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Special Millennium Article
January 2000

Advances in Neurology in the 20th Century

Author Affiliations

From the Department of Neurology, Medical College of Georgia, Augusta.

Arch Neurol. 2000;57(1):60-61. doi:10.1001/archneur.57.1.60

During the early and mid-20th century, there were advances in the underpinnings of neurology, with descriptions of neurologic diseases and neuropathology, defining the scope and basis of neurologic practice. Santiago Ramón y Cajal, MD, won the Nobel Prize in 1906 for his work in neuropathology. The electroencephalogram was then developed in the late 1920s, increasing our understanding of epilepsy and brain function, and the pioneering work of Wilder Penfield, MD, FRCPC, led to a functional map of the human cortex in living subjects. There was progress in the mid-20th century in controlling syphilis and other infectious diseases of the brain with the introduction of antibiotics and mass immunization for polio. The development of more effective drugs for the control of epilepsy started with the introduction of phenytoin. The first effective treatment of a neurodegenerative disease occurred in the 1960s with the use of levodopa for Parkinson disease. Imaging of the nervous system, begun with conventional radiology and angiography earlier in the century, took a great leap forward with the introduction of computer tomographic scanning and magnetic resonance imaging in the 1970s. Progress in neurological surgery using the microscope, computerized techniques, functional procedures, and endoscopy was matched by the introduction by neurologists of high-tech treatments for neuromuscular diseases, cancer, stroke, and immune-mediated diseases of the nervous system. Prion proteins were found to be responsible for Creutzfeldt-Jakob disease, kuru, and other neurologic conditions, leading to the award of Nobel Prizes for Carleton Gajdusek, MD, in 1976 and Stanley Prusiner, MD, in 1997. By century's end, there were advances in understanding the pathogenesis of the notorious "big five" neurological diseases: multiple sclerosis, Parkinson disease, Alzheimer disease, amyotrophic lateral sclerosis, and muscular dystrophy, but only for the last disease was the molecular pathogenesis well understood. During the Decade of the Brain (1991-2000), there were great advances in molecular genetics and understanding the pathogenesis of neurologic diseases, preparing the way for novel treatments, including gene therapy, in the new millennium.