If you've been waiting for an update on Parkinson's disease, you won't want to miss this issue's cover article on page 2155. Written by Rosabel Young, M.D., M.S., and illustrated by John Karapelou, this state-of-the-art review is not only the culmination of months of hard work but also a reflection of a storehouse of knowledge accumulated during the ambitious careers of both author and artist.
Dr. Young—whose education started with a bachelor's degree in biochemistry and a master's degree in pharmacology and physiology and led to a medical degree with specialization in internal medicine, neurology and clinical neurophysiology—is currently chief of the division of neurophysiology and electrodiagnostics at King-Drew Medical Center, Los Angeles. She was previously medical director of the St. Mary of the Plains Hospital Motor Disorders Program in Lubbock, Tex.
John Karapelou is a board-certified medical illustrator based in Columbus, Ohio, with over 23 years of professional experience illustrating medical journals and textbooks. John completed an accredited program in medical illustration at Ohio State University, Columbus, and is a fellow and past-president of the Association of Medical Illustrators. His accomplishments in medical illustration have been recognized with over 30 professional awards, and from time to time you've probably noticed John's excellent cover illustrations for AFP and AAFP's Home Study Self-Assessment monograph series. (Later this year, AFP will have the pleasure of unveiling another of his outstanding cover illustrations.)
In this issue, the works of these two professionals come together to teach and illustrate the complexities of pathophysiology, diagnosis and treatment of Parkinson's disease. Like most who have known or cared for patients with Parkinson's disease, both Dr. Young and John Karapelou acknowledge a great compassion for the victims of this most debilitating disease. Dr. Young's career path toward a focus on movement disorders was influenced by a physician–mentor who overcame handicaps of the disease to continue his practice. John Karapelou's life was touched by a business acquaintance who was severely debilitated with the disease. As I'm sure you'll agree, the intelligence and compassion underlying their efforts shine through in this review of Parkinson's disease.
The concept for the cover illustration, shown above, is the result of a collaboration between John Karapelou and David Klemm, AFP's art coordinator. The illustrators wanted to communicate on three levels: one showing motor control connections that are involved in Parkinson's disease, one showing the mechanism of disease—loss of dopaminergic neurons in the substantia nigra—and one showing the devastating effect of the disease on daily activities of living. The glowing yellow-orange streaks in the coronal section of the brain illustrate the dopaminergic pathways. A group of dopaminergic neurons to the side is rendered in matching yellow-orange tones, with degeneration of a neuron represented as a fading to opaque. The end result, of course, is loss of motor control and subsequent debilitation, such as difficulty holding a coffee cup.
The message that Dr. Young would like to drive home is that patients with movement disorders should no longer feel that there is no hope for improving their condition. Just in the past 10 years, remarkable advances have been made in the treatment of neurologic conditions, including Parkinson's disease, with many new drugs available for treatment, including the increasingly popular dopamine agonists, and advances in surgical techniques such as deep brain stimulation. Family physicians will play an important role in recognizing the condition, coordinating care and offering patients hope with the reminder that new drugs and treatments remain on the horizon.