Achievements of the last century in neurosurgery and a view to the 21st century.

Abstract

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 (19912000), 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.