How one neurologist's dedication built a world-renowned center for Parkinson's disease research and clinical care
In the world of medical science, true progress often stems not from vast resources or famous institutions, but from the unwavering dedication of individuals. The Saskatchewan Movement Disorders Program (SMDP), established in the late 1960s, stands as a powerful testament to this truth. What began as one neurologist's effort to provide the best care for his patients in Saskatoon has grown into a world-renowned program of clinical care and research, contributing immeasurably to our understanding of Parkinson's disease and related disorders 3 5 .
This is the story of how commitment, curiosity, and a profound connection to the patient community built a unique and unparalleled resource. It's a story that demonstrates how careful, long-term clinical observation can answer fundamental scientific questions, and how a program in the Canadian prairies became the envy of researchers across the globe 1 3 .
The SMDP has become a global model for integrating patient care with rigorous clinical research, demonstrating how dedication can overcome resource limitations.
The story of the SMDP is inextricably linked to its founder, Dr. Ali Rajput. He arrived at the University of Saskatchewan in 1967 on a one-year contract, with no initial plans to stay 1 3 . A series of unforeseen events—including the sudden death of his department head and his subsequent marriage—led him to put down roots in the province 1 .
The pivotal moment came in 1968. At that time, a new treatment for Parkinson's disease, levodopa (LD), was creating a wave of optimism. However, it was not yet approved for general use in Canada. Dr. André Barbeau, a leading figure in Canadian neurology, visited the university but informed Dr. Rajput that Saskatoon was not included in a planned national LD drug trial 1 .
Dr. Ali Rajput arrives at University of Saskatchewan on a one-year contract
Pivotal moment: Dr. Rajput seeks special permission to use levodopa for his patients
Program establishes its dual mission: patient care and research
Dr. Rajput felt that his patients deserved access to this promising treatment as much as anyone else in the country. Driven by this conviction, he sought and obtained special permission from Health Canada to use LD, on the condition that he would not only treat patients but also conduct research 1 .
In the early days of LD therapy, most neurologists used high doses, often following the protocol of Cotzias et al., which involved 9 grams or more per day 1 . However, Dr. Rajput observed that these high doses often led to early and disabling involuntary movements (dyskinesias). Based on his observations of patients who had started treatment elsewhere and his own early experience, he independently decided to pioneer a low-dose LD strategy 1 .
His approach was to hospitalize patients and slowly titrate the dose to a maximum of 3 grams of levodopa (the equivalent of 600 mg of the modern levodopa/carbidopa combination) 1 . While improvement was slower, his patients eventually fared as well as those on higher doses, but with significantly fewer side effects.
Maximum 3g levodopa vs. standard 9g+ protocols
What truly sets the Saskatchewan Movement Disorders Program apart is its extraordinary approach to research. Understanding that many questions in movement disorders can only be answered by examining the brain itself, the program made a long-term commitment to clinico-pathological correlation 1 3 .
From the beginning, the clinics were structured to collect research-worthy data, including videos, detailed clinical scales, and longitudinal follow-up on every patient 1 . But the most remarkable achievement is the program's brain bank. In an incredible testament to the trust and rapport built with the patient community, 25% to 30% of deceased patients from the clinic come to autopsy—a rate that is virtually unheard of elsewhere 1 3 . For Parkinson's disease patients, the autopsy rate is even higher 3 .
This has resulted in a unique collection of over 515 autopsy cases, each with frozen and formalin-fixed brain tissue, and, most importantly, linked to a detailed clinical history compiled over many years 1 4 . Unlike standard brain banks that accept tissue from various sources, the Saskatchewan collection is exclusively from patients who were personally evaluated in their clinic, ensuring the highest quality and consistency of clinical data 1 .
Autopsy rate of deceased patients
Autopsy cases in collection
| Feature | Description | Significance |
|---|---|---|
| Source of Tissue | Exclusively from patients evaluated within the SMDP | Guarantees consistent, high-quality clinical data for each case 1 |
| Longitudinal Data | Detailed clinical assessments at every visit, using standardized scales | Allows researchers to correlate brain changes with the progression of symptoms over time 1 |
| Autopsy Rate | 25-30% of all deceased patients (higher for PD) | Provides a representative sample, minimizing selection bias and making findings more generalizable 1 3 |
| International Access | Collaborators are not charged for access to resources | Fosters global scientific collaboration and accelerates discovery 1 4 |
One of the program's most significant contributions was its long-term study on the outcomes of low-dose levodopa therapy, which challenged the prevailing medical practice.
The study followed Parkinson's disease patients who were treated within the SMDP starting in 1968 1 .
Patients were initiated on a lower dose of levodopa with a maximum target of 3 grams per day 1 .
The core results from the program's 1984 publication, which summarized a 12-year experience, were striking 1 :
| Outcome Measure | Saskatchewan Low-Dose Regimen | Reported High-Dose Regimen |
|---|---|---|
| Incidence of Dyskinesia | 10-20% 1 | Significantly higher 1 |
| Motor Response Fluctuations | 10-20% 1 | Significantly higher 1 |
| Quality of Life | As good as high-dose patients after several months, with fewer side effects 1 | Compromised by early and disabling dyskinesias 1 |
| Relationship of Dementia to LD | No relation found 1 | Not reported in this study |
The scientific importance of this work was profound. It demonstrated that a patient-centric, conservative approach could achieve excellent long-term motor control while minimizing debilitating side effects. This study provided robust, real-world evidence that helped shift clinical practice toward more careful dosing strategies, ultimately improving the quality of life for countless Parkinson's patients worldwide.
The work of the SMDP relies on a combination of clinical, pathological, and technological tools. The following table outlines some of the essential "reagents" and resources that are fundamental to their research.
| Research Tool / Resource | Function and Explanation |
|---|---|
| Levodopa (LD) | The gold-standard medication for Parkinson's disease; used both as a treatment and a research tool to understand motor responses and complications 1 . |
| Standardized Clinical Rating Scales | Tools like the Unified Parkinson's Disease Rating Scale (UPDRS) provide a quantitative, reproducible method for measuring symptom severity and progression over time 1 . |
| Video Documentation | Recording patient movements creates an objective visual record that can be reviewed over time and by other experts, invaluable for diagnosing complex disorders 1 . |
| Postmortem Brain Tissue | The cornerstone of the program's research; allows scientists to correlate clinical symptoms observed during life with specific pathological changes in the brain 1 3 . |
| Low Field Magnetic Stimulation (LFMS) | A newer, non-invasive technology being investigated by USask researchers to slow degeneration and improve symptoms in Parkinson's disease, showing promise in animal models 6 . |
The Saskatchewan Movement Disorders Program continues to thrive and evolve. Dr. Ali Rajput has been joined by his son, Dr. Alex Rajput, ensuring the continuity of its mission 1 . In 2023, the program welcomed Dr. Eric Noyes, a new clinical movement disorders fellow, expanding its capacity to serve patients across Saskatchewan 7 .
The program's impact is quantifiable, having saved the healthcare system millions of dollars in direct drug costs through its rational use of medications, and it is recognized as one of the four major medical advances by physicians in Saskatchewan 7 .
Today, the spirit of innovation continues. Researchers at the University of Saskatchewan are exploring groundbreaking technologies like Low Field Magnetic Stimulation (LFMS) as a potential non-invasive treatment to slow the progression of Parkinson's disease 6 . As Dr. Alex Rajput noted, this new research is "exciting work, providing proof of concept that LFMS does not simply improve the motor findings, but actually improves the underlying brain pathology" 6 . The program also boasts a robust Deep Brain Stimulation (DBS) service, with Saskatchewan noted for having virtually no wait-list for this advanced surgery—a rarity in Canada 8 .
The story of the Saskatchewan Movement Disorders Program is a powerful reminder that in medicine, commitment truly does pay off. It was built not with vast funding, but with perseverance, dedication to patients, and a relentless curiosity 3 5 . The program stands as a testament to the benefits of a publicly funded healthcare system that allows for longitudinal follow-up of a large patient population 3 .
For young clinicians and scientists, the legacy of Dr. Ali Rajput and the SMDP is an inspiration. It proves that with careful observation, a focus on clinically relevant questions, and the determination to build bridges with collaborators, one can create a world-class research program that makes a real difference in patients' lives 3 5 . The Saskatchewan Movement Disorders Program is not just a collection of data and tissue samples; it is a living, growing monument to the idea that when a physician commits fully to their patients, the rewards for all of humanity can be immense.