Neuronal vulnerability, pathogenesis, and Parkinson's disease


  • David Sulzer PhD,

    1. Department of Psychiatry, Columbia University, New York, New York, USA
    2. Department of Neurology, Columbia University, New York, New York, USA
    3. Department of Pharmacology, Columbia University, New York, New York, USA
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  • D. James Surmeier PhD

    Corresponding author
    1. Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
    • Correspondence to: Prof. D. James Surmeier, Department of Physiology, Northwestern University, 303 E. Chicago, Chicago, IL 60611, USA. E-mail:

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  • Funding agencies: This work was supported by grants from the JPB Foundation (to D.S. and D.J.S.); NIH (P50NS047085 to D.J.S.; P50NS38370 to D.S.); the Hartman Foundation (to D.J.S.); and the Parkinson s Disease Foundation (to D.S.).

  • Relevant conflicts of interest/financial disclosures: D. James Surmeier has acted as a consultant to Genetech, Merck, Pfizer and Teva. Dr. Sulzer has no industry associations.

  • Full financial disclosures and author roles may be found in the online version of this article.


Although there have been significant advances, pathogenesis in Parkinson's disease (PD) is still poorly understood. Potential clues about pathogenesis that have not been systematically pursued are suggested by the restricted pattern of neuronal pathology in the disease. In addition to dopaminergic neurons in the substantia nigra pars compacta (SNc), a significant number of other central and peripheral neuronal populations exhibit Lewy pathology (LP), phenotypic dysregulation, or frank degeneration in PD patients. Drawing on this literature, there appears to be a small number of risk factors contributing to vulnerability. These include autonomous activity, broad action potentials, low intrinsic calcium buffering capacity, poorly myelinated long highly branched axons and terminal fields, and use of a catecholamine neurotransmitter, often with the catecholamine-derived neuromelanin pigment. Of these phenotypic traits, only the physiological ones appear to provide a reachable therapeutic target at present. © 2013 Movement Disorder Society