Complex I deficiency, either specific or associated with other respiratory chain defects, has been identified in myopathies, encephalomyopathies and in three `neurodegenerative' disorders: Parkinson's disease, dystonia and Leber's hereditary optic neuropathy. The complex I defect is expressed in blood in all these three but, to date, only in LHON have specific mitochondrial DNA mutations been identified. Recent work with ρ° cybrids indicates that, in a subgroup of patients at least, the complex I deficiency is determined by mtDNA, in contrast to dystonia where a nuclear gene defect or toxic influence appears a more likely cause. The actions of specific toxins, e.g., MPTP continue to play an important role in our understanding of pathogenesis of neurodegeneration, particularly in PD.