The topics discussed in this issue provide the platform upon which modern medical management for Parkinson’s disease is built, and from which we can expect new directions of management to emerge.

Over the last 40 years, Parkinson’s disease has changed from being one of the most obscure of the chronic neurological disorders, and one for which treatment was minimally effective—to the best-understood neurodegenerative disorder and one for which we have excellent medical and surgical treatment for symptoms.

These remarkable achievements have come from a series of logically structured studies in basic and clinical science, namely the discovery that dopamine is a neurotransmitter, and it is selectively depleted in Parkinson’s disease. The advances that have taken place in Parkinson’s disease have set an example of what can be achieved by sustained, insightful research.

In this and the next issue of the British Columbia Medical Journal a series of papers are published from the Movement Disorder Clinic at Vancouver Hospital, UBC site. These papers summarize the state of the art of what we know and what we do not know, and point the general direction to where current research is taking us.

In this issue, emphasis is placed on the background of information upon which current management of Parkinson’s disease is based. Topics include a consideration of etiology [8] and pathogenesis. The results of recent epidemiological [9] studies are presented, directing us toward considerations about etiology that have been neglected over the last 3 decades. Two papers discuss the pathology of Parkinson’s disease; one will emphasize new interest in the possible role of inflammatory damage [10] in the brain and the other brings us up to date on the morphological changes [11] that are being revealed by new techniques of immunohistochemistry.

The last paper in this issue deals with the latest imaging studies [12] that are now playing an important role in unravelling some of the unanswered questions about Parkinson’s disease. In particular, positron emission tomography has been a valuable tool because of the many ligands that have become available for dissecting away the different components of synaptic disturbance that occur when the nigrostriatal dopaminergic cells undergo degeneration.

The reader will soon recognize where our major areas of ignorance remain: until we understand the etiology (or etiologies) of Parkinson’s disease, it is unlikely that we will achieve our most challenging goal—to prevent or at least slow down the progression of the disease.

—Donald B. Calne, OC, DM
Director, Neurodegenerative Disorders Centre, Vancouver Hospital and Health Sciences Centre