Rethinking Parkinson’s Disease: Interview with Angelo Antonini
Neurologist Angelo Antonini discusses a shift in understanding Parkinson's disease, moving from a brain-centric view to a systemic multi-organ syndrome. He highlights the 'gut-first' versus 'brain-first' models to explain the diverse clinical presentations of the disease.
Why it matters
This paradigm shift could lead to earlier diagnosis and more personalized treatment strategies by focusing on peripheral symptoms before motor decline occurs.
Angelo Antonini | Full Professor of Neurology; Head of the Parkinson and Movement Disorders Unit, University Hospital of Padua, Italy
Citation: EMJ Neurol. 2026; https://doi.org/10.33590/emjneurol/244OCN6K
For decades, we treated Parkinson’s as if it were strictly an isolated issue in the substantia nigra. But if you actually sit in the clinic and listen to patients, you quickly realise the problem is located in multiple organs.
Long before a patient ever develops a tremor or stiffness, they routinely share stories of years spent dealing with constipation, sleep disturbances (like rapid eye movement sleep behaviour disorder), smell problems, and autonomic issues like orthostatic hypotension. Furthermore, when we look at pathology, we find misfolded α-synuclein aggregates distributed throughout the peripheral nervous system: in the skin, the colon, and the vagus nerve.
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