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Wikipedia:Featured article candidates/Parkinson's disease/archive2

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The following is an archived discussion of a featured article nomination. Please do not modify it. Subsequent comments should be made on the article's talk page or in Wikipedia talk:Featured article candidates. No further edits should be made to this page.

The article was promoted by Laser brain 21:28, 5 March 2011 [1].

Parkinson's disease

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Parkinson's disease (edit | talk | history | protect | delete | links | watch | logs | views)

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Nominator(s): Garrondo (talk) 12:57, 22 January 2011 (UTC)[reply]

A (what I feel) is a complete article in this important disease. PD is the most common neurodegenerative disorder after Alzheimer's disease. The article is considered vital, is considered of top importance by the medicine project and receives almost 300000 visits each month. It has recently been considered a GA after a complete review by a user expert in neuroscience, I feel it covers all the main aspects of the disease without going into unnecessary detail, and I have tried to use as high quality sources as possible. It has been stable for more than a year and while my prose is probably not brilliant it has been copy-edited by several editors, and I only hope that this review will further improve the style so it can be considered one of our best pieces of work.--Garrondo (talk) 12:57, 22 January 2011 (UTC)[reply]

  • Support I recently did the GA review for this article. My focus was on correctness, comprehensiveness, verifiability, and understandability, and I believe that it reaches FA level in those respects, although there are parts that could perhaps be made more understandable to a broad audience. I have given comparatively less attention to aspects such as whether the images were properly licensed and the format is completely standard, but I am not specifically aware of any problems in those respects. This is a very important article because it is read by millions of people each year, and a substantial number of them are likely to have their interactions with people with PD shaped by our article -- so it's definitely worth our time to get this right. Looie496 (talk) 18:31, 22 January 2011 (UTC)[reply]
  • Comments from JFW | T@lk 02:18, 23 January 2011 (UTC)[reply]
    • Some of the links are redlinks. In the past I was advised that it might be better to create a stub for the relevant articles rather than having an FA with redlinks.
      • I would say that that is exactly what red links are for: to encourage article creation. It would be great if I created them, but I would say that leaving them for others to create them would also be great, and in my opinion should not affect this FAC, since the article under scrutiny is neither best nor worse by having more articles in wikipedia. Nevertheless I will try to create some of them. --Garrondo (talk) 09:36, 23 January 2011 (UTC)[reply]
    • Parts of the NICE/NCC-CC guideline are cited in separate references. Would it be an idea to make this an article reference (similar to what James and I have been doing at dengue fever)?
      • I would rather not have a notes section for references and a references section also for references as in dengue fever. I do not see the advantages of such proposal. Nevertheless I am open for discussion and comments from other reviewers in this issue.--Garrondo (talk) 09:51, 23 January 2011 (UTC)[reply]
    • The reference to Garcia Ruiz (2004) has a dead link (PMID 15568171). Is there a comparable source in English (I suspect there may not be)?
      • I have tried to find a similar article in English but I have not been able to. I believe that this is one of those strange cases were a foreign ref does a better job than an English one... Regarding the link I have simply eliminated it.--Garrondo (talk) 09:36, 23 January 2011 (UTC)[reply]
    • "Causes" has only one subsection. Is the level 3 header needed?
    • In causes, I see no mention of a previous association with glucocerebrosidase mutations (PMID 15525722). Has it been disproven?
      • It was partly there (GBA), but actually was misexplained, since it said that it was a gene common to familial PD also. I have corrected text and added further info on GBA causing Gaucher's disease. Many thanks for the catch.--Garrondo (talk) 13:05, 24 January 2011 (UTC)[reply]
    • I'm struggling with the image in "pathophysiology". Clearly, some of the layers moved about when the images were converted to PNG format. Would it be more useful to have a more schematic drawing, or for it to be redrawn?
    • "Epidemiology" has only one subsection. Is the level 3 header needed? Alternatively, could the risk and protective factors be split in separate sections?
    • I have fixed some phrasing and grammar issues. There are definitely a few remaining, but I reckon they will be ironed out in the course of the FAC.
    • I am happy to support FA status for this vital article. It has travelled a long rocky road, and it is now a source of pride for our WikiProject and Wikipedia as a whole. JFW | T@lk 21:33, 21 February 2011 (UTC)[reply]
  • Comments by Axl
    • From the lead section, paragraph 1: "Cognitive and neurobehavioral problems, including dementia, are common in the advanced stages of the disease." I suspect that many readers may not know what "neurobehavioral problems" are. Axl ¤ [Talk] 09:36, 24 January 2011 (UTC)[reply]
    • From the lead section, paragraph 2: "Current treatments are effective at managing the early motor symptoms of the disease, through the use of levodopa, dopamine agonists and MAO-B inhibitors." I am surprised to see the MAO-B inhibitors mentioned in the lead. The DOPA-decarboxylase inhibitors are invariably used with levodopa. MAO-B inhibitors are infrequently used. Even the COMT inhibitors are used more often than the MAO-B inhibitors in the modern approach. Axl ¤ [Talk] 09:42, 24 January 2011 (UTC)[reply]
      • I have eliminated the reference to MAO-B inhibitors in the lead. Reason for not commenting about DOPA-decarboxylase inhibitors in lead is precisely that they are sistematically used in combination with levodopa, and in the text they are explained under the levodopa subsection, instead of independently.--Garrondo (talk) 12:55, 24 January 2011 (UTC)[reply]
    • From the lead section, paragraph 4: "The disease is named after English surgeon James Parkinson, who gave the first detailed description of it in "An Essay on the Shaking Palsy" (1817). " I don't think that needs to be mentioned in the lead, particularly when the next sentence is irrelevant to it. Axl ¤ [Talk] 09:45, 24 January 2011 (UTC)[reply]
      • I fully disagree in this case. A believe that a line on history in the lead is quite important. However I am more than open to proposals in how to better integrate the sentence in the lead.--Garrondo (talk) 12:55, 24 January 2011 (UTC)[reply]
        • How about moving the description of James Parkinson later on, where the advocacy action uses his birthday. "PD is a costly disease to society. Several major organizations promote research and improvement of quality of life of those with the disease and their families. Research directions include a search of new animal models of the disease, and investigations of the potential usefulness of gene therapy, stem cells transplants and neuroprotective agents. Advocacy actions include the use of a red tulip as the symbol of the disease, and world Parkinson's day, April 11, chosen as the birthday of the English surgeon James Parkinson, who gave the first detailed description of PD in "An Essay on the Shaking Palsy" (1817). People with PD who have greatly affected public awareness include Michael J. Fox and Muhammad Ali." Axl ¤ [Talk] 10:31, 29 January 2011 (UTC)[reply]
    • From "Signs and symptoms", first paragraph: "Non-motor symptoms, which include autonomic dysfunction, cognitive and neurobehavioral problems, and sensory and sleep difficulties, are also common." Are "cognitive and neurobehavioral problems" the same as "neuropsychiatric" symptoms? If so, the sentence should be changed in line with the subsection's title. Axl ¤ [Talk] 09:57, 24 January 2011 (UTC)[reply]
    • "Signs and symptoms", subsection "Neuropsychiatric", paragraph 4. Isn't it worth mentioning dopamine dysregulation syndrome? Axl ¤ [Talk] 09:26, 25 January 2011 (UTC)[reply]
    • From "Signs and symptoms", subsection "Other": "PD is also related to several ophthalmological abnormalities ... ." Why not "eye abnormalities"? Axl ¤ [Talk] 09:32, 25 January 2011 (UTC)[reply]
    • From "Causes", paragraph 4: "LRRK is the most common known cause of familial and sporadic PD...". Should this be "Mutation in LRRK2 is the most common known cause..."? Axl ¤ [Talk] 10:57, 28 January 2011 (UTC)[reply]
      • Fixed: Since the word mutation appeared twice in the following sentece I thought it was clear enough. I have reworded to: Alterations in LRRK are the most common known cause of familial and sporadic PD, with mutations in the gene in up to 10% of patients with a family history of the disease. I have used alterations so as not to use 3 times the word mutation in just 2 sentences.--Garrondo (talk) 18:18, 28 January 2011 (UTC)[reply]
    • From "Causes", last paragraph: "Several other mutations in 3 different genes have been found to be risk factors for sporadic PD. Two of these genes are the same as for familial forms of the disease (SNCA and LRRK2). The third is the glucocerebrosidase (GBA) gene...". The preceding paragraph already mentioned that LRRK2 causes sporadic PD. Also, that paragraph mentioned G2019S as a cause of sporadic PD. How about: "Mutations in several different genes—including SNCA, LRRK2 and G2019S—are risk factors for sporadic PD. Mutations in the glucocerebrosidase (GBA) gene are also associated with sporadic PD as well as Gaucher's disease." Axl ¤ [Talk] 09:54, 31 January 2011 (UTC)[reply]
      • G2019S is a specific mutation of LRRK2, not a different gene. Additionally it would be incorrect to say "Mutations in several different genes": 3 genes are known up to date, witch several mutations in them (over 40 in the case of LRRK2) being related to PD. To address the comment I have: 1-eliminated mention to G2019S, it was probably too specific and prone to mislead readers; 2-Move paragraph on sporadic cases to earlier in the section; 3-Leave last paragraphs on SNCA and LRRK2, since they are related both to sporadic and familial PD. What do you think?--Garrondo (talk) 12:20, 1 February 2011 (UTC)[reply]
        • From "Causes", paragraph 3: "The most extensively studied PD-related genes are SNCA and LRRK2. Mutations in other genes; including SNCA, LRRK2 and glucocerebrosidase (GBA), have been found to be risk factors for sporadic PD." The second sentence doesn't seem to follow on from the first; the first sentence mentions SNCA and LRRK2 so they are not "other genes" in the second sentence. Axl ¤ [Talk] 09:16, 3 February 2011 (UTC)[reply]
    • From "Pathophysiology", subsection "Pathology": "As the disease progresses, Lewy bodies later attain the substantia nigra...". "Attain"? Axl ¤ [Talk] 10:58, 1 February 2011 (UTC)[reply]
    • From "Management", paragraph 1: "The main families of drugs useful for treating motor symptoms are levodopa, dopamine agonists and MAO-B inhibitors." I am not happy about that sentence. There is no mention of the DOPA-decarboxylase inhibitors or the COMT inhibitors. I realise that those enzyme inhibitors are described in the section entitled "Levodopa". Axl ¤ [Talk] 09:26, 5 February 2011 (UTC)[reply]
      • What do you think about: "The main families of drugs useful for treating motor symptoms are levodopa (usually combined with DOPA-decarboxylase or COMT inhibitors) dopamine agonists and MAO-B inhibitors."?--Garrondo (talk) 08:08, 7 February 2011 (UTC)[reply]
        • That's close. However levodopa is not combined with DOPA-decarboxylase. You're also missing a comma after the closing bracket. How about: "The main families of drugs useful for treating motor symptoms are levodopa (usually combined with a DOPA-decarboxylase inhibitor or COMT inhibitor), dopamine agonists and MAO-B inhibitors." Axl ¤ [Talk] 09:34, 7 February 2011 (UTC)[reply]
  • From "Management", subsection "Levodopa", paragraph 2: "Only 5-10% of L-DOPA crosses the blood-brain barrier." Do the DOPA-decarboxylase inhibitors/COMT inhibitors increase the amount of L-DOPA crossing the blood-brain barrier? I don't actually know the answer to this. Axl ¤ [Talk] 10:54, 7 February 2011 (UTC)[reply]
    • From the source originating the paragraph:Levodopa is now always combined with carbidopa (co-careldopa) or benserazide (co-beneldopa) to block its metabolism by dopa decarboxylase. This increases levodopa bioavailability by twofold to threefold and reduces peripheral side effects. However, only 5–10% of each levodopa dose crosses the blood-brain barrier, the rest being metabolised to 3-O-methyldopa by catechol-O-methyl transferase (COMT). The aim of COMT inhibitors is to further reduce the metabolism of levodopa and thus increase the amount crossing into the brain. Answer would be yes, since the more quantity of L-DOPA is available the more will cross the BB-barrier.--Garrondo (talk) 11:25, 7 February 2011 (UTC)[reply]
  • From "Management", subsection "Levodopa", paragraph 3: "Entacapone is available for treatment alone (COMTan) or combined with carbidopa and levodopa (Stalevo)." This sentence implies that entacapone can be used as single-agent treatment. Is this correct? Axl ¤ [Talk] 10:47, 9 February 2011 (UTC)[reply]
  • From "Management", subsection "Levodopa", paragraph 4: "Levodopa results in a reduction in the endogenous formation of L-DOPA, and eventually becomes counterproductive. Levodopa preparations lead in the long term to the development of motor complications characterized by involuntary movements called dyskinesias." These sentences imply that the reduction of endogenous L-DOPA is responsible for the dyskinesias. Is this correct? Axl ¤ [Talk] 10:54, 9 February 2011 (UTC)[reply]
  • From "Management", subsection "Levodopa", paragraph 4: "Delaying the initiation of dopatherapy ... is also common practice." Is "dopatherapy" a real word? Axl ¤ [Talk] 10:58, 9 February 2011 (UTC)[reply]
  • From "Management", subsection "Levodopa", paragraph 4: "Delaying the initiation of therapy with levodopa, using instead alternatives for some time, is also common practice." Are the "alternatives" dopamine agonists? Axl ¤ [Talk] 09:55, 10 February 2011 (UTC)[reply]
  • From "Management", subsection "Dopamine agonists", paragraph 2: "Agonists at higher doses have also been related to a variety of impulse control disorders." Does this refer to dopamine dysregulation syndrome? Low dose dopamine agonists have not been associated with impulse control disorders? Axl ¤ [Talk] 09:51, 10 February 2011 (UTC)[reply]
    • Actually dopamine agonists have been related to impulse control disorder even more strongly than levodopa. I have changed sentence to: agonists have been related to a impulse control disorders even more strongly than levodopa. Example of dysfunctional behaviors include dopamine dysregulation syndrome, compulsive sexual activity and eating, and pathological gambling and shopping. Only problem is that right now similar info appears in the signs and symptoms section, and the levodopa and dopamine agonists subsections of management. Any ideas on how to avoid duplication? --Garrondo (talk) 07:37, 16 February 2011 (UTC)[reply]
      • How about "Agonists have been related to impulse control disorders (such as dopamine dysregulation syndrome) even more strongly than levodopa." There is no need to include the second sentence. Axl ¤ [Talk] 09:47, 16 February 2011 (UTC)[reply]
        • I have attended recent talks by experts with yet unpublished data who believe that actually DDS is more related to levodopa and other impulse control disorders to agonists, so while I do not have a ref for it I would prefer to have as an example of impulse control disorder any other than DDS in the dopamine agonists subsection. In my opinion best way out would be simply to do not name any example here as they have already been detailed in the levodopa subsection. Your opinion? --Garrondo (talk) 16:50, 21 February 2011 (UTC)[reply]
  • From "Management", subsection "MAO-B inhibitors": "Evidence on their efficacy in the advanced stage is reduced...". Does this mean that evidence is lacking, or that they are less effective in the advanced stage? Axl ¤ [Talk] 09:36, 11 February 2011 (UTC)[reply]
    • The latter. I have changed the sentence to "Studies on its effectiveness in the advanced stage are scarce although results point towards them being useful to reduce fluctuations between on and off periods." --Garrondo (talk) 13:48, 11 February 2011 (UTC)[reply]
  • From "Management", subsection "Rehabilitation": "One of the most widely practiced treatments for speech disorders associated with Parkinson's disease is the Lee Silverman voice treatment (LSVT), which focuses on increasing vocal loudness and has an intensive approach for one month. Speech therapy and specifically LSVT may improve voice and speech function." There is duplication of info in these two sentences. Axl ¤ [Talk] 10:00, 16 February 2011 (UTC)[reply]
    • You are right: changed to:... is the Lee Silverman voice treatment (LSVT), which focuses on increasing vocal loudness and has an intensive approach for one month. Speech therapy and specifically LSVT... --Garrondo (talk) 13:03, 16 February 2011 (UTC)[reply]
  • Some new text has appeared in "Management", subsection "Dopamine agonists", paragraph 3: "Two dopamine agonists that are administered through skin patches (lisuride and rotigotine) have been recently found to be useful for initial patients and preliminary positive results has also been published on the control of off states in patients in the advanced state." What are "initial patients"? Axl ¤ [Talk] 09:57, 25 February 2011 (UTC)[reply]
  • From "Prognosis", paragraph 1: "However, it is uncommon to find untreated people nowadays and medication has improved the prognosis of motor symptoms...". Should this read "it is not uncommon"? Axl ¤ [Talk] 10:52, 28 February 2011 (UTC)[reply]
Nope: it is correct: nowadays most patients are treated, so time to dependency has increased and data to the natural history of the (untreated) disease is very scarce and comes from quite old studies.--Garrondo (talk) 13:31, 28 February 2011 (UTC)[reply]
The two sections of the sentence: "it is uncommon to find untreated people nowadays" & "medication has improved the prognosis of motor symptoms" do not bear any relation to each other. Why are they linked by the conjunction "and"? Axl ¤ [Talk] 10:11, 3 March 2011 (UTC)[reply]
Eliminated.--Garrondo (talk) 15:21, 4 March 2011 (UTC)[reply]
  • From "Prognosis", paragraph 1: "In people taking levodopa, the mean progression of symptoms to a stage of high dependency takes around 15 years." Really? How do you (or the authors of the reference) calculate the mean time? I expect that there is a positively skewed distribution. What about people who die before they reach the stage of high dependency? The median time would be much more meaningful than the mean time. Axl ¤ [Talk] 10:58, 28 February 2011 (UTC)[reply]
It is not really clear in the ref how they calculate the figure. They only give a table with 4 different studies on the issue. Caption states: latencies to reach succesive Hoehn and Yahr stages. I have reworded to eliminate term "median" so it does not led to confusion.--Garrondo (talk) 13:57, 28 February 2011 (UTC)[reply]

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Sources comments: The sources are nearly all from scholarly articles or books and look 100 percent reliable. I have only a couple of format queries/suggestions:-

I have not been able to carry out any spotchecks. Otherwise I'm confident that sources meet the required criteria. Brianboulton (talk) 19:21, 24 January 2011 (UTC)[reply]

Also: three disambiguation links revealed by the toolbox, top left of this page. Brianboulton (talk) 19:29, 24 January 2011 (UTC)[reply]

  • Curiosity: I don't think it's strictly necessary, but the description of the protective effect of nicotine immediately makes me curious about the effect of lobeline (and Lobelia, so-called "Devil's tobacco"). It's talked about online quite a bit, with both positive[2] and negative[3] opinions readily available in scientific-looking sources. If someone has some thoughts handy about the topic, I think it would be an interesting addition. You don't have to go on for very long about it of course. Wnt (talk) 05:38, 25 January 2011 (UTC)[reply]
    • I am no expert in pharmacology; nevertheless sources provided actually do not seem very reliable, and a quick search in pubmed of lobeline+parkinson's disease yields no results; so most probably the effects of lobeline for PD have not been much investigated, and therefore mention has no place in the article. Even the mechanism by which nicoteine protects from PD is very much unknownon. --Garrondo (talk) 07:26, 25 January 2011 (UTC)[reply]
  • I concur that there is nothing showing use of lobeline to treat Parkinson's, except for that 2007 paper from Henan about a rat model of Parkinson's. (That paper has not been cited, according to Google Scholar). The NIH has funded a study of lobeline as a treatment for methamphetamine abuse. Our lobeline article has current references on the drug. EdJohnston (talk) 21:06, 2 March 2011 (UTC)[reply]

Disambig/External Link check - no dabs or dead external links. 2 external redirects, see them with the tool in the upper right corner of this page. --PresN 22:02, 25 January 2011 (UTC)[reply]

All the images are on the right hand side, which can lead to white spaces in the article in some browsers. The protein structure of File:GDNF.jpg looks different to that at the source given [4]. There is a link at the source to some programs that I presume allow one to rotate the image, which I haven't done because they look way above my level of knowledge. Is the difference so great that the structure shown is not actually that of GDNF, or are they actually the same but seen from different angles? DrKiernan (talk) 12:13, 9 February 2011 (UTC)[reply]

    • Regarding all on the right: reason is that as there are quite a lot of images if there are some on the left they make titles to move to the middle to the screen. However I do not know what is best or if there is any global recommendation on the issue... Regarding the protein... I actually have no idea of chemistry, I simply searched in commons for an image of the protein, and I assumed it was correct. Nevertheless I do not think that there is any reason to believe it is not GDNF; is it?--Garrondo (talk) 12:38, 9 February 2011 (UTC)[reply]
  • Support—niiiice. It was overlinked with common terms. For example, bias? Risk factor? Injection? I've unlinked. Tony (talk) 12:59, 12 February 2011 (UTC)[reply]
  • Support from Lee∴V (talk • contribs)
  • Brilliant efforts thus far!
  • In the lead, the phrase 'PD is a costly disease to society.' has little context - should be fleshed out with numbers or reasoning or left out.Lee∴V (talk • contribs) 17:05, 12 February 2011 (UTC)[reply]
  • Smoking is protective risk factor - As with anything smoking/alcohol related I'd be very cautious about having this in the lead - it really needs to be put into context, if true it is very interesting but not really a good preventative measure - reduce chance of developing rare disorder whilst greatly increasing chances of various other health issues!Lee∴V (talk • contribs) 17:05, 12 February 2011 (UTC)[reply]
In the advanced stages of the disease, cognitive and behavioral problems, including dementia are common - either commas both before and after "including dementia' or none, but not one....:::Thanks for the catch.--Garrondo (talk) 20:36, 13 February 2011 (UTC)[reply]
...insufficient formation and action of dopamine.. "insufficient formation and activity of dopamine " (??):::Changed.--Garrondo (talk) 20:36, 13 February 2011 (UTC)[reply]
so diagnosis is mainly based on symptoms with tests such as neuroimaging being used to confirm diagnosis - two diagnoses in the one sentence - I concede it might be difficult to avoid this here...:::Changed to "for confirmation".--Garrondo (talk) 20:36, 13 February 2011 (UTC)[reply]
mitigating symptoms - why not just "lessening" or "reducing"?:::Lessening sounds great.--Garrondo (talk) 20:36, 13 February 2011 (UTC)[reply]
Parkinsonisms can be divided into four subtypes.. - I haven't seen it pluralised like this. Single as a collective noun?
Not sure what you mean. Could you clarify?--Garrondo (talk) 20:36, 13 February 2011 (UTC)[reply]
I have never seen the word "parkinsonisms" -I would have thought "Parkinsonism can be divided into four subtypes.." or used the term "Parkinsonian syndromes.." Casliber (talk · contribs) 23:44, 13 February 2011 (UTC)[reply]
It does exist (around 80 hits in pubmed) although it may be rare. I have changed to Parkinsonian syndromes as suggested.--Garrondo (talk) 09:29, 14 February 2011 (UTC)[reply]
In the Classification section you have " parkinson plus" with and without hyphens...needs conforming to one or the other.:::No hyphens now.--Garrondo (talk) 20:36, 13 February 2011 (UTC)[reply]

Ok, I think we owe it to the readers to try and make the article as accessible as possible. It is looking better and I will support soon. I am just mindful of the discussion below and am trying to look extra hard at accessibility vs. jargon vs. losing meaning Casliber (talk · contribs) 08:44, 18 February 2011 (UTC)[reply]

Do we lose any meaning by using the word "drowsiness" rather than "somnolence"?
Done--Garrondo (talk) 16:39, 21 February 2011 (UTC)[reply]
how about "stiffness" for "rigidity"
Most source use rigidity, so in this case I would rather leave it.--Garrondo (talk) 16:39, 21 February 2011 (UTC)[reply]
is any meaning lost by losing the first two words of "At present, there is no cure for Parkinson's disease..."?
Done... Good catch of "Wp:crystal". Changed.--Garrondo (talk) 16:39, 21 February 2011 (UTC)[reply]
PD may be less prevalent in those of African and Asian ancestry, although this finding is controversial -why? Do you mean "disputed"?
yeap: changed.--Garrondo (talk) 16:39, 21 February 2011 (UTC)[reply]
repeated inline reference tags to the same reference - If I have a series of sentences reffed by the same source, I often just stick the ref at the end of the series and add <!-- cites previous four sentences --> at the end, os if someone edits it, they can see what the ref actually references. I think this looks better than several same numbers in a row, but not a deal-breaker.....
I add a citation after each line for two reasons: while improving the article it helps me to see what sentences I have checked up against a ref. Second is related to a side problem of WP being edited by anyone: if somebody adds a sentence between other sentences is quite difficult to know if it is backed up by a ref. Adding a ref after each sentence makes it much harder this to occur and unref facts are spotted much easier. I would rather leave refs, but I do not know if there is a consensus for this issue.--Garrondo (talk) 16:39, 21 February 2011 (UTC)[reply]
That's fine then, I can see your reasoning on that one. Casliber (talk · contribs) 20:04, 21 February 2011 (UTC)[reply]


To conclude, I am not seeing much jargon that can be substituted with more common words without losing meaning. Leaning support once queries looked at. Might look over again too.Casliber (talk · contribs) 14:29, 18 February 2011 (UTC)[reply]

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Provisional impression: too much jargon in introduction. Needs more histopathology adding to the pathology section including brain cell types. "Festination" is rapid shuffling steps and leaning foreword. I did not see palliation in the article, but I could have missed it. As far as I am aware "paralysis agitans" is also used in modern times. I see problems with the article almost everywhere I look; for example, the article says "Most people with Parkinson's disease have idiopathic Parkinson's disease (having no specific known cause).", actually Parkinson's disease is idiopathic. I can only possibly come to the conclusion that this article is not at FA standard. and that it needs a considerable amount of work to bring it to that standard. Snowman (talk) 00:23, 14 February 2011 (UTC)[reply]

Those are all pretty minor points, and with the exception of the "festination" issue (which is easily fixed), all of them are dubious. The "palliation" point is strange, since the current treatment of PD consists of nothing but palliation. Since I don't see any real justification for the level of negativity in this critique, I don't see how it can be addressed. Looie496 (talk) 00:35, 14 February 2011 (UTC)[reply]
Palliative treatment being treatment at the end of life. The article would do well to describe the gross pathology. Another example is how the section on symptoms starts; "Four motor symptoms are considered cardinal in PD". However, the disease starts gradually, and intellectual capacity is often maintained in the early stages. The article does not give a good clinical picture of the illness. Historical aspects of anticholinergic treatment are missing. I am puzzled by your comment; "Those are all pretty minor points", after I wrote that there are problems everywhere I look. I have not changed my mind, and I do not intend participating in a prolonged discussion. Snowman (talk) 01:08, 14 February 2011 (UTC)[reply]
I'm not a primary contributor to this article, but I reviewed it and I'm not keen on the idea that I might have missed a bunch of important things. Also I know that there is a reluctance to promote articles as long as justified opposition remains, so I'll address each specific point here:
  • Too much jargon in intro. Possibly, but one must be careful to say things precisely.
  • Festination. Valid point.
  • Paralysis agitans. Understood by doctors but not widely used.
  • Idiopathic. This term is used erratically in the literature, and causes trouble for everybody.
  • Gross pathology. Belongs in a subarticle in my opinion.
  • Intellectual capacity maintained early. The article tries to say this, perhaps not clearly enough.
  • History of anticholinergic treatments. Too much detail for this article in my opinion.
When a review says that there are problems everywhere, but nearly all of the specifically mentioned problems are arguable at best, it's hard to know what to do about it. Looie496 (talk) 01:33, 14 February 2011 (UTC)[reply]
  • Please ponder recent edits to the introduction. Gross pathology is key here - details of the change in the appearance of the substantia nigra in PA is not even mentioned. That intellectual capacity is maintained early in the disease was not properly included in the clinical section. Anticholinergic treatment was the first ever drug treatment of PA, and the discovery of its action was somewhat accidental, and probably would be interesting light reading in the article. I can not understand where you are coming from. I would like to be helpful, although presumptive, and suggest that you have become a little enmeshed with the article, and this may be a time for you to listen more. Snowman (talk) 12:22, 14 February 2011 (UTC)[reply]
I am sorry to see that you do not find the article good enough. Since most reviewers until this moment disagree with you I hope you could be more specific with your comments. I will try to address some of your comments.--Garrondo (talk) 07:33, 14 February 2011 (UTC)[reply]
  • I feel that there is no need for you to express sorrow that I find the article inadequate for FA, and to be honest I think that a patronising approach is not helpful. I would take a long time to catalogue problems I have with the article; nevertheless, for a start please concentrate on careful copy-editing section by section to improve the prose, make the topic more understandable by reducing vague terms, reduce potential ambiguities, and check for prose that is misleading or erroneous. Quite often reviewers support an article early in the course of an FA, but it can take a further 500–1000 edits before the article is accepted on the FA list. Snowman (talk) 12:04, 14 February 2011 (UTC)[reply]
Still not really helpful. Comments should be addreasseable and to recommend elimination of "vague terms, reduce potential ambiguities, and check for prose that is misleading" is in itself quite "vague ambiguous and misleading". Do you have any specific examples? Could you give so editors see what are you referring to (I for example have no clear idea). Finally regarding the "erroneous" above: erroneous is quite an strong word. If you feel that there are any errors in the article please point them out so we can correct them. This edit unsigned by Garrondo (talk at 12:55, 14 February 2011
At this juncture, I have suggested a strategy to make further improvements and to correct too many problems to list. I do not plan to watch this page. I am prioritising my edits to other parts of the wiki. I might pop back after 2 or 3 weeks, but that is not a promise. I hope that the small parts of the text that I have focused on by way of an examples will give insights in fixing the rest of the article. If you can not see problems yourself, then I presume that you must wait for more reviewers to help out. Snowman (talk) 14:05, 14 February 2011 (UTC)[reply]
Would be easier if it was you instead of others, but thanks anyway. I will take a look at your edits in the last few days to see if I can further improve the article following your examples and I promise to include specific info asked for below.--Garrondo (talk) 16:16, 14 February 2011 (UTC)[reply]
I have added links to captions of images.--Garrondo (talk) 16:25, 14 February 2011 (UTC)[reply]
      • Regarding idiophatic PD: article is only reflecting a contradiction in sources: while PD is defined as an idiophatic parkinsonian syndrome nevertheless those parkinsonian syndromes which clinically are absolutely similar to PD and for which a genetic cause is acknowledged are also included in the definition of PD. For example Samii et al say: Parkinsonism describes a syndrome characterised by rigidity, tremor, and bradykinesia, of which previous termParkinson's diseasenext term is the main cause. previous termParkinson's diseasenext term is usually asymmetric and responsive to dopaminergic treatment, with no historical or examination clues to suggest a cause for symptoms. but later in the article Setting aside the few individuals with previous termParkinson's diseasenext term who have a known gene mutation or exposure to 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), the cause of this disorder is unknown. previous termParkinson's diseasenext term is probably a result of multiple factors acting together, including ageing, genetic susceptibility, and environmental exposures. Would you need more sources I will search for more, but I hope this is enough.--Garrondo (talk) 07:33, 14 February 2011 (UTC)[reply]
      • I agree with Looie on the use of paralysis agitans: a search in pubmed for the term yields 1000 items, and many use the term when talking about history, shaking palys gives 28 results, and finally parkinson's disease 38590. --Garrondo (talk) 07:33, 14 February 2011 (UTC)[reply]
      • Too much jargon in lead: probably quite subjective: it would be great if you could point at specific sentences or even fix it yourself.--Garrondo (talk) 08:01, 14 February 2011 (UTC)[reply]
      • Pathology: the article already gives info on the issue above what some general reviews in the disease give, so I also agree with Looie that place for that info is a sub-article. The article is already very long and I do not feel that we should give more detail in an already long section.--Garrondo (talk) 08:01, 14 February 2011 (UTC)[reply]
  • The article is long, and I see a case for putting the history of the science of the subject in a separate article to make way for expansion. To me omitting "morbid pathology" here is like omitting "centre forward" from the "football" article. Snowman (talk) 12:51, 14 February 2011 (UTC)[reply]
      • I will also try to include a few lines that better show how the disease starts, although emphasis in this 4 symptoms is present in most sources.--Garrondo (talk) 08:01, 14 February 2011 (UTC)[reply]
      • We already say that intellectual capacity is maintained in the early stages: Second line of the neuropsychiatric subsection A high proportion of people with PD will have mild cognitive impairment as the disease advances although cognitive disturbances can also occur in the initial stages of the disease in some cases.--Garrondo (talk) 08:01, 14 February 2011 (UTC)[reply]
      • Festination: while the term did not appear it was defined in the motor symptoms section. I have included the term. Thanks for the catch.--Garrondo (talk) 08:01, 14 February 2011 (UTC)[reply]
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Provisional impression (2). The addition of pallor to the substantia nigra has been added in the pathology section. The addition of the history of treatment of anticholinergic alkaloids is brief and shorter than I expected: Was the effect of atropine was an "accidental" finding? I see that some work has been done towards FA status. However, I found numerous issues remain in a few sections I looked at. I think that the article is not up to FA status. I expect that there are too many issues to list through out the article. This page is not on my watch list. Some examples of the issues I found in sections I looked at: Snowman (talk) 17:00, 21 February 2011 (UTC)[reply]

A red tulip is a colour not a cultivar - I agree that passage is tricky to illustrate as it declares a red tulip is a symbol but the passage uses another red tulip. I am sure there are alot of red tulip cultivars....I'd be inclined to lose the image if not the cultivar intended. Casliber (talk · contribs) 20:04, 21 February 2011 (UTC)[reply]
I see that Garrondo has removed the image. What would really be nice would be to have an SVG of one of the tulip cartoons that are used by a variety of PD organizations. Of course this raises all the usual licensing issues, so I don't think the FA should be held up for this reason -- but it would improve the article in the long run if a usable image could be found. Looie496 (talk) 20:25, 21 February 2011 (UTC)[reply]
I guess, that it is not a problem for FA that there is no tulip image. Snowman (talk) 12:54, 22 February 2011 (UTC)[reply]
I don't think this is specific enough to PD to warrant expansion here - thickened fluids are used in people with strokes or other neurological conditions where gag reflex is compromised. Casliber (talk · contribs) 20:04, 21 February 2011 (UTC)[reply]
Agreed with Casliber. A brief mention is enough for the general article. Further details could be added to a secondary article but not here.--Garrondo (talk) 20:55, 21 February 2011 (UTC)[reply]
I meant just a quick line with appropriate words to say that thickening fluids help because a more viscous fluid is more cohesive and less likely than ordinary drinks to "splash" and cause chocking when swallowing is uncoordinated. Dysphagia is jargon anyway, and could mean a physical blockage. Snowman (talk) 21:37, 21 February 2011 (UTC)[reply]
Done. Also explained gastrostomy.--Garrondo (talk) 22:05, 21 February 2011 (UTC)[reply]
From OED, preventing is; "The action of precluding or stopping an anticipated act or event." It seems to me that "... both measures preventing choking." would be an over-inclusive statement here. Snowman (talk) 13:53, 22 February 2011 (UTC)[reply]
Changed to both measures reducing the risk of choking.--Garrondo (talk) 14:01, 22 February 2011 (UTC)[reply]
  • Inconsistency in the explanation of pesticides "most frequently replicated relationships" in the Epidemiology section and "Toxins that have been consistently related to the disease are certain pesticides," in the section. Need for the magnitude of the risks of pesticides and agent orange to be specified, and magnitude of the protective effect of smoking. Snowman (talk) 17:00, 21 February 2011 (UTC)[reply]
I actually do not see any inconsistency. Both sentences say almost the same with different words. Nevertheless I will try to get specific numbers.--Garrondo (talk) 20:55, 21 February 2011 (UTC)[reply]
I think that the context in the two sections are different. Is there unnecessary and confusing duplication? Snowman (talk) 21:25, 21 February 2011 (UTC)[reply]
Please rephrase last comment. I did not follow you. It would also be important that you looked more carefully before asking for info. Article already said Toxins that have been consistently related to the disease are certain pesticides, such as rotenone or paraquat, and herbicides, with exposure increasing the risk by as much as a factor of two. On further reading of the section I have summarized it since agent orange is only another herbicide, with no more evidence than others and the statement on veterans does not really belong in this article.--Garrondo (talk) 22:42, 21 February 2011 (UTC)[reply]
I have added the relative risk of smokers versus non smokers as requested.--Garrondo (talk) 07:52, 22 February 2011 (UTC)[reply]
Actually is probably almost impossible to say since studies on cost are quite variable on their results depending on country, model of research of the authors, population, etc. I'll take a look into the source tomorrow to see if the say anything more specific on the issue.--Garrondo (talk) 20:55, 21 February 2011 (UTC)[reply]
In which case the article should reflect that situation better. Snowman (talk) 21:37, 21 February 2011 (UTC)[reply]
Already in article without going into uneccesary detail. First sentence on costs already says: but difficult to calculate exactly due to methodological difficulties in research and differences between countries.--Garrondo (talk) 22:05, 21 February 2011 (UTC)[reply]
The drive to find once daily drugs is true in all areas of medicine. Patches might be more specific but are still used and sought in a variety of conditions. Casliber (talk · contribs) 20:04, 21 February 2011 (UTC)[reply]
Agreed with Casliber: Main article is not the place to talk about ways of intaking medication. I believe that info on the chemicals used, without going to details or their different preparations is enough, specially since the section on treatments is already huge.--Garrondo (talk) 20:55, 21 February 2011 (UTC)[reply]
See Treatment Options in the Modern Management of Parkinson Disease by Anthony H. V. Schapira, a review in Arch Neurol. 2007;64(8):1083-1088. Patches are already used in some countries, and a once daily drug seems imminent. There is a lot of details about research in the article, and I think that it is an omission to omit these advances. Snowman (talk) 21:25, 21 February 2011 (UTC)[reply]
I know they are already used. Info was formerly in main article, treatment section (since they are already used it is where it belongs), and moved at some point to the secondary article to summarize. I have brought it back per your request: levodopa subsection now says There are controlled release versions of Sinemet and Madopar in the form of patches that spread out the effect of the levodopa. Slow-release levodopa preparations have not shown an increased control of motor symptoms or motor complications when compared to immediate release preparations.--Garrondo (talk) 22:11, 21 February 2011 (UTC)[reply]
I have fixed a mistake: transdermal patches are dopamine agonists and have shown their efficacy.--Garrondo (talk) 17:27, 22 February 2011 (UTC)[reply]

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A comment to Snowmanradio and FAC delegates: Most comments from Snowmanradio up to now have been to say that the article lacks this or that piece of spezialized info. I agree with him (or her) that those pieces of info are both interesting and are not present in the article. However I disagree with him on that I do not feel that they should be here to this article be a FA article. FA criteria say that is a thorough and representative survey of the relevant literature. and It stays focused on the main topic without going into unnecessary detail . Parkinson's disease is a huge topic and there are actually more than 10000 reviews on it in pubmed, so it is clear that we cannot have every interesting info on the disease in the main article. When I wrote the article what I did was to look into general reviews on the disease, following them as a guide on what to include. Point is that many of these proposed additions to an already long article are barely or not mentioned at all in general reviews of the disease. My opinion is that best place for that kind of info is secondary articles and that we would be doing a bad favor to the general reader by including them. --Garrondo (talk) 20:55, 21 February 2011 (UTC)[reply]

  • I think that you are putting too much of the burden on the reviewers to provide lists of problems. I think I have been clear about the sort of problems that I see in the article. My priority is with other parts of the wiki, and I do not want to spend a lot of time here. I have added a small sample of the sort of problems still in the article below. Snowman (talk) 00:20, 22 February 2011 (UTC)[reply]
  • The caption "Handwriting of a person affected by PD; showing micrographia in addition to other abnormal characteristics." This is a part sentence and should not end in a full stop. Other captions have this full stop MoS error. Also, "other abnormal characteristics." is rather vague. Please be clearer. Snowman (talk) 00:13, 22 February 2011 (UTC)[reply]
Agreed. Simply eliminated the latter part. More info can be obtained if going to the image description.--Garrondo (talk) 07:39, 22 February 2011 (UTC)[reply]
The image description on commons helpfully gives the original text that was published with the image of the hand-writing, and there is no mention that the writing is small. Without a scale it is impossible to say if the writing is small or not. The "t" in Cahterine looks shorter than the "t" in the surname, so is the writing getting bigger? Presumably it is original research that this specimen of writing exhibits micrographia. I think you could say with certitude that the writing looks like it has been written with a shaky hand, and Charcot describes it at length. I think that the caption should include where the signature came from. There are hints for writing captions in the guidelines. Snowman (talk) 10:24, 22 February 2011 (UTC)[reply]
First historical description of micrographia is posterior to the publishing of the image. Nevertheless one of the most characteristic characteristics of micrography is that writing gets smaller as the person writes. This is clearly seen in the image, since numbers at the right are much smaller than capital letters and numbers at the left. This is usually related to going upward in the sheet with writing which is also seen. Additionally other sign of micrographia is seen in that there is almost no space inside circles of letters such as "a" or "o" even if we do not have a scale. I would say it is more than sensible to say that it shows micrography, although it would be great to hear other people opinions. --Garrondo (talk) 11:09, 22 February 2011 (UTC)[reply]
I have just looked at the definition of micrographia in the OED, which gives; "Unusually small handwriting, often progressive over time, as a sign of various neurologic disorders, esp. Parkinson's disease." To me the size of the handwriting is unknown. To me the size of the handwriting is not small, and it certainly is not unusually small. I maintain that calling this handwriting micrographia is original research. Any tendency for the letter to become smaller is marginal and counterbalanced by "t" which becomes bigger. Snowman (talk) 11:38, 22 February 2011 (UTC)[reply]
As a neuropsychologist I am quite sure of its micrographia, but as you say that is OR and if controverted I will not discuss over its inclusion. I have eliminated mention to micrographia. Just for curiosity: meaning of OED?--Garrondo (talk) 13:05, 22 February 2011 (UTC)[reply]
The on-line version of OED, now wikilinked. Snowman (talk) 13:34, 22 February 2011 (UTC)[reply]
  • "It affects to a greater extent the most distal part of the limb, and at onset typically appears in only a single arm or leg, becoming bilateral later." There is nothing here about typical pill-rolling movements. To me this part if the article is written in a verbose vague style without mentioning a typical feature of the start of the illness. Snowman (talk) 00:13, 22 February 2011 (UTC)[reply]
I have expanded section to include pill-rolling and frequency of tremor.--Garrondo (talk) 08:04, 23 February 2011 (UTC)[reply]
I have expanded description of bradykinesia. --Garrondo (talk) 13:49, 24 February 2011 (UTC)[reply]
  • "Rigidity is due to joint stiffness and increased muscle tone" : as far as I am aware the rigidity has little to do with stiffness within joints, at least in the early stages of the illness. The stiffness is because of muscle tone in the early stages of the disease. Perhaps, there are secondary changes in the joints later in the illness. I find that the phrasing in the article confusing. Snowman (talk) 00:13, 22 February 2011 (UTC)[reply]
I have fully rewritten the paragraph using further sources and expanding content. I hope it is clearer now.--Garrondo (talk) 10:35, 2 March 2011 (UTC)[reply]
OK. Snowman (talk) 11:52, 2 March 2011 (UTC)[reply]
  • Rigidity is due to joint stiffness and increased muscle tone, which combined with a resting tremor produce a ratchety, "cogwheel rigidity" when the limb is passively moved. I doubt if anyone who had not come across cogwheel rigidity would be able to understand cogwheel rigidity from the article. The wikilinked "cogwheel" in redirected to gear, and the word "cogwheel" does not appear in the "gear" article. I think cogwheel rigidity should be explained better as it is one of the basics of the illness. What has resting tremor got to do with cogwheel rigidity? I think that simplicity and clarity of language is needed here. Snowman (talk) 00:13, 22 February 2011 (UTC)[reply]
Done per above.--Garrondo (talk) 10:35, 2 March 2011 (UTC)[reply]
I have made amendments. Incidentally, it is easier to feel cogwheel rigidity than see it. Snowman (talk) 11:52, 2 March 2011 (UTC)[reply]
  • The article may be more focused with only a small section on the history of the science, and a longer separate article of the history of the science provided. Moot point perhaps. Snowman (talk)
  • I think that the history section is brief and in adequate and the topic does not have a main article. The discovery of the use of atropine in parkinsonism should really be expanded to give it a higher priority, and I would say that there are serious omissions here. Please re-think data organisation. Snowman (talk) 10:24, 22 February 2011 (UTC)[reply]
Do you have a source to back up that atropine importance is underrepresented or is it just your opinion? We have several articles on history of the disease as sources and the only one that mentions disovery of atropine is "The history of movement disorders and says: "Belladona alkaloids were empirically identified as helpful in Parkinson's disease in the latter half of the 19th century. Charcot noted that the anticholinergic alkaloid hyoscyamine (the levorotatory form of atropine) was modestly beneficial for the tremor of Parkinson's disease, as reported in the doctoral thesis of his German student Ordenstein in 1867 (Foley, 2003). In 1887, Wilhelm Erb successfully introduced scopolamine (initially somewhat confusingly called “hyoscine”) (Foley, 2003). Similar preparations were used for generations with at best modest success. Synthetic centrally acting anticholinergic medications were introduced in the 1950s and were soon adopted because they were associated with fewer systemic side effects (Corbin, 1949 K.B. Corbin, Trihexyphenyl: evaluation of a new agent in the treatment of Parkinson's disease, JAMA 141 (1949), pp. 373–381.[Corbin, 1949] and [Dorshay and Constable, 1949])." I will try to get Foley 2003 (PMID 15641199) which is specifically on history of medications.--Garrondo (talk) 11:28, 22 February 2011 (UTC)[reply]
It is something I recall and your solid reply is beginning to cause me doubts on my recollections. I have stored away my older pharmacology books and they are not very accessible. The story I recall wrongly or rightly is that atropine-like drugs were given to geriatric patients to reduce drooling, and it was noticed by chance that parkinsonism symptoms improved. I think it was also used as an example of the chance discovery of drugs, which makes it more interesting. Please do not add this anywhere without a reference to a proper source. Snowman (talk) 12:17, 22 February 2011 (UTC)[reply]
  • On my screen there is one area where the text is between an image on the right and an image on the left. There is another area where there is a huge image on the right and a narrow column of text on the left. Image positioning needs attention. Snowman (talk) 00:47, 22 February 2011 (UTC)[reply]
    • With the variety of screens it is impossible to make everybody happy. The problem of having text between two images comes precisely from comment from another editor who asked to have images at right and left. Regarding huge image: it is a double image so if not that big it was difficult to see anything in it.--Garrondo (talk) 07:39, 22 February 2011 (UTC)[reply]
  • I think that the guidelines say to avoid having text between images to the left and right. It is possible to clear the text from the left of the huge image. Web designers should consider a variety of users screens and browsers, and I see no excuse to be expedient here. Snowman (talk) 10:24, 22 February 2011 (UTC)[reply]
  • I think the gait and tremor needs to be seen to be appreciated, and I think that this article should have links to good external resources, and I would call this a FA requirement here. I have not asked for external links in a review before, but I think this is an exception. External links are meant to guide readers to useful external resources and I think that this article is lacking without such helpful external links. Snowman (talk) 10:24, 22 February 2011 (UTC)[reply]
I have been searching for 40 minutes and I have not been able to find videos of symptoms in reliable sites (many of them on youtube, but hardly reliable). Only thing found is a comparison of a patient with DBS on and off. My reasoning is that reliable sites (NHS, NIH...)do not show PD symptoms videos so as not to scare recently diagnosed patients and their families. I have added the video to the external links section.--Garrondo (talk) 14:04, 22 February 2011 (UTC)[reply]
I suppose the reliability depends on the authors of the youtube videos. Snowman (talk) 19:22, 22 February 2011 (UTC)[reply]
Of course, but since 99 % there are home made or do not give any info on authorship and copyright is really hard to find anything useful.--Garrondo (talk) 19:41, 22 February 2011 (UTC)[reply]
European Parkinson's Disease Association has a set of videos. There is a link to one of these from the EPDA website, so I presume these will be OK to link. There might be more at other self-help organisations. Snowman (talk) 21:17, 22 February 2011 (UTC)[reply]
I had alredy seen those in the EPDA site. No copyright problems with them. However most of them are interviews with patients, families and experts, and none of them show the symptoms of the disease which was what you initially asked for, and that is reason what I did not even mention them. I am not sure about the usefulness for the article.--Garrondo (talk) 07:41, 24 February 2011 (UTC)[reply]
Actually: in the same youtube channel there are videos from a public Spanish television, which are copyrighted. Adding a link to the full collection of videos would breach WP policy on external links. I do not think adding the youtube channel is appropiate. --Garrondo (talk) 13:24, 24 February 2011 (UTC)[reply]
After further searching I have found no appropiately licensed videos per WP:ELNO with images of patients symptoms. At this point I believe the proposal is hardly actionable.--Garrondo (talk) 07:37, 2 March 2011 (UTC)[reply]
After even further searching I have added two videos showing symptoms in patients.--Garrondo (talk) 14:46, 2 March 2011 (UTC)[reply]
Yes, shaking and gait and so on is shown quite well, albeit with captions and in a foreign language. I think these are helpful. Snowman (talk) 20:07, 4 March 2011 (UTC)[reply]
Agree. Just added to the "other" subsection.--Garrondo (talk) 07:57, 22 February 2011 (UTC)[reply]
I see that a brief line has been added to the "Other" section. I think that some of the changes that can occur prior to diagnoses could be called psychological or psychiatric, and would be relevant to the "Neuropsychiatry" section. Snowman (talk) 22:17, 25 February 2011 (UTC)[reply]
I have added a line saying that cognitive changes can also occur prior to diagnosis. Among all neuropsychiatric are the best known to begin early in the course of the disease.--Garrondo (talk) 13:17, 28 February 2011 (UTC)[reply]
  • Mohamed Ali's diagnosis is somewhat uncertain, I understand. The caption says "Muhammad Ali in 2006, 26 years after diagnosis". It does not say diagnosis of what. A reader quickly looking at the images on the page might think that he had Parkinson's disease. Need strict accuracy with autobiographical details, so I think his image should be removed from a page on Parkinson's disease. More than a week ago I pointed out that some captions had MoS issues with full stops at the end of part sentences, and I am puzzled why such MoS issues are still present in captions. I just removed the full-stop after at the end of the part sentence from this image. I still see other captions with MoS issues. Snowman (talk) 11:22, 22 February 2011 (UTC)[reply]
Most sources say he has PD and he was diagnosed of PD. Text of article already says that some debate this diagnosis. I do not believe controversy should be included in image caption.--Garrondo (talk) 11:32, 22 February 2011 (UTC)[reply]
I was not clear on your meaning with full stops on images. I will eliminate them today (I suppose you only refer to last one in each image).
Done.--Garrondo (talk) 11:35, 22 February 2011 (UTC)[reply]
It only applies to the end of part sentences. This could be the first sentence or the second sentence. It is all in the MoS, if you have any doubts. Snowman (talk) 11:41, 22 February 2011 (UTC)[reply]
I see you have done it wrong, and this makes me wonder if the editors of the page have read the guidelines or not. I indicated that it is all in guidelines on captions, so do you read up on it? "Presence of Lewy bodies in the brains of those with PD has led to the classification of the disease as a synucleinopathy." This is a full sentence and it needs a full stop. Snowman (talk) 11:51, 22 February 2011 (UTC)[reply]
I see the caption now reads; "Muhammad Ali in 2006, 26 years after diagnosis of Parkinson's disease". I would call this an over-simplification of the diagnostic issues related to a biography. Snowman (talk) 12:26, 22 February 2011 (UTC)[reply]
I have changed it to parkinsonism which is probable more adequate: from the source:It has now been 22 years, and quite possibly longer, since parkinsonism began its relentless march through Ali's nervous system. He was diagnosed with parkinsonism, the umbrella term for movement disorders including Parkinson's disease, in 1984, three years after the last fight of his 21-year boxing career. Now, the increasing tremors in his limbs, the painful slowness of his gait, the reports of balance problems and the whispers of falls have led the neurologist who diagnosed him to suspect Ali may in fact suffer from full-blown Parkinson's disease.: He was initially diagnosed of parkinsonism while degenation now indicates PD.--Garrondo (talk) 13:05, 22 February 2011 (UTC)[reply]
The suspicions of the physician who you have quoted has not been treating M. Ali for a number of years, and it seems to me that he is going on what he has heard indirectly for recent information, which is not ideal for a reliable wiki source for information. I think it would probably be OK to use the part of the reference where he quoted his opinions based from when he was treating M. Ali. Snowman (talk) 13:19, 22 February 2011 (UTC)[reply]
"... diagnosis of parkinsonism"; is parkinsonism a diagnosis? Snowman (talk) 13:23, 22 February 2011 (UTC)[reply]
Editorial on the neurology now article (also used as source in article) says:To tell it as it's never been told, Wally interviewed Dr. Stanley Fahn - one of the world's leading Parkinson's experts, a past president of the American Academy of Neurology, and the specialist who diagnosed Ali 22 years ago. Having had the privilege of working with Dr. Fahn, I know firsthand that he has worked tirelessly to improve the quality of life for people with Parkinson's through his own research program, advocacy efforts and the outstanding clinical care he provides. Although he hasn't treated Muhammad Ali in a long time, Dr. Fahn's vast experience with Parkinson's patients gives him insight into Ali's current condition. Moreover "Neurology now" is as reliable as we can get a source for the society section so we are not the ones to debate over its content.--Garrondo (talk) 13:44, 22 February 2011 (UTC)[reply]
While I believe that to say "diagnosis of parkinsonism" is correct as it it a syndrome I have changed caption to say "appearance of parkinonism".--Garrondo (talk) 13:50, 22 February 2011 (UTC)[reply]
I think people know what you mean by "diagnosis of parkinsonism", and on further consideration I think it is likely to be correct as it goes quite a long way in determining the nature of the disorder; although not an exact diagnosis. However, I would say it would be wrong to say "diagnosis of headache", since headache is a symptom. I think in an ivory tower of medicine you would probably get a shower of protestations if you said "diagnosis of parkinsonism". Snowman (talk) 14:16, 22 February 2011 (UTC)[reply]
I have had to amend your version of the caption, since with him the time of diagnosis and the time of first showing signs (the appearance of the disease) are years different. I have written a suggestion for the caption. Snowman (talk) 14:51, 22 February 2011 (UTC)[reply]
I agree with your first edit of the caption. Regarding the second indicating place of photo I am not so sure. In this case info is completely irrelevant to article, and guidelines also say that captions should be succint. Since info on picture is in its description page in this case I would rather have it simpler.--Garrondo (talk) 15:12, 22 February 2011 (UTC)[reply]
On second reading I really did not like info per reasoning above, so I reverted to your previous version.--Garrondo (talk) 15:21, 22 February 2011 (UTC)[reply]
OK. Snowman (talk) 16:19, 22 February 2011 (UTC)[reply]

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  • "<!-- DO NOT ADD MORE LINKS TO THIS ARTICLE. WIKIPEDIA IS NOT A COLLECTION OF LINKS -->" The first sentence of this hidden notice in the text does not appear to me to be consistent with the principals of the wikipedia. Surely, anyone can add appropriate external links if they wanted to. Snowman (talk) 14:45, 22 February 2011 (UTC)[reply]
I agree completely. Eliminated.--Garrondo (talk) 15:12, 22 February 2011 (UTC)[reply]
  • Pathophysiology is about abnormal physiological processes, so it seems illogical to me to have the heading "Physiology" as a subheading to "pathophysiology", because physiology is normal functioning. The word "Pathology" could mean "the study of disease" or it could mean "laboratory medicine", and I think that it is illogical to have this broad heading as a subheading to "Pathophysiology", which is a specific type of pathology. Snowman (talk) 23:22, 23 February 2011 (UTC)[reply]
Intention was to make a difference between microscopy findings from functional knownledge of how the basal ganglia function and are altered in PD. We are not the only ones to make such distinction with same terms: The seminal book by Jankovic and Tolosa has a chapter entitled "Neurophisiology of motor control and movement disorders" (Ch 2), which would be similar to the first section, and another chapter entitled "Neuropathology of parkinsonian disorders" (ch. 22) which would be similar in content to the second section. While I understand your comment I am not sure of a better way to make such distinction. Any proposals would be of aid.--Garrondo (talk) 07:29, 24 February 2011 (UTC)[reply]
A possibility would be to simply eliminate subheadings. What do you think? Any other ideas? --Garrondo (talk) 13:14, 24 February 2011 (UTC)[reply]
Since there was no response I was bold and eliminated subsection titles.--Garrondo (talk) 08:05, 28 February 2011 (UTC)[reply]
It would probably have been slightly better to have started such a general discussion with a request for other ideas on the talk page. I think that the resulting heading is not appropriate and I have already indicated above why this is. Also, I think that the resulting section is probably too big. Snowman (talk) 10:40, 28 February 2011 (UTC)[reply]
Overall, it was quicker to fix this section myself. Snowman (talk) 20:07, 4 March 2011 (UTC)[reply]
  • "However the relationship between the two diseases is complex and still has to be clarified." and "Thus the two diseases, ..."; The section mentions three diseases; Alzheimer's, PD, and dementia with Lewy bodies. Snowman (talk) 21:57, 25 February 2011 (UTC)[reply]
It referred to LBD. Broken paragraph into two for clarity.--Garrondo (talk) 08:19, 27 February 2011 (UTC)[reply]
The part "Thus the two diseases, especially PD with dementia, may be considered parts of the same continuum." does not make sense to me. This is like saying two things are similar except for one of them. Snowman (talk) 14:44, 27 February 2011 (UTC)[reply]
Clarified to: Dementia with Lewy bodies is another synucleinopathy that has many similarities with PD. Thus dementia with Lewy bodies and Parkinson's disease may be considered parts of the same continuum, and this is even more clear for the subset of PD cases with dementia.--Garrondo (talk) 08:05, 28 February 2011 (UTC)[reply]
All statistics I have found were country specific. That is reason why I did not add any to lead, but then another reviewer asked for more info, and I simply add that sentence as an example. I could re-eliminate it.--Garrondo (talk) 08:22, 27 February 2011 (UTC)[reply]
Eliminated.--Garrondo (talk) 13:09, 2 March 2011 (UTC)[reply]
  • "Non-motor symptoms, which include autonomic dysfunction, cognitive and behavioral problems (neuropsychiatric), and sensory and sleep difficulties, are also common.[1]" This is the introduction to the "Signs and symptoms" section. As an introduction, I think it should include brief mention of mood and thought problems. Snowman (talk) 22:17, 25 February 2011 (UTC)[reply]
Precisely is what "cognitive and behavioral problems (neuropsychiatric)" refers to, just with another words.--Garrondo (talk) 08:19, 27 February 2011 (UTC)[reply]
A mood problem (ie depression) is not a classified as a cognitive or a behavioural problem. A thought problem (ie delusion) is not classified as a cognitive or a behavioural problem. Snowman (talk) 14:49, 27 February 2011 (UTC)[reply]
I have reworded to: neuropsychiatric problems (mood, cognition, behavior or thought alterations),.--Garrondo (talk) 08:05, 28 February 2011 (UTC)[reply]
  • "Visuospatial difficulties are part of the disease, ...". To me this sounds like a psychological problem and not a psychiatric problems, and it seems out of place under a heading about "Neurophychiatry". What about alcoholism in PD? Snowman (talk) 14:55, 28 February 2011 (UTC)[reply]
Visuospatial difficulties is a cognitive problem, not psychological, as it is problems with abstract reasoning or language. Similar to agnosia (although probably less specific). If we (as many sources do) include cognitive problems inside the greater umbrella of neuropsychiatric difficulties the section is its place.--Garrondo (talk)
Regarding alcoholism: not sure on what do you mean. If you ask why is it not mentioned: place would be neuropsychiatry section, close to the other compulsive behaviors, although I do not think it was mentioned in sources. --Garrondo (talk) 16:26, 28 February 2011 (UTC)[reply]
Changed to dry eyes.--Garrondo (talk) 16:26, 28 February 2011 (UTC)[reply]
  • "Individuals with PD may have problems with these cognitive processes." I think that there should be a better account of what problems of executive functions may occur, as the current text not translate to signs and symptoms without prior knowledge. Snowman (talk) 15:44, 28 February 2011 (UTC)[reply]
You are right: I will clarify later or tomorrow.--Garrondo (talk) 16:26, 28 February 2011 (UTC)[reply]
I do not see any changes. Snowman (talk) 11:44, 2 March 2011 (UTC)[reply]
I have made some changes, but it could be better. Snowman (talk) 20:07, 4 March 2011 (UTC)[reply]
  • In the "Neuropsychiatry" section there is a piece on "cognitive impairment" (translates to dementia) in the second paragraph and more about dementia in the third paragraph. Both pieces are about the rates and time of onset of dementia in PD, so I think that they could be incorporated together. Snowman (talk) 15:55, 28 February 2011 (UTC)[reply]
It would make a huge paragraph and it can also lead to confusion since although related dementia and cognitive impairment are not the same. I would rather leave it as it is.--Garrondo (talk) 16:26, 28 February 2011 (UTC)[reply]
OK. I rephrase my point and say "cognitive impairment" is a vague tern and could mean almost anything, so can it be used less often and a specific term used instead where possible. Snowman (talk) 18:00, 28 February 2011 (UTC)[reply]
Seems less important now after copy-editing by various people. Snowman (talk) 20:07, 4 March 2011 (UTC)[reply]
  • "In terms of pathophysiology, PD is considered a ..."; the rest of this paragraph appears to me to be about histopathology and biochemistry. I do not see anything that would be wholly pathophysiology (ie abnormal physiology). Snowman (talk) 16:28, 28 February 2011 (UTC)[reply]
Overall, it was quicker to fix this myself. Snowman (talk) 20:07, 4 March 2011 (UTC)[reply]
Diagnosis section already says: "On the other hand, diagnosis can be difficult when the symptoms are not fully typical of PD, since parkinsonism can occur due to a range of causes and the difference with PD may be subtle, particularly in the early stages when symptoms may be mild". --Garrondo (talk) 10:25, 1 March 2011 (UTC)[reply]
I did read that bit you quote carefully. A difficult diagnosis to make is not the same as uncertainty of the diagnosis. Also, the article does not go into dealing with uncertainty in the diagnosis. Snowman (talk) 10:47, 1 March 2011 (UTC)[reply]
So what is the difference between the two terms? What is a difficult diagnosis? What is an uncertain diagnosis?...My opinion is simply that some sources prefer one use and others the other: Proof is that we have the NICE guideline in the article and you have brought another similar (although more condensed) scotish guideline. The Scotish one uses "uncertainty in diagnosis" the English one "difficulty". When reviewing more or less the same sources the word "uncertainty" does not appear in the whole NICE guideline related to diagnosis, while the opposite occurs for difficult in the Scotish guideline.--Garrondo (talk) 17:13, 1 March 2011 (UTC)[reply]
NICE: "Given the error rate in making a diagnosis of PD, even in expert hands, it is apparent that the diagnosis should be kept under regular review." Snowman (talk) 19:03, 1 March 2011 (UTC)[reply]
Do not see your point: that line could be summarised as well with concept of uncertainty than difficulty of diagnosis.--Garrondo (talk) 07:24, 2 March 2011 (UTC)[reply]
Yes, you can add this line using uncertainty or difficulty in the section, but with out this extra information, the sense of the uncertainty in diagnosis and the need to review diagnosis is missing. This is an omission. Snowman (talk) 11:39, 2 March 2011 (UTC)[reply]
'I have added: 'Since differential diagnosis may be in some cases difficult patients may be followed and diagnosis re-evaluated and changed if evolution of symptoms is not in line with PD.'--Garrondo (talk) 13:06, 2 March 2011 (UTC)[reply]
On diagnosis of depression: Case is similar to essential tremor below. We have many signs and symptoms and related conditions. in the main article. As there is a secondary article on symptoms in most cases symptoms are only name or briefly described. In no case we say how a specific symptom or comorbid condition is diagnosed. This is the perfect example of an interesting fact too much specific for the main article. I have added it to the secondary article. I believe that sources we have support my decision: Sami's and Davis' general reviews on the disease do not mention it. Neither does the Jankovic article which is centred on symptoms and differential diagnosis. Of the two clinical guidelines NICE guideline only says a line on page 114 (There are difficulties in diagnosing mild depression in people with PD as the clinical features of depression overlap with the motor features of PD.) and the Scotish guideline has a paragraph in page 15 (Accurate recognition, diagnosis and formulation of such disorders is vital, though the process is not straightforward because of the overlap between the cognitive and somatic symptoms of PD and those associated with depression. This may lead to inaccurate diagnosis with some patients with PD being misdiagnosed as depressed when symptoms are caused directly by the PD. In other patients a genuine mood disorder may be missed as symptoms of depression may be wrongly assumed to be caused by the underlying PD.) Taking into account weight given in the sum of these 5 sources main article is not its place.--Garrondo (talk) 14:53, 4 March 2011 (UTC)[reply]
Probably too specific for the main article. I have added it the signs and symptoms subarticle, to the tremor paragraph.--Garrondo (talk) 13:35, 3 March 2011 (UTC)[reply]
I believe sources support my decision: I have taken a look at four of our sources: Nice and scotish guidelines do not even mention it. Sami's lancet source, which has a full subsection between the differential diagnosis of PD and essential tremor neither mentions it. Only one to mention it is Jancovik which only says: "There are several clues to the diagnosis of existent essential tremor when it coexists with PD, including longstanding history of action tremor, family history of tremor, head and voice tremor, and no latency when arms are outstretched in a horizontal position in front of the body, although some patients may also have a re-emergent tremor related to their PD, tremulous handwriting and spiral, and improvement of the tremor with alcohol and beta-blockers--Garrondo (talk) 13:52, 3 March 2011 (UTC)[reply]
Probably will not affect FA. Snowman (talk) 20:07, 4 March 2011 (UTC)[reply]
  • Seborrhoeic dermatitis is not in the source provided (at least I did not find it). Instead, a quick search found "seborrhoea" in the source. Unfortunately, the wikilink for seborrhoea goes to "seborrhoeic dermatitis", but it is two are not the same. Seborrhoea means oily skin and that is already listed, so I think you just need to remove "seborrhoeic dermatitis". Snowman (talk) 20:55, 28 February 2011 (UTC)[reply]
Done. The wikilink confounded me.--Garrondo (talk) 08:34, 1 March 2011 (UTC)[reply]
You should have checked the Seborrhoeic dermatitis article and looked it up somewhere else, which has no mention of seborrhoea. Snowman (talk) 20:07, 4 March 2011 (UTC)[reply]
  • Re File:Parkinson surgery.jpg, the "electrode in brain" image. I would like to see expansion of the image description on commons and the caption in the article, as I do not find much there to indicate what the image is about. Is there a burr hole? Is it a general anaesthetic? What is the equipment called? What is happening in the photograph? Where are the surgeons and theatre staff? It might be worth contacting the author. The current caption says; "Placement of an electrode, to be deep-seated in the brain"; however, I have looked at the image at high resolution, and I do not see anything placed in the brain, although something might be about to be put in the brain or something might have been put in the brain earlier. If necessary, see tips on writing a caption in the wiki guidelines. Snowman (talk) 21:19, 28 February 2011 (UTC)[reply]
I have taken a look at the user that uploaded the image at commons: the image was uploaded in 2005, was the only contribution of the user, has no edited talk or user page at commons and does not have a user page in English Wikipedia. We will have to assume that we are not going to get any extra info. Since an image of neurosurgical operation is not easy to get; much less specifically of implantation of a DBS I would rather have this image in the article even if the image would be improved with further info.--Garrondo (talk) 15:03, 4 March 2011 (UTC)[reply]
Pending. I think that the documentation of this image is inadequate. Suggest try asking at user page on commons. Snowman (talk) 20:07, 4 March 2011 (UTC)[reply]
  • The section "Surgery and deep brain stimulation" should separate destructive surgery with electrode implantation. Presumably, the old surgery was cutting into pathways or nerve centres. I do not know much about this topic; however, the wikilink for "pallidotomy" indicates that this is destructive (a hot electrode is used to obliterate parts of the brain) and looks wrongly placed. I think that the section is fatally flawed. Snowman (talk) 22:03, 28 February 2011 (UTC)[reply]
  • "The study of the microscopic anatomy of the affected tissues (histology) ..."; Gives wrong impression. The study of diseased tissues is called "histopathology". The line is clunky as well. Snowman (talk) 22:38, 28 February 2011 (UTC)[reply]
  • "... is unusual before the age of 40 years"; I added this to the introduction some time ago, sourced from Davidson's Principles and Practice of Medicine. I have just noticed, that this fact is not referenced in the article. Please source something like this from one of the reviews and include it in the main body of the article. Snowman (talk) 00:20, 1 March 2011 (UTC)[reply]
Epidemiology section says: The mean age of onset is around 60 years, although 5–10% of cases, classified as young onset, begin between the ages of 20 and 50: I believe it is close enough.--Garrondo (talk) 08:34, 1 March 2011 (UTC)[reply]
And of course it is referenced (to Sami et al).--Garrondo (talk) 13:55, 3 March 2011 (UTC)[reply]
Pending: Probably not common knowledge, so I expect this would need a specific reference. Regret my textbook is older than five years, so not ideal for a reference. Snowman (talk) 20:07, 4 March 2011 (UTC)[reply]
  • I doubt that levodopa is copyrighted. Anybody could probably manufacture it in their garage and would not be illegal. Probably not even self consumption for their PD would be illegal. On the other hand selling it would be illegal in most countries (I am not sure even if in all countries).--Garrondo (talk) 14:00, 1 March 2011 (UTC)[reply]
  • Update: I have removed the new image. I see no reason for prioritising this preparation in particular by showing a photograph of the tablets. Whey should this preparation have emphasis above the others? Snowman (talk) 12:43, 1 March 2011 (UTC)[reply]
I ask why not: it is as representative as any of the others and since we can not have all of them we have to choose a prototype. Why do we have the structure of GNDF and not other chemicals? A PET image instead of an fmri? An specific PET image made with an ECAT Exact HR+ PET Scanner and not other machines by other enterprises? an image of Ali instead of others mentioned in the article? If we had Fox would you eliminate him since we were favoring his foundation? Why do we have an image of the US army using agent orange instead of other country also using it? Arent we being anti-american accusing that country of using dangerous weapons? I have reverted your elimination.--Garrondo (talk) 13:55, 1 March 2011 (UTC)[reply]
I think that one drug should not be picked by showing an image, because it gives that one brand too much emphasis. It is a branded drug, it is not generic. We can go on to talk about the selection of the other images. Image removed again by me. Snowman (talk) 17:21, 1 March 2011 (UTC)[reply]
Place for that kind of specific subjective individual point is NOT a FAC but the talk page.unsigned edit by Garrondo (talk) 18:07, 1 March 2011 (UTC)[reply]
Of course, the drug has a role. However, this branded combination is not the most widely used drug in PD. It is not the first choice by most in the early stages of the disease. It is not the cheapest. All these comments are objective. I think that this product placement is actionable and is very relevant in this discussion. Snowman (talk) 18:25, 1 March 2011 (UTC)[reply]
Garrondo, could you state what goal you are hoping to meet by mentioning a specific drug? I do see the value of showing an example of the type of medicine that is actually prescribed. Stalevo gets some credit for having been reviewed in clinical trials, but I can see the argument that another combination could be equally worthy of mention. Is there anywhere we can get data on what medicines are prescribed most frequently? Even if it was just from a specific hospital, or textbook, that said 'pick this drug combination first for a standard PD case.' EdJohnston (talk) 18:43, 1 March 2011 (UTC)[reply]
The drug treatment is tailored to the individual patient, so there is no one particular recommended starting drug. The BNF says that the drug combination in the image is useful in end of dose motor fluctuations when not adequately controlled with levodopa and dopa-decarboxilase inhibitors. Snowman (talk) 19:15, 1 March 2011 (UTC)[reply]
I do not really care on which image to use. Stalevo is used in PD and my only point is that it is better than no image and as valid as an image as any other of another drug.--Garrondo (talk) 19:46, 1 March 2011 (UTC)[reply]
My point is that it would be better not to select one drug to show unless it was the most popular one used, or the first used, and so on. The image I removed was a tipple drug combination formulation, and the I think that the brand placement was inappropriate. Snowman (talk) 23:31, 1 March 2011 (UTC)[reply]
Yeap, you have given your opinion several times, as have I. That does not make it more or less truth or more or less consensus. From my point of view both reasonings (image should be only the used or any drug used in clinical practic) are valid. Nevertheless I am so tired of only hearing you and me in this discussion that you can have it your way.--Garrondo (talk) 07:34, 2 March 2011 (UTC)[reply]
I have not heard any reasoned argument to select the triple combination preparation. Your stated view; "I do not really care on which image to use" is not convincing to me. Incidentally, there were three contributors to this thread of the discussion on this image. Snowman (talk) 11:29, 2 March 2011 (UTC)[reply]
That it is a medication specific for PD was reason enough for me, but as I said I would rather not further discuss the issue.--Garrondo (talk) 12:48, 2 March 2011 (UTC)[reply]
I conclude that the issue is settled and that the image is removed. Snowman (talk) 20:07, 4 March 2011 (UTC)[reply]
I disagree and this, similarly to the above is a very subjective, specific, individual opinion which would be best discussed out of the FAC, hearing other people's opinion.unsigned edit by Garrondo (talk) 18:07, 1 March 2011 (UTC) Moreover: the reference we have is specific to the use by the US of agent Orange during the vietnam war and its effects is veterans (although it primary articles it is based on are not specific to veterans.)--Garrondo (talk) 18:14, 1 March 2011 (UTC)[reply]
I think that the role of helicopter in war using defoliants is controversial and I think that there is no need to highlight this with an image. I think that this image needs proper context and it out of place on this page. I think it should be removed Snowman (talk) 18:21, 1 March 2011 (UTC)[reply]
role of helicopter in war is of not relevancy for this article. Your opinion or any others on the use of any kind of weapons is not a valid reason to eliminate an image. Fact is that agent orange, and its use by US army, has been related to PD by a US government agency. Therefore image is most surely a valid one. Nevertheless I have to point again that such kind of debatable and subjetive proposals is for talk page and not for FACthis edit unsigned by Garrondo (talk) 19:46, 1 March 2011 (UTC) [reply]
Surely, an inappropriate image can be discussed here. My remarks about the helicopter are actionable and belong in this discussion. Snowman (talk) 23:26, 1 March 2011 (UTC)[reply]
I would rather hear other opinions of others and if I have time I will begin a thread in talk page since it is quite subjective issue and you are me are only two people giving their subjective opinion both with partly valid reasons. Nevertheless I reiterate: the role of helicopter in war using defoliants is controversial is a reason of no relevancy for the Parkinson's disease article, and we do have a secondary high quality recent source specifically centre among other things in use of defoliants by US army soldiers. Per such source the image is a valid one. --Garrondo (talk) 07:24, 2 March 2011 (UTC)[reply]
Consensus would most likely minimise subjective ideas. Would make good point for discussion on the article talk page. In the absence of a consensus here may not affect FA. Snowman (talk) 20:07, 4 March 2011 (UTC)[reply]
Since it is made with the specific neurotracer used to diagnose PD shows very well how basal ganglia look in a healthy subject.--Garrondo (talk) 18:07, 1 March 2011 (UTC)[reply]
... But there is not another to show the abnormal findings in PD, so surely it is as pointless as showing a man walking normally or a normal elbow. Snowman (talk) 18:20, 1 March 2011 (UTC)[reply]
Most people know how is normal walking. Most do not know how a PET does. I believe it is useful, you believe it is not. I have stated my reasons you have stated yours. Feel free to start a discussion on talk page of the article to seek opinions by others or bring better image. --Garrondo (talk) 19:46, 1 March 2011 (UTC)[reply]
I am looking to reduce page bulk. I think that the best image would be a photograph of a cross section of the brain stem showing a cut surface that shows the substantia nigra. Snowman (talk) 17:13, 2 March 2011 (UTC)[reply]
I have looked many times for good free images in the last year and found none. Feel free to bring one better if you find it.--Garrondo (talk) 08:40, 4 March 2011 (UTC)[reply]
Consensus may be formed on article talk page, if discussion started there. May not influence FA. Snowman (talk) 20:07, 4 March 2011 (UTC)[reply]
  • The branded formulations of drugs mentioned on the page are only a few of the possible list. I would recommend the removred of branded drug names from the article. Snowman (talk) 19:15, 1 March 2011 (UTC)[reply]
Is there somewhere in MEDMOS or MOS that says that unless all brand names are named none should appear or is it again a subjective opinion?--Garrondo (talk) 20:03, 1 March 2011 (UTC)[reply]
On second thought: info is on articles wikilinked and might be a way of reducing a bit the article.--Garrondo (talk) 20:09, 1 March 2011 (UTC)[reply]
Done.--Garrondo (talk) 20:18, 1 March 2011 (UTC)[reply]
Several is quite vague. In my opinion only short paragraph as of today is the one on motor signs and symptoms, which I plan to expand as soon as I can. At the begining of some sections there are also some sentences that summarize or introduce the section, but which due to their function I would rather leave as they are.--Garrondo (talk) 12:52, 2 March 2011 (UTC)[reply]
There is one paragraph consisting of one sentence; see Wikipedia:Writing_better_articles#Paragraphs. Snowman (talk) 17:03, 2 March 2011 (UTC)[reply]
I have just expanded it.--Garrondo (talk) 11:59, 4 March 2011 (UTC)[reply]
While probably a good exception to that guideline (as an historical image trying to serve as image for the concept of first seminal description) changed to Charcot image.--Garrondo (talk) 08:40, 4 March 2011 (UTC)[reply]
Consensus may be gained on discussion on article talk page. In the absence of a consensus here, it may not affect FA. Snowman (talk) 20:07, 4 March 2011 (UTC)[reply]
  • "... abnormalities in ocular pursuit and saccadic movements, and difficulties in directing gaze upward."; jargon. Websites mention blurred vision and double vision, but no mention in article. Snowman (talk) 16:20, 3 March 2011 (UTC)[reply]
Websites are NOT reliable sources, Jankovic is. Additionally our article says "such as" which means "some examples but not all problems are named". Regarding ocular pursuit I feel is easy enough to understand. Regarding saccades: clarified.--Garrondo (talk) 08:40, 4 March 2011 (UTC)[reply]
Pending: The webpage was a PD society leaflet, and I have no reason to question it. Snowman (talk) 20:17, 4 March 2011 (UTC)[reply]

Some of these issues are open to discussion, but I think others should be copy-edited in the normal course of ironing out problems from this article, without someone having to prompt at every problem. It has not taken me long to find another list of problems, and a bit longer to write a short list as examples. I reiterate that the article needs more careful copy-editing to reduce vagueness, reduce inadvertent ambiguities, and illuminate misleading or erroneous text. I would anticipate that the article needs a lot of work and that it will take quite a long time to reach FA. I would anticipate that most of these problems should be ironed out without needing a prompt at every issue. If there are no editors that can further copy-edit and enhance the prose then the article is not going to reach FA in my opinion. This page is not on my watch list I am not planing to participate in a prolonged dialogue. I am prioritising my edits to other parts of the wiki. I might pop back occasionally or after 1 to 2 weeks, but that is not a promise. Snowman (talk) 00:13, 22 February 2011 (UTC)[reply]

On images to Snowmanradio:

  • On full stops on captions: After checking MOS I have found point you referred to and tried to fix article. I hope it is correct now.--Garrondo (talk) 15:37, 22 February 2011 (UTC)[reply]
  • Following your recommendation I have expanded caption in micrographia image adding place and date of publication.

Arbitrary break 5

edit
  • Support—Thank you for addressing my concerns.—RJH (talk) 17:38, 28 February 2011 (UTC)[reply]
    Comment—For the most part it looks FA ready, albeit a long read replete with jargon. Still, it's interesting material. There are a few points that I would appreciate if you could fix before I lend my support:
    • "Clinical evaluation is based in similar tasks consisting such as alternating movements between both hands or feet." This sentence doesn't quite make sense. What is "similar tasks consisting"? Does "...alternating movements between both hands or feet" mean "between both hands or both feet" or does it mean "alternating movements between both hands and feet"?
Former, that is why I used or instead of and.--Garrondo (talk) 08:48, 27 February 2011 (UTC)[reply]
    • "Other motor symptoms include ... are examples of the range of common motor problems..." Please fix the redundancy.
Done.--Garrondo (talk) 08:48, 27 February 2011 (UTC)[reply]
    • "...while the cost per individual per year in the US..." Is this individual patient or the total population?
i will take a look at ref and clarify. I would say that the former.--Garrondo (talk) 08:48, 27 February 2011 (UTC)[reply]
It was per patient. Clarified in article.--Garrondo (talk) 11:51, 28 February 2011 (UTC)[reply]

Arbitrary break 6

edit
  • Comments by Sasata (talk) 04:57, 26 February 2011 (UTC)[reply]
  • I don't have the time for an exhaustive review of the entire article, so instead I focussed my efforts on one section, "Research directions". This analysis leaves me with the feeling that the article still needs some polish to bring it up to FA standards.
  • The section begins by listing the "two key questions" that PD research is trying to answer. The closest following citation does not frame or summarize PD research in this way, so I'm wondering if there's a citation missing here.
I have simply eliminated the mentioned sentences.--Garrondo (talk) 08:48, 27 February 2011 (UTC)[reply]
  • "How might those cells be replaced or their loss compensated for?" The "for" at the end of the sentence is awkward; is any meaning changed by just omitting the word?
As eliminated no further an issue.--Garrondo (talk) 08:48, 27 February 2011 (UTC)[reply]
  • "Currently active research directions include the search of new animal models of the disease" Shouldn't that be "search for new animal models" ?
Changed.--Garrondo (talk) 08:48, 27 February 2011 (UTC)[reply]
  • I didn't see gene therapy linked earlier, isn't that bluelink-worthy?
Done
  • "However, the tragedy of a group of drug addicts in California in the early 1980s" is "tragedy" WP:NPOV?
I have reworded the sentence... however since they got parkinsonian symptoms for life it was probably quite neutral to say it was a tragedy.--Garrondo (talk) 08:48, 27 February 2011 (UTC)[reply]
  • "Gene therapy is currently under investigation." This is a weak lead sentence to start a subsection, imho. Sounds like it's being suspected of committing a crime.
I would have never thought of it. Eliminated and reworded. Additionally it was quite redundant in a section entitled research directions.
  • Isn't "clinical trial" bluelink worthy, especially in a section called "Research directions"?
It was precisely the copy edit of another reviewer in FAC which eliminated it given as reason overlinking. I really do not care one way or another.--Garrondo (talk) 08:48, 27 February 2011 (UTC)[reply]
  • "The gene used leads to the production of an enzyme which helps to manage PD symptoms or protects the brain from further damage." That really leaves me hanging… not even a mention of what enzyme it is?
Well, that is the general method, there is not ONE enzyme, but several under investigation and anyway I would say that is very specialized content. --Garrondo (talk) 08:48, 27 February 2011 (UTC)[reply]
  • "However none of them has been conclusively demonstrated to reduce degeneration." "However" at the beginning of the sentence should be followed by a comma; since the subject is "several molecules", shouldn't the underlined "has" be "have"? (Same question regarding the GDNF image caption)
Done.--Garrondo (talk) 08:48, 27 February 2011 (UTC)[reply]
  • "… the best constructed studies up to date indicate …" Is the easter-egg link appropriate (rather than just explicitly stating double-blind, placebo-controlled)? Should "up to date" really be "to date"?
Quite subjetive point. I myself believe that it is precisely an appropiate way to avoid some jargon.
Easter egg links are not in line with guidelines. Snowman (talk) 14:50, 27 February 2011 (UTC)[reply]
Removed then.--Garrondo (talk) 11:28, 28 February 2011 (UTC)[reply]
  • rodent is overlinked (i.e., twice) in the section
Delinked rodent and monkey.--Garrondo (talk) 08:48, 27 February 2011 (UTC)[reply]
  • "Nevertheless use of fetal stem cells is controversial." Like "however", "nevertheless" starting a sentence needs a comma immediately following it.
Checked and fixed full article. Thanks.--Garrondo (talk) 08:52, 27 February 2011 (UTC)[reply]
  • The references need to be swept through with a fine-tooth comb, e.g.:
  • the formatting of journal titles is not consistent in that the abbreviated titles do not always have fullstops (eg., #9 "Parkinsonism Relat. Disord." vs. #10 "Parkinsonism Relat Disord")
Added full stops and other fixes to refs.--Garrondo (talk) 09:32, 27 February 2011 (UTC)[reply]
  • Current ref #6 has the page range in the format "508-512" (note the incorrect hyphen), which is not the same as the others; also #16, #28, etc.
Fixed ref 6, however hyphens for pages in 16 and 28 are correct. Are you referring to the isbn number? Does it also have to be hyphenated.--Garrondo (talk) 09:08, 27 February 2011 (UTC)[reply]
No, the page range format is inconsistent: all three pages are given for starting and ending pages, compared to others which have only the final two pages given. Sasata (talk) 16:50, 28 February 2011 (UTC)[reply]
Ahhhh, Ok, I had not even noticed. Fixed all over article (I think). Is the problem of manually formatting :-) .--Garrondo (talk) 08:20, 1 March 2011 (UTC)[reply]
  • have to be consistent in giving states for US cites (e.g. #3 "Hagerstwon, MD:" (note typo) vs. #6 "Totowa:") Fixed by EdJohnston 17:01, 28-Feb-2011.
I am not American and I have no idea on how to do it. If Totowa is the only case it would be of help if you did it. thanks.--Garrondo (talk) 09:08, 27 February 2011 (UTC)[reply]
I'm not American either, but I think "Hagerstwon" is a misspelling of "Hagerstown". Sasata (talk) 16:50, 28 February 2011 (UTC)[reply]
  • why is ref #24 (Bronstein et al. 2010) in title case?
No idea since I always copy and paste from diberris tool. Fixed.--Garrondo (talk) 09:08, 27 February 2011 (UTC)[reply]
To Sasata, at the top of your list it says that this is a list of problems from one section. I presume that your list is a set examples found in section and that you are suggesting that similar problems could exist throughout the page? Snowman (talk) 17:28, 28 February 2011 (UTC)[reply]
That is correct. If I find more time I'll go through another section and give more examples, but based on what I've read in the one section (& scanning the refs), some more work is needed to make this one of Wikipedia's best medical articles. Sasata (talk) 17:32, 28 February 2011 (UTC)[reply]
  • Comment: I notice that some editors above have complained about jargon. For a sample of good clarity and avoidance of jargon take a look at a capsule summary of PD in a document from the Royal College of Physicians (Preface):
…the management of Parkinson’s disease must take into account the fact that the mainstay of pharmacological treatment, levodopa, can eventually produce dyskinesia and motor fluctuation. Furthermore, there are a number of agents besides levodopa that can help parkinsonian symptoms, and there is the enticing but unconfirmed prospect that other treatments might protect against worsening neurological disability. Thus, a considerable degree of judgement is required in tailoring individual therapy and in timing treatment initiation...
PD is a progressive neurodegenerative condition resulting from the death of the dopamine containing cells of the substantia nigra. There is no consistently reliable test that can distinguish PD from other conditions that have similar clinical presentations. The diagnosis is primarily a clinical one based on the history and examination. People with PD classically present with the symptoms and signs associated with parkinsonism, namely hypokinesia (ie poverty of movement), bradykinesia (ie slowness of movement), rigidity and rest tremor.
Parkinsonism can also be caused by drugs and less common conditions such as: multiple cerebral infarction, and degenerative conditions such as progressive supranuclear palsy (PSP) and multiple system atrophy (MSA).
Although PD is predominantly a movement disorder, other impairments frequently develop, including psychiatric problems such as depression and dementia. Autonomic disturbances and pain may later ensue, and the condition progresses to cause significant disability and handicap with impaired quality of life for the affected person.
Pushing even more technical terms out of the lead is something to consider. It is of interest that the Royal College of Physicians manages to condense the material now in the third paragraph of our lead into just three sentences (those in the first paragraph of the above small-print excerpt).
The following text in our current lead could surely be moved elsewhere, or made shorter:

The main symptoms are collectively called parkinsonism, or sometimes a "parkinsonian syndrome". They can arise from a variety of causes. Parkinson's disease is often defined as a Parkinsonian syndrome that is idiopathic (has no known cause), although some atypical cases have a genetic origin.

This has the flavor of 'bookkeeping' on the disease definition, and may not register any meaning at all for a lay person. The second sentence has the air of a contradiction (idiopathic but also of genetic origin). The subtle boundaries of parkinsonism vs PD could surely be moved later in the article (or only vaguely addressed in the lead), and I see some people are already objecting to 'idiopathic.' That is the kind of word that ought to be pushed into the fine print lower down, if at all possible. EdJohnston (talk) 06:52, 26 February 2011 (UTC)[reply]
I agree that it might make sense to move that material out of the lead. The confusion about idiopathic versus genetic, though, is simply a reflection of confusion in the literature. If PD is defined as idiopathic, then the consequence is that as soon as we know what caused any given case of parkinsonism, it isn't PD! Therefore PD becomes mysterious by definition, which is ridiculous. The definition of PD as idiopathic was really meant to exclude parkinsonism caused by certain identifiable forms of damage, not to define PD out of existence as soon as all cases are understood. Looie496 (talk) 18:30, 26 February 2011 (UTC)[reply]
The usual maximum number of headings in the introduction is four, with five being used in exceptional circumstances. Can the introduction be formed from four paragraphs here, or is this article one of the exceptions? This long introduction could indicate that the article is too long. Perhaps, the history sections of this article could be substantially shortened and a better expanded main page on the history of the science of the disease could be created. Snowman (talk) 10:48, 28 February 2011 (UTC)[reply]
Are you referring to the number of paragraphs in lead? It is right now 4 paragraphs so I am not sure to understand your comment...--Garrondo (talk) 11:56, 28 February 2011 (UTC)[reply]
Yes, there is four now. There used to be five. Snowman (talk) 14:20, 28 February 2011 (UTC)[reply]
Hardly relevant for the FAC, but I have checked 1 version each day along the whole FAC and there has not been 5 paragraphs at any point (although it may have been at some intermediate version in a single day...).--Garrondo (talk) 14:31, 28 February 2011 (UTC)[reply]
My mistake with number of paragraphs. I presume I counted wrong by loosing visual reference points with scrolling up and down unevenly. Snowman (talk) 15:04, 28 February 2011 (UTC)[reply]
To Ed: Less is not always better. In my opinion our third paragraph is more informative than those in the guideline. That certainly has some advantages: if somebody only reads the lead (which many people do) at least they will have some idea on the fact that there are several possible treatments for the disease and its symptoms, which would hardly occur with the introduction of the NICE guideline. Regarding mention of parkinsonism vs PD: I would leave it. The lead is expected to summarize the whole article and if we want "classification" to be included in the lead the difference between the two has to be included. Nevertheless I am open to any proposals.--Garrondo (talk) 14:25, 28 February 2011 (UTC)[reply]
Of course, Ed is User EdJohnston. His last edit is several lines above. Snowman (talk) 16:40, 28 February 2011 (UTC)[reply]
With regard to PD including genetic causes (at the top of this section). It does seem paradoxical that genetic cases are included with the "idiopathic disease" PD, but it does seem to be the case, as seen in SIGN guidelines. I think that every attempt should be made to explain this paradox of terminology in simple and clear English. It is probably easy to see why it could look silly to some (although it is correct), if it is badly explained on the wiki. Perhaps, explanation of the atypical presentations of genetic cases could also be added for clarification. Snowman (talk) 21:43, 28 February 2011 (UTC)[reply]

To Snowmanradio: I have created a history subarticle and summarized in main page.--Garrondo (talk) 15:08, 28 February 2011 (UTC)[reply]

Arbitrary break 7

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  • Request: This page is getting nearly impossible for me to read, particularly in trying to determine what feedback has been resolved, what feedback is in-work, or what feedback has been left at an impasse. To those of you who have left feedback at length, would you be willing to move sections of addressed feedback to the talk page, or possibly strike it out? --Andy Walsh (talk) 16:31, 28 February 2011 (UTC)[reply]
  • Resolved issues should have a strike through. It would be even more confusing, if relevant parts of this FAR were removed to the article talk page, hence I think that nothing about resolved issues should be removed from this page. Snowman (talk) 16:37, 28 February 2011 (UTC)[reply]
  • I have just looked at every comment I have made on this page and put a strike to the resolved issues. Incidentally, I have been minimising my feedback and just choosing examples from a few sections. Snowman (talk) 17:16, 28 February 2011 (UTC)[reply]
  • Provisional impression (3): I do not know when time will be called on this review. I am still finding problems in the article almost everywhere I look. I would like to prioritise my edits to other parts of the wiki. I might be presumptive and I might be wrong, but it seems to me that most of the progress has been directly in response to reviewers comments, and it seems to me that this is going reasonably well. I hope that the whole of the article is brought up to standard by careful copy-editing over the next few weeks or before the review is closed, and I would like to see more proactive copy-editing that would reduce the work load on reviewers. As a medical article, rather than a general science article, it should be particularly well written; see MedMoS. My view is that a medical topic includes basics that have to be included and correctly emphasised. Snowman (talk) 00:00, 1 March 2011 (UTC)[reply]
  • The abbreviation 'LB' for Lewy Bodies is only used three times. It would be clearer if we drop the abbreviation and spell it out in every case.
Done.--Garrondo (talk) 07:38, 1 March 2011 (UTC)[reply]
  • The link from the Infobox to the GeneReviews book does not work, and I couldn't fix it. It should go to http://www.ncbi.nlm.nih.gov/books/NBK1223. The book is entitled 'Parkinson Disease Overview.' There seems to be some trick with how that template is coded. The template works fine in the Autism article.
No idea on how templates work, nor where to find help to fix it.--Garrondo (talk) 08:24, 1 March 2011 (UTC)[reply]
  • JFW commented above on File:Basal ganglia circuits.svg, suggesting that 'some of the layers moved about when the images were converted to PNG format'. I suspect that the image is not broken, but I don't think it has any expository value here. My vote would be to drop it from the article. Certainly the article text does not try to explain any of the terms introduced in the figure or in its caption. Too much detail for this level of narrative, and it does little to help the reader understand the mechanism of PD. What we should get across to the reader is: Cell death in the substantia nigra through unknown process, causing not enough dopamine, causing not enough disinhibition of the motor neurons. This makes initiating movement harder. (We basically say this in the third paragraph of Pathophysiology).
I agree that the image is probably too specialized for the level of detail of the article. I have eliminated it and the related one in the levodopa section.--Garrondo (talk) 07:38, 1 March 2011 (UTC)[reply]
  • To deal with the paradox that idiopathic Parkinson's could have a genetic cause, how about trying to say 'primary Parkinson's' wherever we can, instead of 'idiopathic Parkinson's'. The ICD-10 seems to treat the two terms (primary and idiopathic) as almost synonymous. It would not be puzzling if primary Parkinson's ultimately turns out to have a genetic cause. EdJohnston (talk) 01:12, 1 March 2011 (UTC)[reply]
See discussion below.--Garrondo (talk) 08:24, 1 March 2011 (UTC)[reply]
I struck the GeneReviews issue since I was able to locate the document code and fix the link. Also struck out two other items that were fixed by Garrondo. EdJohnston (talk) 15:08, 2 March 2011 (UTC)[reply]

On "idiopathic parkinsonism"

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Since discussion on the correcteness-uncorrectness according to sources and clearness-unclearness of explanation on article of the issue of PD being defined as primary and idiopathic, with the addition of genetic forms, has been commented by several reviewers backs and forwards in their opinions it might be a good idea the centralize discussion in this subsection. It might be even better if reviewers cut and pasted their comments in this specific issue and moved them here.--Garrondo (talk) 08:00, 1 March 2011 (UTC)[reply]

For the moment I have tried to clarify the situation in the classification section: right now article reads like this: Parkinson's disease is the most common form of parkinsonism and is usually defined as "primary" parkinsonism, meaning parkinsonism with no external identifiable cause.[2][3] In recent years several genes that are directly related to some cases of Parkinson's disease have been discovered. As much as this can go against the definition of Parkinson's disease as idiopathic, genetic parkinsonisms with a similar clinical course to PD are generally considered true cases of Parkinson's disease. Changes include addition of the word "external" to give more importance to the "secondary" term, and the addition of the last sentence specifically stating problems with the definition. Comments and ce would be greatly appreciated.--Garrondo (talk) 08:00, 1 March 2011 (UTC)[reply]

New lead (addressing 'idiopathic')

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Please see User:EdJohnston/Sandbox, a proposed draft for the article lead, which (in my opinion) helps to deal with the 'idiopathic' problem. It also tries to fix three things that bothered me about the existing lead:

  1. The opening section was trying too hard to cover all the bases, making it unclear whether it was describing a well-defined disease entity
  2. The real test for the disease is the presence of Lewy Bodies. They can only be checked for post mortem
  3. None of the therapies can reverse the effects of the disease or cure it. They are just a way to address the symptoms. (This point is made in the sub-article Treatment of Parkinson's disease), but was not stated in the main article.)

Please look at this proposed lead and see what you think. EdJohnston (talk) 14:33, 1 March 2011 (UTC)[reply]

Sounds great to me.--Garrondo (talk) 16:45, 1 March 2011 (UTC)[reply]
Thanks for reply. A further sentence I am hoping to put in the lead is some form of this capsule of PD: Cell death in the substantia nigra through unknown process, causing not enough dopamine, causing not enough disinhibition of the motor neurons. This makes initiating movement harder. (This would be reworded properly and would be checked against the references before being added). EdJohnston (talk) 17:03, 1 March 2011 (UTC)[reply]
I can't agree that the revision is an improvement -- I think that naive readers will find it much more confusing. I don't believe that there is any way of briefly explaining the distinction between PD and parkinsonism that readers won't find confusing -- even professionals in the field are often confused by it. The best course of action, therefore, is to keep the explanation in the lead short, and make sure that it does not spread confusion to other aspects of the lead. Looie496 (talk) 19:08, 1 March 2011 (UTC)[reply]

Sporadic Parkinson's disease

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Our article uses the term 'sporadic PD' but does not define it or provide a link to any other article. There is a book by Braak and Tredici, called "Neuroanatomy and Pathology of Sporadic Parkinson's Disease", which appears to use 'sporadic PD' as though it were a synonym for primary (or idiopathic) PD. Should we add 'sporadic PD' in the lead as yet another synonym? EdJohnston (talk) 17:35, 2 March 2011 (UTC)[reply]

Those are a good points. Snowman (talk) 23:56, 2 March 2011 (UTC)[reply]
Sporadic PD is the opposite to familial PD, so it is closely related to idiopathic-primary.--Garrondo (talk) 07:15, 3 March 2011 (UTC)[reply]
I have added "The terms "familial Parkinson's disease" and sporadic Parkinson's disease" can be used to differentiate genetic from truly idiopathic forms of the disease. to the classification section.--Garrondo (talk) 11:42, 4 March 2011 (UTC)[reply]

Provisional impression (4): I have had a close look and edited one of the sections namely the diagnosis section, and I found that the readability problems there were dense. Essentially, I think that the original diagnosis section required re-writing with odd parts being checked against sources, and that work on that section is not completed. Unfortunately, I think that this is representative of many parts of the article. I understand that another reviewer, who is busy, has provided adequate evidence that he would also be able to find multiple problems throughout the article. My overall impression of the whole a article is that it is not up to the standard of an FA article, and that a considerable amount of work is needed to bring it to that standard. My impression is that throughout the article medical terminology is often used not-quite correctly and sometimes medical terminology and phrases in sources appear to have been misunderstood slightly and a slightly distorted from may appear in the article. It would be good if all this could be corrected during this review, but I think that this article it heading towards failing FA status. I think it will need to mature for at least three months and probably longer before returning for another FA assessment. Snowman (talk) 20:55, 2 March 2011 (UTC)[reply]

Can you mention a sentence in the Diagnosis section that you are not happy about? Your comment implies that the section contains factual errors. Who is the other reviewer that you cite? We can only work on what we know about. I would fix the style in many places if I thought others would accept my changes. Thanks, EdJohnston (talk) 22:16, 2 March 2011 (UTC)[reply]
  • Please make some edits. Snowman (talk) 23:36, 2 March 2011 (UTC)[reply]
  • I find the problems dense and there are many issues, so I edited the diagnosis section directly as a quicker way to illustrate problems with the article than making lists here, but this is only apparent if the sequence edits are analysed. I have changed the following line amongst others that I thought had the wrong and a misleading emphasis, I have changed the article from "Common presentations of the disease are usually easily diagnosed." to "PD is generally easy to diagnose when there are many easily recognisable signs and symptoms of PD.". The in-line reference said; "Although the diagnosis of PD is straightforward when patients have a classical presentation, ...". Snowman (talk) 23:30, 2 March 2011 (UTC)[reply]
  • See other reviews comments above. With this edit I asked him; "I presume that your list is a set examples found in section and that you are suggesting that similar problems could exist throughout the page?", and he replied with this edit which was his last edit on this page. Snowman (talk) 23:41, 2 March 2011 (UTC)[reply]
In addition to being quite a tendentious question "could exist" is not the same as "he would be able to find". --Garrondo (talk) 08:27, 3 March 2011 (UTC)[reply]
I asked this for clarification after seeing Sasata's earlier edit. Snowman (talk) 19:48, 3 March 2011 (UTC)[reply]

My own opinion as an answer to Snomanradio's comments: Snowmanradio has stated several times that he sees many problems. He has stated that in his opinion the article is not up to FA standard and he seems determined to get the article failed. While I respect him as an editor at the very least it seems paradoxical that many other expert editors in the medical field and FAC have not seen those "many" problems. As of today Looie496, JFW, DrKierman, Leevanjackson, Graham Colm, Casliber, Tony1, and RJH have stated their support and Sasata, Axl and EdJohnston reviewed several sections and made what I think were constructive minor comments mainly on language issues but certainly did not oppose the article. Moreover Snowmanradio has said that there are many errors when following sources and last time he says that he has taken a close look to the diagnosis section and edited it to show what the example of mistakes he has found. I have taken a close look to the edits Snowmanradio made to diagnosis: See differences between his two versions here.

  • He has precisely stated that I have changed the article from "Common presentations of the disease are usually easily diagnosed." to "PD is generally easy to diagnose when there are many easily recognisable signs and symptoms of PD.". The in-line reference said; "Although the diagnosis of PD is straightforward when patients have a classical presentation, ...". Regarding content I do not see any better following of the source in his version to the one of the article: Classical, ie normal, ie typical, ie with easyly recognisable signs and symptoms, ie.as many others as language can produce are generally easy to diagnose. Non-classical, ie non normal, ie non typical, ie with non easily recognisalbe signs and symptoms are not easily diagnosed. Moreover: regarding style Snowmanradio sentence is poor with two "easy" in a single sentence. This edit by Garrondo (talk) 08:27, 3 March 2011 (UTC)[reply]
  • It is with some sadness that I reply indicating your misunderstanding. Classical tends to mean an obvious text-book presentation; for example, a presentation showing a set of easily recognisable florid symptoms. An appendicitis can present with the classical symptoms, but I this is not the same as the common mode of presentation. Snowman (talk) 12:30, 3 March 2011 (UTC)[reply]
They are actually classical because they are the most common, following your example I am sure that classical presentation is of appendicitis is also the most common with a big difference to the others, so it would be the same to say the "common presentation of appendicitis" than the "classical presentation". Nevertheless in this case I am not saying that your proposal is wrong or that I do not like the word classical, simply that what you point as "huge problems that may embarrass the wiki" may not be so.--Garrondo (talk) 13:21, 3 March 2011 (UTC)[reply]
I think that saying "classical presentation" implies a presentation with symptoms and signs that are commonly found in the disease and when they are florid enough to be easily recognisable. Common symptoms can start years before diagnosis is considered or possible. Snowman (talk) 19:17, 3 March 2011 (UTC)[reply]
Further discussion of an already accepted issue is completely useless.--Garrondo (talk) 08:19, 4 March 2011 (UTC)[reply]
I am please that you now appear to be able to see the original problem. Snowman (talk) 20:17, 4 March 2011 (UTC)[reply]
  • Changes to first and differential diagnosis paragraphs are in my opinion minor and only expression related. I am sure he prefers his version. I am not so sure that everybody would think it is better. I am sure they are not reason enough to say that article is clearly months far from being a FA. This edit by Garrondo (talk) 08:27, 3 March 2011 (UTC)[reply]
  • I changed it because of the original line "Differential diagnosis requires distinguishing PD from other kinds of tremors and other causes of parkinsonism.". I think that "Differential diagnosis" was used incorrectly and was certainly jargon. A list of possible diagnoses for a condition is the "differential diagnosis". Snowman (talk) 13:05, 3 March 2011 (UTC)[reply]
  • While he has stated that article did not follow sources the only error I actually spot right now in the article has been inserted with his edition: He implies in it that there is no definitive test in life as opposed to diagnosis after death. Actually pathological diagnosis is definitive in the sense that it will be hardly be changed since patient is dead, but as of today is far from being definitive in the sense of "conclusive" since other diseases (Mainly lewy bodies dementia) can also show Lewy bodies at autopsy. Similarly to above while it is interesting his change saying "in brain" his language is again far from perfect since to say "after death at autopsy" is quite redundant (can there be an autopsy when you are still alive?) This edit by Garrondo (talk) 08:27, 3 March 2011 (UTC)[reply]
  • "Post-mortem" is the word commonly used in the UK for autopsy. This version using "autopsy" as unexplained jargon may not be as understandable in British English. Snowman (talk) 12:46, 3 March 2011 (UTC)[reply]

Summarizing: along this long month of FAC in my opinion article is heading towards consensus. At this point 8 reviewers (in addition to me, the nominator) have stated their support, and only one is clearly against it. While this editor clearly against it being a FA has said different times that article is full of errors and problems everywhere he fails again in showing the many errors, and many of his proposed changes and problems are highly debatable. I would welcome further comments from Sasata , Axl Edjonhston and any other reviewer that may indicate how truly far is the article from being a FA since at this point I feel that Snowmanradio is not neutral regarding this article and his opinion should be balanced against others taking this into account.

Forgot to sign.--Garrondo (talk) 11:05, 3 March 2011 (UTC)[reply]

  • Wrong: Sasata says here that "I don't have the time for an exhaustive review of the entire article, so instead I focussed my efforts on one section, "Research directions". This analysis leaves me with the feeling that the article still needs some polish to bring it up to FA standards.". Snowman (talk) 10:05, 3 March 2011 (UTC)[reply]
  • All of my comments about this page are backed up by lists of problems found on the page. I wish that this page was up to FA status, but I think that it has potential to embarrass the wiki if it was elevated to FA status at this juncture. Snowman (talk) 10:05, 3 March 2011 (UTC)[reply]

I have just corrected the poor version produced by Snowmanradio: now says: A physician would make or suspect a diagnosis of Parkinson's disease mainly from the medical history and a neurological examination by determining the presence or absence of signs and symptoms of PD and other related diseases.[1] Reduction of motor impairment in response to administration of levodopa markedly increases the likelihood of PD.[1] There is no definitive test for diagnosis, but finding Lewy bodies in brain samples at autopsy has traditionally been considered the gold standard.--Garrondo (talk) 11:13, 3 March 2011 (UTC)[reply]

I presume you refer to this edit of yours. The minor adjustments are marginal in my opinion. I never said that my version was perfect, in fact I said the section still needs work. The point is that I have removed errors that would embarrass the wiki. However, the line is still an over simplification, because Lewy bodies are also found in Lewy body dementia (which is a different diagnosis to PD). Also, I think that the section is still not quite right, because it seems a bit clunky. Snowman (talk) 12:01, 3 March 2011 (UTC)[reply]
Not only marginal errors: to say that no definitive test exist in life is wrong since there are no definitive test neither in life, nor when somebody is death.--Garrondo (talk) 13:21, 3 March 2011 (UTC)[reply]
So what is the point of a post mortem (autopsy in the USA)? Snowman (talk) 19:26, 3 March 2011 (UTC)[reply]
While not perfect it is the best we have, and if there has been symptoms on life LB in autopsy it will serve to reassure diagnosis. Even more important: there may be a person for example with a vascular parkinsonism. In such case no presence of LB in autopsy will serve to rule out PD. --Garrondo (talk) 19:50, 3 March 2011 (UTC)[reply]

To SnowmanRadio: In your last several edits to the neuropsychiatric section most changes are in either for good or neutral, but you introduced an error that I have corrected: source says that people have higher probabilities of going to a nursing home, does not say that they have more probability of needing it (although common sense says that this is most probably also true).--Garrondo (talk) 11:36, 4 March 2011 (UTC)[reply]

  • Thank you. Some editors would have saved time and just mentioned this in an edit summary for me to see. To me, my version seems a bit better than the original version that said "... a higher probability of attending a nursing home.", and I think your development of my version is even better. I am glad that the end result was good. I am reassured that you can only find this tiny problem with my re-write. Snowman (talk) 20:48, 4 March 2011 (UTC)[reply]

Management section is long

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The article is 87,200 bytes including references, while there are 21,800 bytes in 'Management.' So this section is one quarter of the article. There is a main article for Management at Treatment of Parkinson's disease. It is surprising that the Management section would still be so large, since we could employ summary style there. Would editors accept shrinking the Management section by moving some material to the sub-article? EdJohnston (talk) 03:29, 3 March 2011 (UTC)[reply]

I believe it is an important section, difficult at this moment to summarize without loosing important points. I do not think it is a good idea at the moment.--Garrondo (talk) 08:31, 3 March 2011 (UTC)[reply]
There is a lot of repetition between this PD article and the article on the treatment on PD. It seems that a lot of the treatment article was copied from the PD article. I think that these two pages should be considered to see if data organisation across articles can be improved. Is there anything in the linked page on treatments that is not in the main ariticle? If the long version is going to be kept in the main article, can the pages be merged? Snowman (talk) 14:23, 3 March 2011 (UTC)[reply]
Sequence of what happened was as follows: When I got to the main article a year ago the secondary article already existed but in a horrible state: full of primary sources, undue weight, missing data... At some point the main article was better and had more info than the secondary article so I copied most content to the secondary article, substituting most of its content. Nevertheless there is some extra info in the secondary page that is not in the primary page (mainly some info in research directions and some info on surgery and some info on meds for symptoms other than motor.) That, and the fact that in the main article there is no place for more info, but it can be added to the secondary page would make me discourage the merging since most probably what would occur is that it would be recreated soon. It would also be a pity to loose the extra info in this page.--Garrondo (talk) 19:45, 3 March 2011 (UTC)[reply]
  • Comments:
    • "As of 2010... " This is recent. That's OK, but nominators need to bear in mind that they need to maintain this particular section in order to avoid breaking the article's accuracy.
That line was written in 2010. Now that we are in 2011 I have changed it to "in 2010 there were".--Garrondo (talk) 07:42, 4 March 2011 (UTC)[reply]
    • "Other predominant toxin-based models employ the insecticide rotenone, the herbicide paraquat and the fungicide maneb" Are we saying that these chemicals induce Parkinson's? not clear.... oh wait, I see something up in the Risk factors" section. I dunno if internal wikilinks are considered bad form these days (as a form of self-reference, perhaps); if not, then a link here to the prior section might be acceptable.--Garrondo (talk) 07:42, 4 March 2011 (UTC)[reply]
They do not induce PD in animals. They are used to create an animal model, which is shows some features similar to the human disease and serves (more or less) for research, but that it is far from being exact to the disease. I think internal wikilinks are discouraged. I have clarified as follows: PD is not known to occur naturally in any species other than humans, although animal models which show some features of the disease are used in research. The appearance of parkinsonian...--Garrondo (talk) 07:42, 4 March 2011 (UTC)[reply]
    • "Synuclein proteins being the main component of Lewy bodies was discovered in 1997" The proteins were discovered then, or the fact that they are the main component of Lewy bodies was discovered then? Simple grammar fix.
The latter. Changed to "That alpha-synuclein is the main component of Lewy bodies was discovered in 1997".--Garrondo (talk) 11:00, 4 March 2011 (UTC)[reply]
    • And by the way, "synuclein protein" is twice given as "alpha-synuclein protein" and once without the alpha. Dunno if that matters. I see a couple relevant WP articles but won't attempt to wikilink as I am not a domain expert (and alpha-Synuclein protein is wl'd in at least one prior passage.
Alpha-synuclein is a protein of the bigger familiy of synuclein proteins. Now the article only refers to alpha-synuclein and synucleinophaty.--Garrondo (talk) 11:00, 4 March 2011 (UTC)[reply]
    • Person-year redirects to Man-hour... is that a valid wl? ... I'm not sure that the meaning of person-time and person-year is clear here; and additional 8 words or so wouldn't hurt.
Clarified inside bracket to "usually number of new cases per thousand individuals in a year". Is it clear enough now?--Garrondo (talk) 11:03, 4 March 2011 (UTC)[reply]
    • Please pardon my ignorance, but is there a reason why the "Causes" section is separate from the "Epidemiology" section? Can or should those sections, or any elements thereof, be combined? I do see the term "risk factor" in the former, forex... or should the "Causes" section be retitled "genetic causes" or similar, since that seems to be all that is discussed? Tks.
No ignorance at all. That dichotomy is present also in sources with some separating both sections and others having them together. I decided to have them separated per two reasons: 1-Maintain consistency with the sections proposed in WP:MEDMOS. 2-Risk factors as of today are not proven enough to say that they cause PD, their mechanism of effect is not really known and have mainly been studied in epidemiological studies with all the pitfalls that that kind of research suffers.--Garrondo (talk) 07:42, 4 March 2011 (UTC)[reply]
    • "progression time of symptoms to a stage of high dependency may be" dependency on levodopa, or on caregivers?
The latter. Clarified.--Garrondo (talk) 08:14, 4 March 2011 (UTC)[reply]
    • "Autonomic disturbances" not defined and no relevant WP article.
It was linked as autonomic nervous system in signs and symptoms. I have added a wikilink to autonomic dysfunction in the signs and symptoms introduction.--Garrondo (talk) 08:14, 4 March 2011 (UTC)[reply]
    • "On the other hand a disease mainly characterized" would "case" or "symptom set" a similar term be preferable to "disease" here?
How about "disease pattern"? I have added disease pattern to article.--Garrondo (talk) 08:14, 4 March 2011 (UTC)[reply]
    • "may delay motor complications but are less effective at controlling symptoms" I thought motor complications were symptoms... do you mean "other symptoms", or...?
Motor complications refers to the secondary effect of long-term use of levodopa, so they are not exactly symptoms. Changed to: may delay motor complications of medication use--Garrondo (talk) 08:14, 4 March 2011 (UTC)[reply]
    • "become more common with age at onset" means "become more common with increased age at onset"?
    • I added a blockquote; please feel free to remove it if it seems undesirable.
Section (and article) is quite long, and does not add that much, but it is still interesting and well choosed. I have moved to secondary article.--Garrondo (talk) 08:14, 4 March 2011 (UTC)[reply]
    • Conditional Support. Please consider this a Support when all of my comments above (most of which are minor) are addressed. Congratulations on an excellent article. – Peacock.Lane 07:08, 4 March 2011 (UTC)[reply]

Talk page discussion opened

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In the belief that this review is no longer raising major issues and ought to be moved toward an endpoint, I have made a comment to that effect at WT:Featured article candidates#Parkinson's disease FAC -- I'm giving a pointer here so that reviewers will be aware of it. Looie496 (talk) 01:51, 4 March 2011 (UTC)[reply]

I have asked for further opinions of the article at the medicine and neuroscience projects.--Garrondo (talk) 13:46, 4 March 2011 (UTC)[reply]

Provisional impression (5); A number of editors have done copy editing and correcting mistakes by direct editing to the page, and I think this has moved things on a lot. I would support FA providing some remaining issues listed below are considered. Snowman (talk) 16:59, 4 March 2011 (UTC)[reply]

I have checked all your editions and fixed errors are you worked. I believe it is done.--Garrondo (talk) 17:11, 4 March 2011 (UTC)[reply]
I hope to work in it on Sunday.--Garrondo (talk) 17:11, 4 March 2011 (UTC)[reply]
Sorry, but I do not understand your comment.--Garrondo (talk) 17:11, 4 March 2011 (UTC)[reply]
Evidence of the pesticides and so on. One section says that all evidence is equivocal and then the next says a two fold increase in risk of PD. Snowman (talk) 17:18, 4 March 2011 (UTC)[reply]

Provisional impression (6): There has been an undertaking to fix remaining problems. I support FA status. Snowman (talk) (talk) 17:18, 4 March 2011 (UTC). See Provisional impression (7) below Snowman (talk) 21:47, 4 March 2011 (UTC)[reply]

  • Support: I too support promotion to FA. Here and there I think the prose style could be better; it sounds waffly and equivocating in areas that really aren't that hard to summarize well. I may have a few more suggestions. EdJohnston (talk) 17:26, 4 March 2011 (UTC)[reply]
With this edit I tried to simplify the first two paragraphs of Diagnosis. Comments are invited. To obtain clarity, it may sometimes be necessary to omit details, but they could be added lower down or in a subarticle if they are believed to be essential. Diagnosis is one of the sections I felt to be 'waffly'. Some of the details appear to be common sense observations that should not require spelling out to our readers. EdJohnston (talk) 19:50, 4 March 2011 (UTC)[reply]
Fine. What do you think of my modification? I put a comment in the edit summary. Please re-word it as necessary. I like to team up with someone that can write good English when writing something complicated. Snowman (talk) 21:02, 4 March 2011 (UTC)[reply]
  • Provisional impression (7): I would support promoting article to FA providing the short list of issues above and a number higher up the page that I have marked "pending" are resolved (not many issues remaining). Snowman (talk) 20:26, 4 March 2011 (UTC)[reply]

Today I did a 50km trekking and I am death-tired. If I have forces I will take a look tomorrow. If not I will try to finish everything on Monday.--Garrondo (talk) 19:55, 5 March 2011 (UTC)[reply]


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