Surgery may include thalamotomy, pallidotomy or the placement of deep brain stimulation (DBS) devices.

The DBS system maybe located in the thalamus, pallidum, or subthalamic nucleus.

It is crucial that only appropriate patients be selected for surgery since all patients with Parkinson's disease are not suitable to undergo these procedures.

Once the diagnosis of Parkinson's Disease has been made, the nextdecision is whether a patient should receive anti-parkinsonianmedication, which depends on:

• The degree of functional impairment
• The degree of cognitive impairment
• Ability to tolerate medication
• The advice of the attending physician

No two patients react the same way to a given drug; therefore, ittakes time and patience to find an appropriate medication and dosage toalleviate symptoms.

Many approaches are available for achieving the proper balance ofanti-parkinson medication-treating symptoms effectively while minimizingunpleasant side effects. Many issues must be considered when makingmedication decisions.

For various reasons, many people prefer to take as little medicationas possible, as late in the disease as possible, and most doctors preferto prescribe the least amount of medication necessary. Every personwith Parkinson's disease needs to follow a program of drug therapyspecifically designed for that individual.

There are many reasons why a standard regimen of medications cannotbe applied across the board to everyone with Parkinson's disease. Thisis another reason why your physician should be experienced in thetreatment and management of Parkinson's disease.

Only in the last 30 years have dramatic breakthroughs been made inthe management of Parkinson's disease. Current treatment can significantly relieve people's symptoms and markedly improve their quality of life.

Treatment Options

Treatment for Parkinson's disease may include any or all of the following:

• Medication
• Surgery
• Rehabilitation program
• Clinical research trials

The first stage of treatment for Parkinson's is an accurate diagnosis.This is tricky, as we have noted, particularly early in the disorder when distinguishing Parkinson's disease from other diseases with similar symptoms is particularly difficult. It may be helpful to see a neurologist who is experienced with what are called movement disorders.

A movement disorder specialist has expertise in diagnosing and treating Parkinson's disease and related disorders. A visit to a movement disorder center may also be useful. Most such centers are connected with a department of neurology at a medical school, although some are freestanding clinics.

Singapore scientists develop zebra fish model for studying Parkinson's Disease

Scientists at the Genome Institute of Singapore (GIS), a biomedical research institute of the Agency for Science, Technology and Research (A*STAR), have recently developed a zebra fish model for Parkinson's disease that can be used for understanding the mechanism underlying its development. The knowledge gained will be helpful for future screening of new drugs to treat Parkinson's disease (PD).

This study describes the first zebra fish model for LRRK2 mutation-related PD. It is able to overcome some limitations of other animal models ofLRRK2 and demonstrates that zebra fish, a tropical freshwater fish that can often be found in aquariums, can be used to study the development of human diseases. Led by GIS Group Leader Dr Liu Jianjun, the finding was published in PLoS Genetics on April 22, 2010.

To explore the biological functions of LRRK2, the scientists studied this gene in zebra fish by blocking its normal function. This resulted in Parkinsonism-like phenotypes in zebra fish, including locomotive defects and loss of neurons, similar to those of PD patients. It was found from the study that the defects of the fish can be rescued by expressing the normal protein of LRRK2. Significantly, the administration of Levo-dopa(L-dopa), a compound that is widely used to treat PD, can also rescue the locomotive defects caused by the modification of the zebra fish LRRK2protein.

Parkinson's disease (PD) is a degenerative disease of the brain that often impairs motor skills, speech and other functions.The discovery of several gene mutations in affected patients clearly demonstrated the involvement of genetic factors in the development of PD. LRRK2 was discovered from previous studies by the same team of researchers to be one of the most important genetic causes of PD in the Asian population.

"This work shows how the use of a simple model system in fish can help decipher the root causes of a serious human disorder like Parkinson's disease, " said Professor Edison Liu,Executive Director of the GIS.

Dr Lim Kah Leong, Associate Professor of the National Neuroscience Institute and Duke-NUS Graduate Medical School, added "This novel and elegant study has illuminated the role of an otherwise poorly understood but important domain of LRRK2that is associated with an increased risk for Parkinson's disease amongst Asian populations. The use of zebra fish as a disease model is aclever approach. I am definitely pleased to note that our arsenal of experimental organisms for drug screening has expanded with this study."

The zebra fish model derived from this study serves as a vertebrate model suitable for large-scale drug screening and provides a good disease model for PD. Using a novel technology known as the Zinc-finger nucleases (ZFNs), further research is being carried out to generate additional mutations of zebra fish LRRK2 gene. Such mutated zebra fishes can be used for advancing investigation for the biological mechanism of PD and screening of new drugs for PD treatment.

More information:The research findings can be found in the April 22, 2010 print issue of PLoS GENETICS under the title "Deletion of the WD40 Domain of LRRK2 in Zebra fish Causes Parkinsonism-Like Loss of Neurons and Locomotive Defect".

Provided by Agency for Science, Technology and Research(A*STAR)