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From: "WE MOVE" <[log in to unmask]>
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Sent: Monday, June 19, 2000 3:21 PM
Subject: Long-term Outcomes in PD Fetal Transplants (MovDis Congress 2000)


> E-MOVE reports from the 6th International Congress of Parkinson's Disease
> and Movement Disorders, held in Barcelona, Spain, 11-15 June 2000.
> Citation numbers refer to abstract numbers published in Movement Disorders
> 2000;15 (Supplement 3).
>
> Double-blind controlled trial of embryonic dopaminergic tissue transplants
> in advanced Parkinson's disease
> S Fahn
> M114
>
> Fetal transplants for Parkinson's disease can lead to modest improvement
> in motor scores for younger patients, but at the risk of unpredictable and
> disabling dyskinesias, according to this platform presentation by Dr.
> Stanley Fahn. Fahn presented results from a double-blind study and
> long-term, open-label continuation.
>
> Forty patients were randomized to receive either fetal implants or sham
> surgery. Results at one year showed significant, modest motor improvements
> as determined by "off" UPDRS scores, in patients younger than age 60, with
> the majority of improvement in rigidity and bradykinesia. Older patients
> did no show significant improvement. "Freezing and gait did not improve,
> and if anything, they got worse in older patients," Fahn said. Two thirds
> of operated patients, but no sham patients, showed improved PET scans of
> the putamen, which was correlated with motor improvements in young, but
> not old, patients. Acute significant adverse events were statistically
> significantly higher in operated patients, but not related to the
> procedure, according to Fahn. One patient who died due to accidental
> injury in a storm showed about 5% cell survival on autopsy.
>
> Following the breaking of the blind, 14 sham-operated patients received
> open-label implantation. Analysis of all operated patients with follow-up
> of 16-36 months showed younger patients continue to improve. Older
> patients have shown some improvement, "but follow-up lengths are still
> short, and there is also no more blind," noted Fahn. Nine of 33 operated
> patients report being better than before surgery.
>
> However, Fahn went on to report the late emergence of unexpected,
> disabling "off" period dyskinesias in 4 patients. Patients have shown arm
> and leg dyskinesias that interfere with activities of daily living and
> walking, as well as facial dystonia. Some patients had difficulty
> swallowing, with one requiring a gastrostomy tube. "These patients are not
> on medicines, but are still having dyskinesias. We've never seen that
> before in Parkinson's disease," Fahn said.
>
> Fahn concluded, "We've established the proof of principle, that
> bradykinesia and rigidity can be helped with surgery. However, we did not
> anticipate these "runaway dyskinesias," and if I knew they were going to
> occur, I would not have done the study. Until we can figure out how to
> prevent or control them in animal studies, I can't recommend this
> procedure."
>
> Copyright 2000 WE MOVE
> Editor: Richard Robinson ([log in to unmask])
>
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