Parkinson's disease, as conventionally clinically defined, constitutes a syndrome rather than a disorder with a specific pathology. This does not raise a barrier to performing therapeutic trials with cases of clinically probable PD, but must inevitably hinder attempts to determine the aetiology of the disorder. If one accepts that brainstem Lewy body disease is the pathological hallmark of PD then it becomes necessary both to consider other syndromes as part of this entity (isolated tremor, dystonia, dementia) and to accept atypical features (supranuclear gaze palsy, myoclonus, lack of dopa-response) as occasional associations.
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