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http://www.kumc.edu/Pulse/breaknews/Break_news100295.html
>                       BREAKING NEWS! on Pulse:
>
>                               [Image]
>
>                        For Immediate Release
>
> October 2, 1995
>
>  KU Medical Center Is First U.S. Site for Pallidal Brain Stimulation
>                     for Treatment of Parkinson's
>
> KANSAS CITY, Kan. -- The first pallidal stimulation for the
> treatment of Parkinson's disease in the United States will be
> performed Oct. 5 at the University of Kansas Medical Center.
> Pallidal stimulation involves threading a thin wire electrode into
> the globus pallidus of the brain, the site of abnormal activity in
> Parkinson's disease. The electrode, attached to a pulse generator,
> sends a high-frequency signal to block the brain's overactive
> impulses that result in the tremor and halting steps of Parkinson's.
>
> "This is certainly not a cure for Parkinson's disease; but the
> pallidal stimulation may offer some relief from its symptoms, which
> include tremor, slowness, stiffness and gait problems," said William
> Koller, M.D., Ph.D., chair of neurology at KU Medical Center. "It
> also appears to decrease some of the drug-induced side effects of
> Parkinson's, the involuntary movements called dyskinesia."
>
> The theory is that brain cells which fire to drive normal movement
> do not shut off in the Parkinson's disease patient.
>
> "The circuit in the brain is overactive in patients with Parkinson's
> disease," said Steven Wilkinson, M.D., neurosurgeon. "If you disrupt
> the circuit, you can improve some of the symptoms.
>
> Patients are awake during the surgical implantation of the
> stimulator and its effects are immediate. A microelectrode with a
> single cell recorder is threaded through the brain so the
> neurosurgeon can see, as well as hear, which brains cells are firing
> too rapidly. The area of increased activity is where the electrode
> is implanted.
>
> KU Medical Center has approval to do five pallidal stimulations. The
> study will be used to determine how to optimize the procedure and
> how long benefits last. Using current criteria, the first five
> patients will be relatively young Parkinson's disease patients, who
> have reached the limits of benefit from drug therapy and who
> experience significant disability and dyskinesia.
>
> "There is no information that pallidal stimulation will halt the
> progression of the disease; however, it can improve function and
> patients will be able do more things," Koller said. "We know some
> patients will have dramatic benefits, but it is yet to be determined
> how long the benefits will last. "
>
> Since January 1994, KU Medical Center has implanted electrode
> stimulators in 40 patients targeting the brain's thalamus. Thalamus
> stimulation has caused significant reduction of tremors in patients
> with essential tremor and the tremor of Parkinson's disease. But for
> Parkinsonian patients, thalamus stimulation only improves the
> tremor, not the drug-induced side effects which alternately cause
> episodes of involuntary movements and muscular rigidity or other
> Parkinsonian symptoms. One other site in the country, Mount Sinai
> Hospital, New York, has approval to implant stimulators for
> Parkinson's disease in a different area of the brain, the
> subthalamius nucleus.
>
> A surgical procedure called a pallidotomy, which actually destroys
> tissue in the globus pallidus, has been tried at other medical
> centers for treatment of Parkinson's disease. Pallidotomies first
> were used 30 years ago but grew out of favor with the advent of
> Levodopa, the drug of choice for Parkinson's disease. There has been
> a resurgence of interest in the procedure as patients reach the
> limits of benefit from Levodopa and also experience "on periods,"
> defined by abnormal movements, and "off periods," defined by
> rigidity, from long-term use of the drug.
>
> Koller said that pallidal stimulation may offer some advantages over
> the pallidotomy: 1. no brain tissue is destroyed 2. the frequency
> and strength of stimulation can be adjusted to the needs of each
> patient 3. the stimulus can be removed if there is an adverse effect
> and 4. stimulation can be done on both sides of the brain while a
> pallidotomy can only be done on one side because of risks of speech
> and swallowing difficulties. Wilkinson and Koller plan to perform
> pallidotomies after the five pallidal stimulations.
>
> "There is a lot of scientific interest and a lot of potential to
> help Parkinson's disease patients when we have run out of other
> options," Koller said. "We still need to learn more about these
> procedures. They are investigational and there are some risks
> involved."
>
> (Story by Peggy Graham, University Relations, 913-588-5240)
> --------------------------------------------------------------------
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