PARKINSON'S DISEASE NEWS
31st March 2008 - New book
Life in the Balance : A physician's memoir of life, love, and loss with Parkinson's Disease and Dementia
Thomas Graboys, Peter Zheutlin
At the age of 49, Dr. Thomas Graboys had reached the pinnacle of his career and was leading a charmed life. A nationally renowned Boston cardiologist popular for his attention to the hearts and souls of his patients. He had a beautiful wife, two wonderful daughters, and a thriving private practice. Today, Graboys is battling a particularly aggressive form of Parkinsonís disease and progressive dementia, and can no longer see patients. Despite the physical, mental and emotional toll he battles daily, Graboys continues by telling his story so that others may find comfort, inspiration, or validation in their own struggles. His is not a sugar-coated story with a silver lining; brutally honest and direct, this is an unflinching memoir of a devastating illness. Click here for more details
30th March 2008 - New research
ADVERSE EVENTS AFTER DBS SURGERY
Movement Disorders  23 : 343-349 (A Videnovic, L Verhagen Metman) Complete abstract
DBS is a surgical method of treating Parkinson's Disease that uses electrodes implanted into the brain. For more information go to Deep Brain Stimulation. Traditionally, the two most common sites in the brain used in surgery are the subthalamic nucleus (STN) and the globus pallidus interna (GPi). The authors analysed reports of adverse events from over a thousand patients who had undergone DBS surgery. The most common adverse events were, in order : weight gain, then confusion, then speech difficulties. Neither part of the brain that was used had clearly fewer adverse events than the other. Adverse events related to DBS surgery are common, but the study authors concluded that their true prevalence cannot be accurately determined with current reporting methods. For more information go to the Complete article The most common adverse events were :
Procedure related events (% of STN / % of GPi) : Mental status / behaviour (mostly confusion) 18% / 9%, Infection 2% / 3%, ICH-symptomatic 2% / 4%, Misplaced electrode 2% / 2%, Speech disturbance 2% / 4%, Infarction 1% / 2%.
Stimulation or progression related events (% of STN / % of GPi) : Weight gain 37% / 18%, Dysarthria (speech disorder) 13% / 12%, Eye opening apraxia 11% / 0%, Gait ignition failure 0% / 17%.
Hardware-related events (Combined % of STN and GPi) : One or more events 9%, Infection 2%, Malfunctioning 1%, Lack of benefit 1%.
29th March 2008 - New research
HEAD INJURY CAUSING PARKINSON'S DISEASE
American journal of neuroradiology  29 (2) : 388-391 (Hšhnel S, Stippich C, Weber I, Darm H, Schill T, Jost J, Friedmann B, Heiland S, Blatow M, Meyding-Lamadť U.) Complete abstract
Parkinsonism Related Disorders  Mar 24; [Epub ahead of print] (Spangenberg S, Hannerz H, Tuchsen F, Mikkelsen KL.) Complete abstract
A few years after the end of his boxing career during which he was the three time world heavyweight world champion, Muhammad Ali was diagnosed with Parkinson's Disease. It has been widely both claimed and denied that he had developed Parkinson's Disease due to blows to the head he received as a boxer. In boxing, the head is hit at a high speed and with great force. This can lead to shear movement between different brain tissues, resulting in microhemorrhages. In the ďHeidelberg Boxing StudyĒ high-resolution MRI data were used to search for tiny changes in the brains of amateur boxers and a comparison group of non-boxers. These changes were suggested as the most likely precursors for later severe brain damage in Parkinsonís Disease. Microhemorrhages were found in some of the boxers, while in the comparison group of non-boxers there were no such changes. However the difference between the two groups was found to be statistically insignificant. So there was no evidence that boxing causes Parkinson's Disease.
Another study assessed the association between severe head injury and Parkinson's disease. Everybody in Denmark who was older than 20 at the beginning of 1981 was followed for the next three years for hospitalisation due to previous head trauma, and for hospital contacts due to Parkinson's Disease for the following 20 years. The number of observed cases of Parkinson's Disease among people at hypothetical risk due to previous head injury was even less than would be generally expected. So contrary to what is widely assumed, the study provides no support at all for severe head injury among adults being a risk factor for Parkinson's disease.
28th March 2008 - New research
PESTICIDE EXPOSURE DOUBLED IN PARKINSON'S DISEASE
BMC Neurology 8:6 (28 March 2008) (Dana
B Hancock, Eden R Martin, Gregory M Mayhew, Jeffrey M Stajich, Rita
Jewett, Mark A Stacy, Burton L Scott, Jeffery M Vance, William K Scott)
26th March 2008 - New research
THE MAIN CAUSE OF DEATH IN PARKINSON'S DISEASE
Parkinsonism Related Disorders  Mar 19; [Epub ahead of print] (Nobrega AC, Rodrigues B, Melo A.) Complete abstract
The main cause of death due to Parkinson's Disease is respiratory infection. The reduced function of the respiratory muscles in Parkinson's Disease causes respiratory infections to be particularly dangerous. This study assessed whether Silent laryngeal penetration or Silent aspiration (SLP/SA) increases the likelihood and seriousness of respiratory infections in Parkinson's Disease. Silent Aspiration is when fluid or solids are sucked into the airway when breathing in, and when there is no coughing to quickly rid it. Silent Laryngeal Penetration is when material enters the top of the airway and is subsequently removed during the swallowing. People with Parkinson's Disease who produced excessive saliva during the day were evaluated. Of those in which Silent laryngeal penetration or silent aspiration (SLP/SA) was observed, most developed respiratory infection. Some of them died of it. The authors claim that the results suggest that patients with Parkinson's disease with diurnal sialorrhea (excessive saliva during the day) and SLP/SA have an increased risk of respiratory infections, which is the main cause of death in Parkinson's Disease patients. The data support a greater emphasis on preventive measures regarding these issues in order to improve survival in people with Parkinson's disease.
25th March 2008 - New research
RESTLESS LEGS SYNDROME IN PARKINSON'S DISEASE
Movement Disorders  22 (13) : 1912-1916
(Gomez-Esteban JC, Zarranz JJ, Tijero B, Velasco F, Barcena J, Rouco I,
Lezcano E, Lachen MC, Jauregui A, Ugarte A.)
24th March 2008 - New research
CLONED CELLS RID PARKINSON'S DISEASE IN MICE
Nature Medicine  Mar 23; [Epub ahead of print] (Viviane Tabar, Mark Tomishima, Georgia Panagiotakos, Sayaka Wakayama, Jayanthi Menon, Bill Chan, Eiji Mizutani, George Al-Shamy, Hiroshi Ohta, Teruhiko Wakayama & Lorenz Studer) Complete abstract
Researchers are claiming that therapeutic
cloning has been used to successfully treat Parkinson's Disease in mice.
In therapeutic cloning, the nucleus of a cell is inserted into an egg with
the nucleus removed. This cell then develops into an embryo from which
stem cells can be harvested and used as a treatment. In this study, stem
cells were developed into dopaminergic neurons, the cells whose reduced
activity causes Parkinson's Disease. Researchers see this as a means of
creating a person's own embryonic stem cells. For
more information go
Despite what has been widely reported,
the mice did not actually have Parkinson's Disease. They were not rid of
all artificially induced Parkinson's Disease symptoms either. The
researchers did not check for persistent effects, as the mice were
assessed for less than three months. Stem cell surgery operations are
already being carried out almost every day involving Parkinson's Disease.
Yet they have not rid anyone of Parkinson's Disease. Stem cell surgery is
based on the assumption that people with Parkinson's Disease are suffering
a massive loss of dopamine producing cells. Despite this being widely
claimed, no research has ever shown this to be true.
HOW ALPHA-SYNUCLEIN EXACERBATES PARKINSON'S DISEASE
Neurochemical Research  Mar 21; [Epub ahead of print] (Liu D, Jin L, Wang H, Zhao H, Zhao C, Duan C, Lu L, Wu B, Yu S, Chan P, Li Y, Yang H.) Complete abstract
Alpha-Synuclein is the main component of Lewy Bodies. Lewy Bodies can remove damaged elements from the cells involved in Parkinson's Disease. For more information go to Alpha-Synuclein. It has been claimed that alpha-synuclein is involved in the cause of Parkinson's disease. Parkinson's Disease normally occurs when the formation of dopamine is insufficient. Previous studies have shown that alpha-synuclein is involved in the regulation of dopamine, possibly by reducing the formation of tyrosine hydroxylase. Tyrosine hydroxylase is responsible for the formation of L-dopa. This study found that alpha-synuclein did not interfere with the formation of tyrosine hydroxylase. However, alpha-synuclein was still found to reduce the activity of tyrosine hydroxylase, and by that means, reduce the formation of L-dopa and dopamine. The reduced dopamine formation this leads to can enable alpha-synuclein to exacerbate the symptoms of Parkinson's Disease.
21st March 2008 - New research
NEW GENETIC FORM OF PARKINSON'S DISEASE
American Journal of Human Genetics  Apr 11; [Epub ahead of print] (Corinne Lautier, Stefano Goldwurm, Alexandra DŁrr, Barbara Giovannone, William G. Tsiaras, Gianni Pezzoli, Alexis Brice, Robert J. Smith) Complete study
According to this study, mutations in the gene, known as GIGYF2, appear to be directly linked to the development of Parkinsonís in people with a family history of the disease. GIGYF2 was found to be located right in the centre of a chromosomal region called PARK 11, a region that was initially identified through a genetic analysis of families with Parkinsonís disease. The researchers identified seven different forms of GIGYF2 mutations occurring in 12 different people, which was approximately 5% of those in the study. All of them had relatives with Parkinson's Disease. Eight of these patients had at least one parent with Parkinsonís, one had both parents affected, and three had one sibling affected. When available, relatives with Parkinsonís were also sampled. Researchers found they carried the same mutation, which led to single amino acid substitutions in the protein encoded by the GIGYF2 gene. None of the mutations were observed in those that did not have Parkinson's Disease. For more information go to the Complete article.
20th March 2008 - News report
NEUPRO BEING WITHDRAWN FROM USE
Neupro (rotigotine), is a dopamine agonist formulated in a transdermal delivery system. For more information go to Neupro. Belgian drugmaker UCB said on Thursday it was recalling its Parkinson's patch Neupro in the United States and some batches from Europe. UCB said the recall decision was not the result of contamination or toxicity but that the clinical performance of some samples on the market was not as required. "As a result, there will be an out-of-stock situation with Neupro in the United States by late April 2008. In the European Union and most other regions, Neupro supply is sufficient," it continued. A spokeswoman said it was not clear how long UCB would be out of stock in the U.S.A.. As supplies will soon run out in the U.S.A., UCB is strongly advising healthcare professionals and patients not to abruptly stop their therapy, and that dosing should be gradually reduced instead under medical supervision in order to avoid certain complications. For more information go to Complete article. The manufacturers have detailed which patches are still likely to work in the meantime. For full details go to Neupro.
19th March 2008 - New research
ON WHICH SIDE OF THE BODY DO SYMPTOMS FIRST APPEAR ?
Parkinsonism Related Disorders  Mar 15; [Epub ahead of print] (Yust-Katz S, Tesler D, Treves TA, Melamed E, Djaldetti R.) Complete abstract
The prevalence and predictive factors of which side of the body symptoms first appear in Parkinson's Disease has hardly been investigated. The aim of this study was to assess whether right handedness or left handedness determined the side of the body on which symptoms first appeared by assessing over 300 people with idiopathic Parkinson's disease. The dominant hand was recorded in each case, as were right-left differences in tremor, bradykinesia, and rigidity. Around 85% of patients were found to have initiated symptoms on one side of the body rather than the other. In right handed patients, the initial symptoms appeared on the right side in 47% of patients, and on the left hand side in 38% of patients, with 15% of patients having symptoms appearing on both sides simultaneously. In left handed patients, the initial symptoms appeared on the right side in 36% of patients, and on the left hand side in 52% of patients, with 22% of patients having symptoms appearing on both sides simultaneously. So there is a tendency for symptoms to begin on the side that people use most, but only a tendency. This tendency is clearly nowhere near as strong as had been previously assumed.
18th March 2008 - News report
nuropro - for the detection of parkinson's disease
Power3 Medical Products have started a 300 patient clinical validation study of its NuroPro diagnostic test for Parkinsonís disease and Alzheimerís disease. The study includes 100 Alzheimerís disease patients, 100 Parkinsonís disease patients and 100 controls. The NuroPro test is based on Power3ís discovery of a group of 59 proteins in the blood that demonstrate significant differences in blood serum concentration for patients with Alzheimerís Disease and Parkinsonís Disease. In blood serum, these protein biomarker combinations, when measured by blood serum proteomics, could lead to a far more effective diagnosis and treatment of Parkinsonís Disease and Alzheimer's Disease. Power3 expects to launch NuroPro at the end of 2008. For more information go to the Complete article. The test is based on proteomic technology. A small sample of blood is drawn from a vein. When a blood sample is collected and stored in a tube without anticoagulant, it forms a clot after 30-60 minutes. The liquid portion remaining is the blood serum. This serum sample is then frozen and transported to the Power3 Medical CLIA certified laboratory, utilizing pre-approved carriers/delivery service, where sample preparation and analysis begins. Power3ís statistical model evaluates the quantitative information of the protein biomarkers and automatically assigns a probability score. This indicates to the physician the patient has a Neurological disease or is disease-free. For more information go to NuroPro.
17th March 2008 - New book
Proud Hands : Personal Victories with Parkinson's
Publisher's description : Parkinson's disease affects many areas of a person's daily living, but does not need to become the whole story of a person's life. That is why Teva Neuroscience and the American Parkinson Disease Association (APDA) have partnered to showcase the many inspirational things people living with PD accomplish every day. "Proud Hands" is filled with personal photos and stories from people across the nation sharing messages of hope and encouragement. The coffee table book is a unique collection from people with diverse backgrounds and ages. All proceeds from the sale of this book go directly to the APDA to support research, people living with PD, their caregivers and Parkinson's education. Click here for more details
16th March 2008 - New research
HOW MANY PEOPLE ARE SUITABLE FOR DBS SURGERY ?
Parkinsonism Related Disorders  13 (8) : 528-531 (Morgante L, Morgante F, Moro E, Epifanio A, Girlanda P, Ragonese P, Antonini A, Barone P, Bonuccelli U, Contarino MF, Capus L, Ceravolo MG, Marconi R, Ceravolo R, D'Amelio M, Savettieri G.) Complete abstract
DBS is a surgical method of treating Parkinson's Disease that uses electrodes implanted into the brain. For more information go to Deep Brain Stimulation. Researchers estimated the percentage of people with Parkinson's Disease that are suitable for subthalamic nucleus (STN) deep brain stimulation (DBS). They used the Core Assessment Program for Surgical Intervention Therapies in PD (CAPSIT-PD), which examines patients in a "practically defined off state" after overnight 12-hour drug withdrawal and again in the on state after their usual morning dose of L-dopa. They found that out of 641 Parkinson's Disease patients only less than 2% fulfilled strict criteria in order to be eligible. When the researchers applied more flexible criteria, the percentage of eligibility increased. Yet the number of those that were eligible was still less than 5%. Most patients - 60% of them - were ineligible because they did not satisfy multiple questionnaire items. Items related to disease severity were responsible for the largest number of those people being excluded from eligibility.
15th March 2008 - New research
THE SENSE OF SMELL IN PARKINSON'S DISEASE
Arquivos de Neuropsiquiatria  65 (3A) :
647-652 (Quagliato LB, Viana MA, Quagliato EM, Simis S.)
14th March 2008 - New research
COMPULSIONS IN PARKINSON'S DISEASE
Neurologist  14 (2) : 89-99 (Stamey W, Jankovic J.) Complete abstract
This research examined the medical literature over a period 28 years concerning impulse control disorders in Parkinson's Disease. Pathologic gambling emerged as one of the most prominent impulse control disorders. Hypersexuality, compulsive shopping and other manifestations of obsessive-compulsive disorder may also dominate. Affected patients may display a pattern of self-escalation of dopaminergic drug dosing, which may lead to a state of drug dependency. Those patients most commonly affected by impulse control disorders, such as pathologic gambling and hypersexuality, are males who develop Parkinson's Disease at a younger age, and those with a previous history of mood disorders, or alcohol abuse, or obsessive-compulsive disorder. Dopaminergic drugs, particularly certain dopamine agonists, play an important role in triggering these symptoms. When somebody takes dopamine agonists such as Ropinirole (Requip) and Pramipexole (Mirapex), they disproportionately stimulate the D3 dopamine receptor, far more than L-dopa does. This causes arousal in the limbic system, which is where the D3 dopamine receptor is primarily located. Given that the limbic system is connected with the pleasure centre and with sexual arousal, the use of certain dopamine agonists can especially lead to unwanted compulsions or sexual arousal.
13th March 2008 - New research
NEW TEST FOR DETECTING PARKINSON'S DISEASE
Brain  131 (2) : 389-396
Due to faulty diagnosis, a huge number of people diagnosed with Parkinson's Disease do not actually have it. This is because diagnosis is usually based solely on a review of symptoms. Clinical trials are also hindered because of difficulties in the assessment of symptoms. New research has shown a test that profiles molecular biomarkers in blood that could become the first accurate diagnostic test for Parkinson's disease. It relies on changes in dozens of small molecules in serum. These "metabolomic" alterations form a unique pattern in people with Parkinson's disease. No one molecule was definitive, but a pattern of about 160 compounds emerged that was highly specific to Parkinson's patients. These included low uric acid, and increased glutathione. More work needs to be done to validate the findings. A test that would be used routinely by doctors is still a few years away. For more information go to the Complete article.
12th March 2008 - New research
DIETARY URATE REDUCES RISK OF PARKINSON'S DISEASE
American Journal of Epidemiology  Mar
7; [Epub ahead of print] (Gao X, Chen H, Choi HK, Curhan G, Schwarzschild
MA, Ascherio A.)
11th March 2008 - History
PARKINSON'S DISEASE IN ANCIENT CHINA
In China, descriptions and treatments of
Parkinson's Disease date back nearly 2500 years. The Yellow Emperor's
Internal Classic was titled with the name of the Yellow Emperor around
425-221 BC. The Yellow Emperor's Internal Classic Plain Questions is a 24-volume
section of the Yellow Emperor's Internal Classic that collected clinical
of Chinese practitioners up to that period. Volume 22 describes symptoms
of tremor and stiffness. Volume 5 describes symptoms compatible with
limitation of movement, postural disturbances, stiffness, and tremor as
follows : A person appears with crouching of the head and with staring
eyes, bending the trunk with shoulders drooped, with difficulty turning
and rocking the low back, inability of the knees to flex and extend, with
the back bowed, failure to stand for long periods, and tremor while
During the Tang dynasty, Sun Simiao (AD 581-682) wrote a book entitled "Essential Prescriptions Worth a Thousand Gold". Volume 8 recommends a prescription of "Jinya wine" for those who for several years feel heavy, just as if being pulled by a string when raising an arm, a foot, or the body, to those who find it difficult to turn around, to walk without dragging the legs; and to those who cannot avoid getting into a running pace.
10th March 2008 - History
PARKINSON'S DISEASE IN MEDIEVAL CHINA
During the Jin Dynasty, Zhang Zihe (1151-1231)
reported a case in "Ru Men Shi Qin" in which a 59 year old man had tremor in his
jaw, hands and feet for 3 years. He failed to hold things and to eat by himself.
His mouth stayed open, with a blank stare. He was depressed and attempted
suicide, but he was unable to hang himself because of his tremulous hands. Zhang
advocated diaphoresis using Fangfeng Tongsheng San, then inducing vomiting,
expelling wind, and promoting circulation of qi through herbs, and nourishing by
food. After treatment for several months, his condition improved, his feet were
not as heavy as before, the tremor was less, and he was able to walk and to hold
a comb, towel, spoon and chopsticks.
Modern pharmacological studies of Zhang's Fangfeng Tongsheng San have found mechanisms of action that could explain its effects on movement disorders. These include herbs containing scopolamine (Ledebouriella root), anticholinergic compounds including peony root and licorice root, and products with antioxidant and freeradical scavenging effects. Jinya wine and the antitremor pill contain the same herbs as Zhang's Fangfeng Tongsheng San (ie, Chinese angelica root, peony root) and gastrodia as a main element. Gastrodia is particularly interesting because it contains gastrodin, which has been shown to increase dopamine levels in guinea pigs and to inhibit monoamine oxidase type B activity in aging mice. Furthermore, gastrodia appears to promote differentiation of mesenchymal stem cells of rats into neuron-like cells and possesses potential neuroprotective effects.
9th March 2008 - New research
THE BLOOD BRAIN BARRIER AND PARKINSON'S DISEASE
Parkinsonism Related Disorders  Mar 4;
[Epub ahead of print] (Bartels AL, van Berckel BN, Lubberink M, Luurtsema
G, Lammertsma AA, Leenders KL.)
7th March 2008 - New research
THE EFFECT OF DUODOPA ON Parkinson's disease
Neurodegenerative Diseases  5 (3-4) :
244-246 (Antonini A, Mancini F, Canesi M, Zangaglia R, Isaias IU, Manfredi
L, Pacchetti C, Zibetti M, Natuzzi F, Lopiano L, Nappi G, Pezzoli G.)
6th March 2008 - New research
Parkinson's disease drugs and the risk of gambling
European Journal of Neurology  Feb 26; [Epub ahead of print] (Imamura A, Geda YE, Slowinski J, Wszolek ZK, Brown LA, Uitti RJ.) Complete abstract
Recent case-series studies indicated that drugs used to treat Parkinson's disease, especially Pramipexole, which is marketed as Mirapex, is associated with gambling. Patients with Parkinson's Disease without any history of gambling, but who has started gambling, were matched with Parkinson's Disease patients who didn't gamble at all. Combined therapy with Pramipexole and L-dopa did not increase the risk of gambling when compared to the use of Pramipexole on its own. However, the use of Pramipexole was significantly associated with increased risk of gambling. Patients with Parkinson's Disease who has started gambling were more likely to have been taking Pramipexole than any other drugs. L-dopa and dopamine agonists all have a dopaminergic effect. However, no reason is given why Pramipexole has any greater effect on gambling than any other dopamine agonists, or why dopamine agonists make people more inclined to gamble than L-dopa. Previous research showed that gambling is one of several compulsions caused by taking dopamine agonists.
5th March 2008 - New book
Parkinson's Disease in THE OLDER PATIENT
Jeremy Playfer and John Hindle (Editors)
Publisher's description : Parkinsonís Disease in the Older Patient has been fully revised, updated and expanded to include new treatments and entirely new chapters. Detailed information on the aetiology and pathogenesis of the condition, drug and surgical treatments, sleep disturbances, quality of life, and carers is now included, along with the more prevalent older patient issues such as neuropsychiatric disturbances, speech and swallowing problems, balance and falls, and autonomic disturbances. The updates also include new advice on the management and services in primary care, linked to the recent NICE guidelines. This new edition is recommended for all those involved in the treatment of Parkinson's Disease patients. Click here for more details
4th March 2008 - News report
unfertilized STEM CELLS TO BE USED IN parkinson's disease
International Stem Cell Corporation announced
that its human parthenogenetic stem cell lines will be used in Germany in
studies aimed at creating specific cell types to treat human neural
diseases such as Parkinson's disease. ISCO's human parthenogenetic stem
cells are created from unfertilized human eggs, yet they share with
conventional human embryonic stem cells the ability to differentiate into
all tissue types. They are also the first step in solving one of the major
obstacles to stem cell therapy, which is the rejection of implanted cells
by the patient's
immune system. So cells derived from this line will not be immune rejected
after transplantation into millions of individuals of differing sexes,
ages and racial groups. They aim to make their cell lines and intellectual
property easily available, and thereby become a supplier of stem cells for
use by patients across the world. Their intention is to distribute their
human parthenogenetic stem cell lines to as many qualified researchers as
For more information go to
Despite stem cell surgery already taking
place around the world, nobody has been rid of Parkinson's Disease after
3rd March 2008 - New research
istradefylline - a non-dopamine approach to parkinson's disease
Annals of Neurology  Feb 27; [Epub
ahead of print] (Lewitt PA, Guttman M, Tetrud JW, Tuite PJ, Mori A,
Chaikin PC, Sussman NM)
2nd March 2008 - New research
the long term effects of parkinson's disease
Movement Disorders  Feb 28; [Epub ahead
of print] (Hely MA, Reid WG, Adena MA, Halliday GM, Morris JG.)
1st March 2008 - History
shakespeare and parkinson's disease
William Shakespeare (1564-1616) shows in his plays an astonishing knowledge of contemporary medicine. Over 700 quotations are said to be found in his work dealing with medical matters. Extracts from his plays, show that William Shakespeare was well aware of the clinical picture of elderly people with motor difficulties and tremor. In "Richard II (Act II, Scene III), the aging Duke of York describes a loss of arm movement when he says : "How quickly should this arm of mine, now prisoner to the palsy". In Troilus and Cressida (Act I, Scene II), Ulysses talks in his monologue about Achilles, whom he considers old and of no use. He clearly connects "Palsy" with the shaking of tremor when he says : "And with a palsy fumbling on his gorget, Shake in and out the rivet." In "King Henry VI, part 2" (Act IV, scene VII) there is another reference to tremor. When Dick asks "Why dost thou quiver [shake], man ?", the response from Lord Say is "It is the palsy, and not fear, provokes me." It appears that Lord Say also has head tremor, when Jack Cade says : "I'll see if his head will stand steadier on a pole". Shakespeare, and probably his audience, were very familiar with the "palsy" and its symptoms. This term most likely was then used for a clinical picture we today would recognize as Parkinson's Disease.