title: Pathophysiology of Motor Dysfunction in Parkinson's Disease as the Rationale for Drug Treatment and Rehabilitation.
abstract: Cardinal motor features of Parkinson's disease (PD) include bradykinesia, rest tremor, and rigidity, which appear in the early stages of the disease and largely depend on dopaminergic nigrostriatal denervation. Intermediate and advanced PD stages are characterized by motor fluctuations and dyskinesia, which depend on complex mechanisms secondary to severe nigrostriatal loss and to the problems related to oral levodopa absorption, and motor and nonmotor symptoms and signs that are secondary to marked dopaminergic loss and multisystem neurodegeneration with damage to nondopaminergic pathways. Nondopaminergic dysfunction results in motor problems, including posture, balance and gait disturbances, and fatigue, and nonmotor problems, encompassing depression, apathy, cognitive impairment, sleep disturbances, pain, and autonomic dysfunction. There are a number of symptomatic drugs for PD motor signs, but the pharmacological resources for nonmotor signs and symptoms are limited, and rehabilitation may contribute to their treatment. The present review will focus on classical notions and recent insights into the neuropathology, neuropharmacology, and neurophysiology of motor dysfunction of PD. These pieces of information represent the basis for the pharmacological, neurosurgical, and rehabilitative approaches to PD.
authors.affiliation: Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, 37134 Verona, Italy.
authors.forename: Francesca
authors.identifier: 0000-0003-4706-6245
authors.initials: F
authors.lastname: Magrinelli
authors.affiliation: Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, 37134 Verona, Italy; Neuromotor and Cognitive Rehabilitation Research Centre, University of Verona, Piazzale Scuro 10, 37134 Verona, Italy.
authors.forename: Alessandro
authors.identifier: 0000-0002-3558-8276
authors.initials: A
authors.lastname: Picelli
authors.affiliation: Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, 37134 Verona, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Tocco
authors.affiliation: Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, 37134 Verona, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Federico
authors.affiliation: Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, 37134 Verona, Italy; Rehabilitation Unit, Pederzoli Hospital, Via Monte Baldo 24, 37019 Peschiera del Garda, Italy.
authors.forename: Laura
authors.identifier: 0000-0002-3559-6364
authors.initials: L
authors.lastname: Roncari
authors.affiliation: Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, 37134 Verona, Italy; Neuromotor and Cognitive Rehabilitation Research Centre, University of Verona, Piazzale Scuro 10, 37134 Verona, Italy.
authors.forename: Nicola
authors.identifier: 0000-0001-7630-1887
authors.initials: N
authors.lastname: Smania
authors.affiliation: Neurology Unit, Pederzoli Hospital, Via Monte Baldo 24, 37019 Peschiera del Garda, Italy.
authors.forename: Giampietro
authors.initials: G
authors.lastname: Zanette
authors.affiliation: Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, 37134 Verona, Italy.
authors.forename: Stefano
authors.identifier: 0000-0002-1561-2187
authors.initials: S
authors.lastname: Tamburin