We thank Dr Kalaitzakis and colleagues for their interest in our article. While their letter again emphasizes the current limitations in our understanding of PD pathogenesis, most if not all of the issues they raise have already been highlighted throughout our article. Citing the article by Dickson et al,1 we stated in our review that “although the Braak staging scheme with its implications to the premotor features of PD has been largely confirmed by other investigators, several criticisms of this work have been raised”; we then went on to list the potential limitations of this hypothesis. Were it not for editorial constraints, we would also have referenced here work by Saito et al,2 Jellinger,3 Halliday et al,4 Parkkinen et al,5 and Kalaitzakis et al.6
Lim S, Fox SH, Lang AE. Parkinson Disease: Extranigral, Multisystem, and α-Synuclein “Plus”—Reply. Arch Neurol. 2009;66(7):910–916. doi:10.1001/archneurol.2009.141
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