Parkinson's Diseas Surgery Options

by Food and Drug Administration (FDA)

(Page 3 of 3)

A brain operation shown to be helpful for many Parkinson's patients, especially those in late stages of the disease, is called pallidotomy. Doctors are not sure why the procedure works, but an October 1997 report in the New England Journal of Medicine stated that half of the patients in a pallidotomy study at Toronto Hospital, who before the surgery needed help in eating, dressing, and personal hygiene, were able to resume these activities independently. The study cautioned, however, that some of the surgery's effects diminished after two years and that the long-term effectiveness of the procedure still is unknown.

In pallidotomy, a surgeon makes a tiny hole in the skull and uses a tiny electric probe to destroy a small portion of the globus pallidus, which experts believe is overactive in Parkinson's patients. Before operating, the surgeon has "mapped" the patient's brain with imaging techniques such as magnetic resonance and knows precisely where the probe should go. The patient is kept awake, but under sedation, so the surgeon can note responses to stimuli. Though both sides of the brain have a globus pallidus, pallidotomies typically are performed on one side at a time. After the patient has recuperated, a second procedure is done if needed.

For Tom Riess, who has undergone the procedure four times over the last six years, the surgery helped reduce his Parkinson's symptoms, especially the violent shaking, "which was literally killing me," he says. "Unfortunately, it left me with severely impaired speech, which is a fairly common consequence," says the 51-year-old Californian, a Parkinson's patient for 17 years. "Still, the tradeoff is worthwhile."

Thalamotomy, a surgical procedure that destroys a specific group of cells in the thalamus, the brain's communications center, is aimed at the 5 to 10 percent of Parkinson's patients with disabling tremor in the hand or arm. It reduces or eliminates tremor in as many as 90 percent of patients.

On the Horizon

A number of potential Parkinson's treatments in research laboratories now show much promise. They include:

Neurotrophic proteins — These appear to protect nerve cells from the premature death that prompts Parkinson's. One hurdle is getting the proteins past the blood-brain barrier.

Neuroprotective agents — Researchers are examining naturally occurring enzymes that appear to deactivate "free radicals," chemicals some scientists think may be linked to the damage done to nerve cells in Parkinson's and other neurological disorders.

Neural tissue transplants — Researchers are studying ways to implant neural tissues from fetal pigs into the brain to restore the degenerate area. In a clinical trial conducted in part at Boston University School of Medicine, three patients out of 12 implanted with the pig tissues showed significant reduction in symptoms.

Genetic engineering — Scientists are modifying the genetic code of individual cells to create dopamine-producing cells from other cells, such as those from the skin.

Experts say some of these new treatments are still far off. Others say they are hopeful that with bolstered research efforts, such as those earmarked in last year's Udall Act, innovative new therapies will be available in the near future.

"I'm optimistic," says Perry Cohen, 52, a Washington, D.C., Parkinson's activist and patient for two years. "I think we are on the verge of an important development. I'm confident that I won't have to go through the agony I've seen others go through."

A Social Net

For Parkinson's disease patients, both updated information and social interactions are key factors in battling the disease. Though patients seek these through traditional means such as their doctors, families and friends, many are turning to the Internet.

Patients can compare notes on Parkinson's issues and stay in touch with others with the disease by subscribing to an Internet Parkinson's mailing list. Some of these lists deal with Parkinson's as one of a number of neurological disorders. Others focus on caregiving. One list that is an open forum just for Parkinson's patients is called "PARKINSN."

Maintained at the University of Toronto, PARKINSN gives patients a place to pose questions or just let off some steam. A recent scan of the list revealed messages about exercises that can relieve some Parkinson's discomfort, surgery success stories, reviews of books about the disease, poems, even some Parkinson's jokes. One list member announced that he is marrying his doctor, and he invited everyone on the list to his wedding.

About the Author

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FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.