Parkinson's disease arises from genetic and possibly neurotoxic causes that produce massive cell death of the neuromelanin-containing dopaminergic neurons of the substantia nigra. Loss of these neurons is essential for the diagnostic parkinsonian features. Although many genetic mutations have been suggested as causes or risk factors for Parkinson's disease, the low penetrance of some mutations and the low disease concordance in relatives suggests that there must be interactions between multiple factors. We suggest that 'multiple hits' that combine toxic stress, for example, from dopamine oxidation or mitochondrial dysfunction, with an inhibition of a neuroprotective response, such as loss of function of parkin or stress-induced autophagic degradation, underlie selective neuronal death. We discuss the properties of substantia nigra dopamine neurons that might make them particular targets of such multiple hits.