The study of Parkinson disease (PD) undoubtedly provides one of the most complete and satisfying stories in medicine. It allows students of the disorder a meaningful and coherent correlation between the neuroanatomic, neuropathologic, and neurochemical underpinnings on the one hand and the clinical manifestations and treatment modalities on the other. Although PD is perhaps the best understood movement disorder, I would venture the guess that the fascinating panoply of twists, turns, and shakes that encompasses this area of neurology was an important source of inspiration for many of us who chose to become neurologists. In this issue of CONTINUUM, Dr David Charles has called on a capable group of collaborators to better educate us about a variety of movement disorders.
The first two chapters of the issue provide an overview of movement disorders. Initially, Drs Jill Ostrem and Nicholas Galifianakis discuss common disorders, including PD, essential tremor, dystonia, and spasticity. Then Dr Kathleen Poston reviews less frequently encountered disorders, both of the hypokinetic and hyperkinetic varieties. Understanding the genetics of neurologic diseases has become increasingly important, and no discussion of a particular topic today is complete without consideration of heritable aspects. The importance lies, perhaps, more in the biological lessons taught by a study of genetics than with the actual incidence of purely genetic disorders. The subject of movement disorders is no exception to this rule, and Drs Fenna Phibbs and Peter Hedera will update your understanding of this subject.
PD is also relatively unusual among neurologic disorders in its breadth of treatment options, including both medical and surgical modalities. Dr John Fang reviews the medical management of PD, discussing not only the well-recognized motor manifestations of the disorder, but also the increasingly important nonmotor symptoms. Among surgical options for the treatment of PD, as well as some other movement disorders, deep brain stimulation has surpassed destructive surgical procedures. Drs Mustafa Saad Siddiqui, Ihtsham ul Haq, and Michael Okun explore this therapeutic modality with which more and more neurologists are likely to become involved. The introduction of botulinum neurotoxin injection some years ago revolutionized the management of several movement disorders, particularly a variety of dystonias. Many neurologists already perform these procedures, and increasing numbers are acquiring the skill. Dr Charles himself, along with Ms Chandler Gill, addresses this subject.
As usual, this issue of CONTINUUM includes the short sections, Ethical Perspectives in Neurology and Practice Issues in Neurology. In the former, Drs Elizabeth Haberfeld and Michael Williams address the fascinating subject of compulsive behavior associated with the use of dopaminergic medication. Many neurologists may take a rather blasé attitude toward the subject of coding, but in his Practice section, Dr Peter Donofrio explains the importance of precise coding.
You may assess what you've learned from this issue of CONTINUUM by working through the Patient Management Problem crafted by Dr Amie Peterson and the multiple-choice questions developed by Drs Douglas Gelb and Steven Lewis. Even more importantly, these instruments are developed to teach as well as test and have been especially selected to focus on practical clinical matters.
I am certain that you will find this Movement Disorders issue to be jam-packed with practically useful clinical information. I'm confident that you will share my appreciation to Dr Charles and his faculty for their thoughtful, well-organized reviews.
-Aaron E. Miller, MD