In 1984 we made the first observation of a correlation between early age exposure to rural environment (and drinking well water) and development of idiopathic Parkinson's disease (IPD). 13 These findings were subsequently confirmed elsewhere (Barbeau, 1985 ; 25 Tanner, 1985 26 ). Analysis of all early age onset IPD (EPD) cases born and raised in Saskatchewan revealed that 20 of 22 had exclusively rural exposure during the first 15 years of life. This distribution was significantly different from the general population (p = 0.0141). Further study of the EPD group included sampling and metal analysis of childhood sources of drinking water in 18 cases and 36 age and sex-matched controls. Water collected from the two groups was analyzed for 23 metals (including 7 elements implicated in the etiology of IPD). There was no difference in the metal composition of the water between the two groups. 17 Finally, a review of herbicide and pesticide use in Saskatchewan agriculture was undertaken to determine if there was an increased incidence of EPD following utilization of any particular chemical. No increase was found in the incidence of EPD with the introduction of any pesticide or herbicide, including Paraquat, for agricultural use. We conclude that there is a strong correlation between early age rural environmental exposure and development of IPD. We believe well water is a likely vehicle for the causal agent, but neither water metal concentration nor any of the herbicides and pesticides used in Saskatchewan agriculture are related to the cause. RESUME: Etiologie de la maladie de Parkinson et site geographique, qualite chimique de l'eau potable, pesticides et herbicides. En 1984, nous avons rapporte pour la premiere fois l'obervation d'une correlation entre une exposition a un environnement rural dans le jeune age (et l'absorption d'eau provenant de puits) et le developpement de la maladie de Parkinson idiopathique (MPI). 13 Ces constatations ont ete confirmees subsequemment ailleurs (Barbeau, 1985; 25 Tanner, 1985 26 ). Une analyse de tous les cas de MPI a debut precoce qui sont nes et ont ete eleves en Saskatchewan a revele que 20 de ces 22 cas ont ete exposes a un environnement exclusivement rural pendant les 15 premieres annees de leur vie. Cette distribution etait significativement differente de la population en general (p = 0.0141). Une etude plus poussee du groupe de MPI comportait un echantillonnage des sources d'approvisionnement en eau potable utilisees dans leur enfance chez 18 des cas ainsi que chez 36 controles apparies pour l'age et le sexe et l'analyse des metaux contenus dans ces echantillons, soit 23 metaux dont 7 elements deja mis en cause dans l'etiologie de la MPI. II n'existait pas de difference dans la composition en metaux de l'eau entre les deux groupes.

Levodopa is the most useful drug for treatment of Parkinson's disease today. But after continued use for several years, the effectiveness declines, and the undesirable side effects become more frequent, leading to unsatisfactory control. Once the treatment failure emerges, further management is difficult and often unsuccessful. One alternative for preventing side effects and treatment failure is to use a low dose. We are reporting our 12-year experience on uninterrupted treatment with levodopa, 3 grams (approximate) daily. The improvement was comparable with the best reports on higher dosage, and the side effects were significantly less frequent. The frequency of dyskinesia and on-off phenomena showed a strong correlation with duration of treatment. Psychiatric side effects were more common on treatment, but frequency of dementia did not correlate with duration of therapy. Improvement reached a peak after 6 months and remained statistically significant for 3.5 years. By the end of 5 years, the disability profile in the group was similar to that prior to levodopa treatment. So far, there is no satisfactory method for preventing treatment failure. From our observations, low dosage of levodopa is a desirable alternative, but not the answer to therapeutic failure. We recommend that levodopa use be delayed until the patient has a functional and/or psychological handicap that cannot be satisfactorily controlled with less potent antiparkinsonian agents.

ABSTRACT:The cause of idiopathic Parkinson's Disease (PD) is not known but it is believed to be related to some environmental agent(s). Given a long preclinical interval and onset of symptomatology around age 60 years, it becomes impossible to identify and analyze all prior environmental factors satisfactorily. To circumvent these difficulties we evaluated the childhood environment in those PD patients whose symptoms began at age 40 years or earlier. Twenty-one such cases were born and raised in the province of Saskatchewan. Nineteen of these 21 patients spent the first 15 years of life exclusively in rural Saskatchewan. Detailed population analysis indicates a strong predisposition to early onset idiopathic Parkinson's Disease (EPD) in those raised in rural areas (p = 0.0154). All but one case utilized exclusively well water for the first 15 years of life — a trait significantly different from that expected in the provincial population. It is concluded that rural Saskatchewan environments contribute to EPD and that well water used in childhood should be considered as a potential vehicle for the etiological agent.

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