In such a case then, at whatever period of the disease it might be proposed to attempt the cure, blood should be first taken from the upper part of the neck, unless contraindicated by any particular circumstance..
As readers will see in this issue of Continuum, focused not on movement disorders in general, but rather on the treatment of movement disorders, we have come a long way from the specific therapeutic recommendation offered by Parkinson in An Essay on the Shaking Palsy, published in 1817.
But although, at present, uninformed as to the precise nature of the disease, still it ought not to be considered as one against which there exists no countervailing remedy.
On the contrary, there appears to be sufficient reason for hoping that some remedial process may ere long be discovered, by which at least, the progress of the disease may be stopped.
It is sobering to reflect that today, nearly 200 years after Parkinson wrote his famous monograph, we still lack convincing modalities to slow the progression of the disease that bears his name, or, for that matter, most other neurodegenerative illnesses. Clearly, much work is still to be done. Nonetheless, for those of us who were, in years past, sometimes ridiculed for selecting neurology as a specialty because "what can you do after you localize the process and give it a name," this issue of Continuum, crafted by an able faculty chaired by Dr Steven Frucht, is a cause for celebration.
The first two chapters of this issue focus on the therapeutic advances in Parkinson's disease. Following detailed discussion of the medical treatment by Drs Theresa Zesiewicz and Robert Hauser, Drs Mustafa Saad Siddiqui and Michael Okun review the remarkable advances in the surgical management of the disease, emphasizing the role of deep brain stimulation (DBS). This theme is continued in the next chapter in which Dr Elan Louis addresses the management of tremors, both medically and surgically.
We must admit that our therapeutic advances for some other movement disorders have not yet reached the level of success achieved in Parkinson's disease. Nevertheless, progress in classification, as well as specific treatment, have enabled better management of these disorders. In the ensuing chapters, Dr Kathleen Shannon and Dr Frucht cover chorea and myoclonus, respectively. Drs Howard Geyer and Susan Bressman discuss the considerable advances made in our understanding and treatment of dystonias, including the remarkable relief provided by the use of botulinum toxin and DBS in selected circumstances. In the final chapter of this issue, Dr Terence Sanger reviews tic disorders and Tourette syndrome. This chapter is remarkable for addressing the importance not only of treatment, but also of the avoidance of treatment at times. This subject is echoed in the section on Ethical Perspectives, in which Dr Michael Williams discusses a situation in which the wishes of a child (the patient) conflict with those of the parents.
This issue of Continuum provides an added bonus-a CD-ROM that illustrates the movement disorders discussed and some of the treatment responses. We are grateful to Dr Frucht for his exceptional efforts in providing this valuable educational tool. As usual, readers will also profit by reading and attempting to answer the multiple-choice questions deftly crafted by Drs Douglas Gelb and Steven Lewis, as well as the patient management problem devised by Dr Frucht.
I believe this issue of Continuum, with its focus on therapy, reflects a landmark accomplishment for our specialty. At the same time, it should serve as a poignant reminder of how far we still have to go to make significant progress in improving the quality of life for some of our patients.
Aaron E. Miller, MD