_size).

2. The article goes in to too much detail about the biochemistry of Parkinson's, which whilst informative and valid is too complex for the vast majority of readers. In particular please consider this from http://en.wikipedia.org/wiki/Wikipedia:Summary_style: "Since Wikipedia is not divided into a macropaedia, micropaedia, and concise versions like Encyclopaedia Britannica is, we must serve all three user types in the same encyclopedia. Summary style is based on the premise that information about a topic should not all be contained in a single article since different readers have different needs;

many readers need just a quick summary of the topic's most important points (lead section),
others need a moderate amount of info on the topic's more important points (a set of multi-paragraph sections), and
some readers need a lot of detail on one or more aspects of the topic (links to full-sized separate articles)."

3. There are other articles about neurological disease which are better. IMHO these include:

I don't see any reason why we can't make PD as good if not better and make it a featured article.

4. There are several people working on the article that are expert in various fields. For instance it would seem Profsnow is an epidemiologist, General Tojo is a biochemist, I'm a neuropsychologist. Therefore I would suggest that for now we stick firmly within our areas of expertise. We should find a neurologist to take an overview of the introduction, diagnosis, prognosis sections.

5. Until these principles are agreed I don't think anyone should make anymore changes to the page. --PaulWicks 10:13, 21 June 2006 (UTC)[reply]

I support a revision, but please start by reducing unsourced nonsense. At the moment whole sections are unreferenced or use the p4.forumforfree.com site as sources. This is not acceptable. Scientific review articles are the ideal source, not primary studies (the impact of which cannot be judged). Please use your judgement in moving unsupported material to the talkpage, always leaving clear and polite edit summaries.

At present we have no Wikipedia neurologist, so unless one of you can recruit one we'll have to make do without.

I would like to propose that blind reverts are not performed on this article. Rather, a contentious edit can be discussed on this very talkpage, and reverted if other editors agree it was not appropriate.

All editors please familiarise yourself with cite.php and make it a habit to cite peer-reviewed academic studies rather than URLs on potentially unreliable websites. JFW | T@lk 10:43, 21 June 2006 (UTC)[reply]

The Parkinson's Disease Forum contains far more detail, is the most comprehensive source for the toxicology and biochemistry of PD, and and is fully referenced. There is no better source of information online. Brain Talk which is the world's most viewed PD Forum had the biochemistry of PD as their most viewed thread - clear evidence of the interest of people with PD in PD biochemistry.--General Tojo 16:03, 21 June 2006 (UTC)[reply]

But it's not peer-reviewed, and today the URLs gave a 504. As I said, academic references are much to be preferred. Do you disagree with that? JFW | T@lk 16:51, 21 June 2006 (UTC)[reply]

On the Parkinson's Disease Forum, I see 52 peer reviewed references concerning the toxic causes of Parkinson's Disease. It is based on a comprehensive review of the entire scientific literature. It contains far more information on toxic causes of PD that is possible on Wikipedia and so is a very useful and fully referenced additional source of information.

"URLs gave a 504" - I don't know what that means.

Peer reviewed doesn't impress me at all. It's certainly no guide to quality. Dr Hwang's "historical" stem cell breakthroughs were all peer reviewed and in prestigious journals, yet turned out to be the biggest fraud in medical history. All scientific research should be judged on its individual merits. Whether or not its peer reviewed gives little assurance of use or certainty. Approval or disapproval in science is often based on prejudice and has little to do with through scientific evaluation. The peer reviewed scientific literature is full of research that is useless or bogus or that makes false claims.'--General Tojo 17:16, 21 June 2006 (UTC)[reply]

Is the PD Forum free from the influences that caused Dr Hwang's downfall? Your views on peer review are rather original and are certainly unusual for a biochemist. JFW | T@lk 18:06, 21 June 2006 (UTC)[reply]

Prognosis This section has litle to do with the realities of what occurs in most people with Parkinson's Disease. The first section claims increased mortality, but even the second section nullifies it. It then misrepresents what usually occurs by implying that most people with PD die of pneumonia. Very few do, and the biochemistry of pneumonia has nothing to do with PD biochemistry. In disorders such as HIV it is reelvant to describe what usually eventually occurs. However, in PD there is no usual. The prognosis section is misleading, and of no practical use to anyone with PD.

General Tojo from what I understand you are a biochemist. Not a patient. Not an advocate. Not a clinican. Therefore on what basis can you put yourself forward as a representative of "anyone with PD"?. Frankly I'm not finding your edits to be helpful. --PaulWicks 17:49, 21 June 2006 (UTC)[reply]

I have had dialogue with thousands of people with Parkinson's Disease. I read all new research on Parkinson's Disease. I have been involved in Parkinson's Disease far longer and far more extensively than anyone here. As for "I understand you are a biochemist. Not a patient. Not an advocate. Not a clinican", you know virtually nothing about me. --General Tojo 18:18, 21 June 2006 (UTC)[reply]

General Tojo did not read the paragraph properly. It makes it quite clear that increased mortality found in older studies is to be attributed mainly to dementia. As I said before, please avoid removal of well-referenced sections without good discussion. JFW | T@lk 17:56, 21 June 2006 (UTC)[reply]

It is referenced, but it is not relevant. If it relates to dementia it should be in the dementia section. Dementia and Pd are biochemically completely distinct. So please do not continue to revert. --General Tojo 18:18, 21 June 2006 (UTC)[reply]

Revision as of 18:18, 21 June 2006 edit General Tojo (talk \| contribs) 281 edits →‎Major Revision - Principles ← Previous edit		Revision as of 18:20, 21 June 2006 edit undo General Tojo (talk \| contribs) 281 edits →‎Major Revision - Principles Next edit →
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	:General Tojo did not read the paragraph properly. It makes it quite clear that increased mortality found in older studies is to be attributed mainly to dementia. As I said before, please avoid removal of well-referenced sections without good discussion. [[User:Jfdwolff\|JFW]] \| [[User_talk:Jfdwolff\|<small>T@lk</small>]] 17:56, 21 June 2006 (UTC)		:General Tojo did not read the paragraph properly. It makes it quite clear that increased mortality found in older studies is to be attributed mainly to dementia. As I said before, please avoid removal of well-referenced sections without good discussion. [[User:Jfdwolff\|JFW]] \| [[User_talk:Jfdwolff\|<small>T@lk</small>]] 17:56, 21 June 2006 (UTC)

	'''It is referenced, but it is not relevant. If it relates to dementia it should be in the dementia section. Dementia and Pd are biochemically completely distinct.''' --[[User:General Tojo\|General Tojo]] 18:18, 21 June 2006 (UTC)		'''It is referenced, but it is not relevant. If it relates to dementia it should be in the dementia section. Dementia and Pd are biochemically completely distinct. So please do not continue to revert.''' --[[User:General Tojo\|General Tojo]] 18:18, 21 June 2006 (UTC)