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However, DA neurotransmission may be neither the first nor the major neurotransmitter casualty in the neurodegenerative sequence of PD. Growing evidence supports earlier norepinephrine (NE) deficiency resulting from selective degeneration of neurons of the locus coeruleus and sympathetic ganglia. Dopaminergic replacement therapy therefore would seem to neglect some of the motor, behavioral, cognitive, and autonomic impairments that are directly or indirectly associated with the marked deficiency of NE in the brain and elsewhere. Therapeutic strategies to enhance NE neurotransmission have undergone only limited pharmacological testing. Currently, these approaches include selective NE reuptake inhibition, presynaptic \u03b1\n                    <jats:sub>2<\/jats:sub>\n                    \u2010adrenergic receptor blockade, and an NE prodrug, the artificial amino acid L\u2010\n                    <jats:italic>threo<\/jats:italic>\n                    \u20103,4\u2010dihydroxyphenylserine. In addition to reducing the consequences of deficient noradrenergic signaling, enhancement strate\tgies have the potential for augmenting the effects of dopaminergic therapies in PD. Furthermore, early recognition of the various clinical manifestations associated with NE deficiency, which may precede development of motor symptoms, could provide a window of opportunity for neuroprotective interventions. \u00a9 2014 International Parkinson and Movement Disorder Society\n                  <\/jats:p>","DOI":"10.1002\/mds.26048","type":"journal-article","created":{"date-parts":[[2014,10,9]],"date-time":"2014-10-09T03:07:17Z","timestamp":1412824037000},"page":"1710-1719","source":"Crossref","is-referenced-by-count":240,"title":["Norepinephrine deficiency in Parkinson's disease: The case for noradrenergic enhancement"],"prefix":"10.1002","volume":"29","author":[{"given":"Alberto J.","family":"Espay","sequence":"first","affiliation":[{"name":"Gardner Family Center for Parkinson's Disease and Movement Disorders Department of Neurology University of Cincinnati Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter 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