Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Viewpoint
  • Published:

New practice parameters in Parkinson's disease

Nature Clinical Practice Neurology volume 2, pages 638–639 (2006)Cite this article

Clinical judgment is the mark of excellence in medicine. At first glance, guidelines seem to diminish the role of judgment in modern medicine. In fact, however, guidelines are often controversial and can themselves be the subject of scholarly discourse. Given the widespread presence of guidelines and their potential influence on public policy, critical appraisal and development of guideline standards should occur. Guidelines address gaps between clinical practice and existing evidence.1 As such, they serve as clinical tools and educational instruments, and signify a commitment to quality. Professional societies produce guidelines with varying degrees of rigor. I will discuss the qualities of good guideline development using the example of the Parkinson's disease (PD) practice parameters published by the American Academy of Neurology (AAN) in April 2006.2,3,4,5 For the remainder of this piece, the terms 'practice parameter' and 'practice guideline' are used synonymously.

In 2002, the AAN published the first practice parameter in PD therapy since adopting new rigorous methods for guideline development.6 This guideline recognized that levodopa provided superior motor benefit, whereas dopamine agonists provided reduced risk of motor-complication development. Either drug or class was an acceptable first choice depending on patient preference. The conclusions were at odds with the popular opinion at the time, which was that dopamine agonists were preferable to levodopa because of their reduced risk of motor complications and their potential neuroprotective effect. Four years later, however, the guideline conclusions are viewed as balanced and clinically valid.7 Furthermore, the widespread use of dopamine agonists led to increased recognition of complications associated with these agents, such as daytime somnolence and impulse control disorders,7 making therapeutic choice even more complex.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Edelson P (1998) Clinical practice guidelines: a historical perspective on their origins and significance. In Getting doctors to listen: ethics and outcomes data in context, 31–38 (Ed Boyle P) Washington, DC: Georgetown University Press

    Google Scholar 

  2. Suchowersky O et al. (2006) Practice parameter: diagnosis and prognosis of new onset Parkinson disease (an evidence-based review). Neurology 66: 968–975

    Article  CAS  Google Scholar 

  3. Suchowersky O et al. (2006) Practice parameter: neuroprotective strategies and alternative therapies for Parkinson disease (an evidence-based review). Neurology 66: 976–982

    Article  CAS  Google Scholar 

  4. Pahwa R et al. (2006) Practice parameter: treatment of Parkinson disease with motor fluctuations and dyskinesia (an evidence-based review). Neurology 66: 983–995

    Article  CAS  Google Scholar 

  5. Miyasaki JM et al. (2006) Practice parameter: evaluation and treatment of depression, psychosis, and dementia in Parkinson disease (an evidence-based review). Neurology 66: 996–1002

    Article  CAS  Google Scholar 

  6. Miyasaki JM et al. (2002) Practice parameter: initiation of treatment for Parkinson disease: an evidence-based review. Neurology 58: 11–17

    Article  CAS  Google Scholar 

  7. Kurlan R (2005) “Levodopa phobia”: a new iatrogenic cause of disability in Parkinson disease. Neurology 64: 923–924

    Article  Google Scholar 

  8. Shaneyfelt T et al. (1999) Are guidelines following guidelines? The methodological quality of clinical practice guidelines in the peer-reviewed medical literature. JAMA 281: 1900–1905

    Article  CAS  Google Scholar 

  9. Edlund W et al. (2004) Clinical practice guideline process manual [http://www.aan.com/professionals/practice/pdfs/2004_Guideline_Process.pdf] (accessed 18 September 2006)

    Google Scholar 

  10. Shulman LM et al. (2002) Non-recognition of depression and other non-motor symptoms in Parkinson's disease. Parkinsonism Relat Disord 8: 193–197

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Associate Clinical Director of the Movement Disorders Centre and Director of Clinical Services for Neurology, University Health Network and Mount Sinai Hospitals, University of Toronto, Toronto, ON, Canada

    Janis M Miyasaki

Authors
  1. Janis M Miyasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

Ethics declarations

Competing interests

Janis Miyasaki is the first author of one of the American Academy of Neurology guidelines discussed in this Viewpoint article and is co-author of another guideline discussed. She is also co-chair of the Therapeutic and Technology Assessment subcommittee of the American Academy of Neurology (not the subcommittee producing the guidelines discussed in this Viewpoint article).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Miyasaki, J. New practice parameters in Parkinson's disease. Nat Rev Neurol 2, 638–639 (2006). https://doi.org/10.1038/ncpneuro0348

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpneuro0348

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing