The future direction for PSP and MSA epidemiology will depend on various factors. Firstly, clinical anecdotes or natural experiments as occurred with MPTP and parkinsonism, will generate new hypotheses. Whilst many of these will be red herrings, true etiological insights can be gained by methodological sound exploration of such reports. Secondly, new developments in laboratory-based research may highlight etiological factors that have an analogous lifestyle exposure. This in turn can be tested using either questionnaires or, better still, with some plausible biomarker. Finally, well undertaken large case control studies will be necessary to refute or support plausible hypotheses.
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