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Cholinergic-Anticholinergic Antagonism in Parkinsonism

Roger C. Duvoisin, MD
Arch Neurol. 1967;17(2):124-136. doi:10.1001/archneur.1967.00470260014002.
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THE LIMITED clinical efficacy of the belladonna alkaloids in the treatment of parkinsonism was first noted a century ago by Charcot and his student, Ordenstein.1 Although an extraordinary number of pharmacological agents have been tried at various times in the 100 years which have elapsed since this early therapeutical trial, few have been found which can equal the effect of atropine, scopolamine, or stramonium, and none can truly be said to be appreciably more effective. The clinical use of these alkaloids in treating extrapyramidal disorders has been entirely based on empirical observation and was well established long before their fundamental mechanism of action as acetylcholine antagonists was understood. Thus, it seems significant that virtually all known medicinal preparations of botanical origin have been used in parkinsonism over the past century but that only those containing one or more of the belladonna alkaloids achieved enduring and widespread acceptance. Recognition of

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