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1. Diagnosis of parkinsonian syndrome: Bradykinesia and ≥1 of: 1) Muscular rigidity 2) 4-6 Hz rest tremor 3) Postural instability not caused by primary visual, vestibular, cerebellar, or proprioceptive dysfunction |
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2. Exclusion criteria for idiopathic Parkinson disease: 1) History of repeated strokes with stepwise progression of parkinsonian features 2) History of repeated head injury 3) History of definite encephalitis 4) Oculogyric crises (episodes of involuntary gazing, caused by tonic spasms of extraocular muscles) 5) Neuroleptic treatment at onset of symptoms 6) ≥1 affected relative 7) Sustained remission 8) Strictly unilateral features after 3 years 9) Supranuclear gaze palsy 10) Cerebellar signs 11) Early severe autonomic involvement 12) Early severe dementia with disturbances of memory, language, or praxis (ability to perform complex intentional movements) 13) Babinski sign 14) Presence of a cerebral tumor or communicating hydrocephalus on computed tomography 15) Negative response to high doses of levodopa (if malabsorption excluded) 16) Exposure to MPTP |
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3. Supportive prospective positive criteria for idiopathic Parkinson disease (≥3 required for diagnosis of definite Parkinson disease): 1) Unilateral onset 2) Resting tremor present 3) Progressive disorder 4) Persistent asymmetry affecting the side of onset most 5) Excellent response to levodopa (>70%) 6) Severe levodopa-induced chorea 7) Levodopa response for ≥5 years 8) Clinical course of ≥10 years (typical course of Parkinson disease) |
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Adapted from J Neurol Neurosurg Psychiatry. 1988 Jun;51(6):745-52. |
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MPTP, 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine. |