NeuroTalk Support Groups - Beans, Roots, and Leaves: History of PD Treatments

times until the near present (1980). It is not clear whether parkinsonism as it is now defined – a progressive neurodegenerative disorder of the basal ganglia characterized by sharply reduced striatal dopamine levels, particularly in the striatum – has always affected a significant minority of aged persons, but suggestive evidence to this effect in the older literature is reviewed. The major discussion commences, however, with the administration of various plant alkaloids to parkinsonian patients in the second half of the 19th century. Antiparkinsonian therapy since this time may be divided into a number of phases: 1. The employment of alkaloids derived from solanaceous plants: initially hyoscyamine, then hyoscine/scopolamine and atropine. The discovery and characterization of these alkaloids, and the gradual recognition that other pharmacologically useful solanaceous alkaloids (such as duboisine) were identical with one or other of these three compounds, is discussed. 2. With the outbreak of encephalitis lethargica following the First World War, parkinsonian patient numbers increased dramatically, leading to a multiplicity of new directions, including the use of another solanaceous plant, stramonium, of extremely high atropine doses, and of harmala alkaloids. 3. The so-called “Bulgarian treatment” was popularized in western Europe in the mid-1930s. It was also a belladonna alkaloid-based therapy, but associated with greater efficacy and fewer side effects. This approach, whether as actual plant extracts or as defined combinations of belladonna alkaloids, remained internationally dominant until the end of the 1940s. 4. Synthetic antiparkinsonian agents were examined following the Second World War, with the aim of overcoming the deficiencies of belladonna alkaloid therapy. These agents fell into two major classes: synthetic anticholinergic (= antimuscarinic) agents, such as benzhexol, and antihistaminergic drugs, including diphenhydramine. These agents were regarded as more effective than plant-based remedies, but certainly not as cures for the disease. 5. A complete change in direction was heralded by the discovery in 1960 of the striatal dopamine deficit in parkinsonism. This led to the introduction of L-DOPA therapy for parkinsonism, the first approach directed against an identified physiological abnormality in the disorder. 6. Subsequent developments have thus far concentrated on refinement or supplementation of the L-DOPA effect. Recent attempts to develop neuroprotective or -restorative approaches are also briefly discussed. The thesis also discusses the mechanisms by which the various types of antiparkinsonian agent achieved their effects, and also the problems confronting workers at various periods in the design and assessment of novel agents. The impact of attitudes regarding the etiology and nature of parkinsonism, particularly with regard to symptomatology, is also considered. Finally, the history of antiparkinsonian therapy is discussed in context of the general development of both clinical neurology and fundamental anatomical, physiological and biochemical research. In particular, the deepening understanding of the neurochemical basis of central nervous system function is emphasized, for which reason the history of dopamine research is discussed in some detail. This history of antiparkinsonian therapy also illustrates the fact that the nature of experimental clinical pharmacology has markedly changed throughout this period: No longer the preserve of individual physicians, it is now based firmly on fundamental laboratory research, the clinical relevance of which is not always immediately apparent, and which is only later examined in (large scale) clinical trials. It is concluded that antiparkinsonian therapy was never irrational or without basis, but has always been necessarily rooted in current knowledge regarding neural and muscular function. The achievements of L-DOPA therapy, the first successful pharmacological treatment for a neurodegenerative disorder, derived from the fruitful union of the skills and contributions of different types by laboratory scientists, pharmacologists and clinicians