Historical background

James Parkinson, a London physician, first described Parkinson's disease in 1817, using the term paralysis agitans (Parkinson, 1817; Roberts, 1997). The distinctive features of tremor, rigidity, and gait difficulties were appreciated in this early monograph (Goetz et al., 2001). Over 50 years later, in his teaching at the Salpêtrière Hospital, the world renown French neurologist, Jean-Martin Charcot, was more thorough in describing the varied features of the illness and distinguished the hallmark of bradykinesia (Charcot, 1879). He recognized the arthritic changes, dysautonomia, and pain that can accompany the disease. Brissaud (1895) drew attention to midbrain lesions, but Greenfield and Bosanquet (1953) performed the most complete delineation of the selective cell loss, depigmentation and degeneration of the substantia nigra. In the 1960s, the biochemical and pharmacologic discoveries that dopamine was depleted in Parkinson's disease and that levodopa, as the precursor to this neurotransmitter, could improve Parkinson's disease signs were described in landmark studies (Barbeau, 1962; Birkmayer & Hornikewicz, 1962; Cotzias et al., 1967). Besides pharmacological therapy, surgical interventions likewise have a long-standing history in Parkinson's disease treatment (Speelman & Bosch, 1998). Although public awareness of Parkinson's disease has been heightened by recognition of the disease in certain actors, political leaders, and public figures, probably the most notorious historical figure afflicted with parkinsonism was Adolph Hitler (Gerstenbrand & Karamat, 1999; Horowski et al., 2000).

Morphological patterns of vulnerability (pathology)

Pathological findings of Parkinson's disease are discreetly dispersed in highly specific regions of the central nervous system (see Chapter 39).