Historical view on the development of Neurotherapeutics―From technology to science―

Abstract

Until recently, neurotherapeutics has been based on the medical empiricism, which has given us many still very useful medications, such as digitalis, opium or aspirin. But these empirical treatments without sound scientific background are mere medical technology and do not deserve to be called science. In 1934, the first scientific treatment in the history of neurological therapeutics was done by an Irish neurologist Mary B Walker. She successfully treated myasthenia gravis with physostigmine, assuming that the basic pathology of myasthenia gravis is common to that of curare poisoning which can be treated with physostigmine. The door to the scientific neurotherapeutics was opened by Isamu Sano who found in 1959 that dopamine concentration was extremely high in the human striatum. Sano's discovery lead to the investigations of striatal dopamine in Parkinson disease patients which revealed the decrease of dopamine in Parkinsonian striatum. Immediately followed by these basic studies, levodopa therapy was initiated in 1961 and won a great therapeutic success.

Although marked development of neurotherapeutics has been recently realized by scientific background, we have to remember that the important therapeutic discoveries have been done by serendipity. Therapeutic efficacy of β–blocker to essential tremor, prevention of migraine attacks with botulinum toxin, the efficacy of amantadine to Parkinson disease, and the discovery of zonisamide as an anti–parkinsonian agent, all of these are the product of serendipity which was fortunately picked up by excellent clinical neurologists having keen eyes enough to notice the unexpected effects of the medications.

Scientific approach to the neurotherapeutics is getting more and more important, but the keen eyes not to miss the serendipity in daily clinical practices are the most important points to the further development of neurotherapeutics.