Thanks a lot. Great report.

Sid Roberts wrote:

>      On Sunday August 23, the Cleveland Clinic Foundation sponsored a
> symposium, "New Discoveries:  Parkinson's Disease and Tremor Disorders".
> Speakers from the Cleveland Clinic  included:  Gene H Barnett, M.D., Vice
> Chairman, Department of Neurosurgery; R. Stanley Burns, M.D., Director,
> Movement Disorders Program; and Erwin B. Montgomery, M.D., Director of
> Research, Movement Disorders Program.  Ray Watts, M.D., Associate Professor,
> Department of Neurology at Emory University School of Medicine, also spoke.
> (William C. Koller, M.D., Ph.D., of the University of Kansas Medical Center,
> scheduled to speak, was unable to appear.)  Each spoke for about 20 minutes
> and a question and answer period  followed.
>
>     Dr. Montgomery, in his opening remarks, noted that a research project
> concerning the genetic factor in Parkinson's Disease  will be conducted at
> the Clinic.  To aid in this project, the Clinic is seeking as participants,
> families in which more than one member has Parkinson's Disease.  Anyone
> meeting this criterion is urged to  contact the Cleveland Clinic Movement
> Disorders Program, Department of Neurology, at 216-445-1108, or call the
> Clinic at 1-800-223-2273.
>
>      Dr. Burns, speaking on New Medications for Parkinson's Disease,
> centered his remarks on Mirapex, Requip, and Tasmar, all introduced within
> the last year or so.  He explained that Mirapex, which he described as "the
> simplest of the drugs to use", produces the effect of dopamine, but is a
> synthetic agent, as opposed to levadopa (Sinemet), a natural chemical.  Dr.
> Burns noted that Mirapex is a long-acting drug  which complements Sinemet in
> aiding tremor, balance, and postural problems, but also has some  unique
> properties, providing  both anti-depressant and anti-fatigue effects.   He
> remarked that the "down side" of the drug  is its capacity to cause
> confusion, hallucinations, psychosis and paranoia in some patients, and
> noted that, for these reasons, its use should be monitored.
>      Dr. Burns characterized Requip as a "sister to Mirapex", with the
> distinction of  more difficulty in adjusting dosage, but less likelihood of
> producing side effects.
>      Tasmar was described  by Burns as a complex drug with no intrinsic
> anti-Parkinson's  Disease activity.  By itself, Tasmar will do nothing, he
> noted; Tasmar must be used in combination with Sinemet.  As the newest drug,
> learning how to adjust dosage is key , and it will take longer to optimize
> its effect.  Tasmar's primary benefit is decreasing fluctuations (on/off
> periods);  its primary challenge will be refinement in its use.
>      Dr. Burns commented on new drugs now in the laboratory stage, noting
> that the goal is to improve the function of dopamine-producing cells still
> intact and to reduce the rate of progression of the disease.
>
>      Dr. Barnett, speaking on Surgical Options for Movement Disorders,
> stated that surgery for Parkinson's Disease was not new, but was popular in
> the '50's and '60's, with thalamotomy being the most used, but then
> abandoned.  In l992, the surgical treatment, pallidotomy, was developed, and
> interest in fetal transplant of dopamine-producing cells increased.  In
> 1997, the deep brain stimulation procedure was approved by the FDA.
>      Presently, thalamotomy is the procedure preferred for control of
> tremor.  Pallidotomy, which destroys selected cells in the thalamus, globus
> pallidum, and sub-thalamic nucleus which have become hyper-active due to the
> death of cells in the substantia nigra, is more effective for other symptoms
> such as dyskinesea.
> The newest development, deep brain stimulation (DBS), implants electrodes in
> the brain, connected to a pacemaker located under the clavicle.
>      Dr. Barnett distinguished DBS from the pallidotomy procedure by noting
> that the gamma knife, used in the pallidotomy, is "often but not always"
> perfect, and involves destruction of cells, whereas DBS is both adjustable
> and reversible.
>
>      Dr. Ray Watts, discussing the future of surgery for Parkinson's
> Disease, explained that the fundamental problem is the death of
> dopamine-producing cells, and that the goal is to stop progression of the
> loss of such cells and, ideally, to restore their function.
>      Early Swedish experiments in transplanting human fetal
> dopamine-producing cells found the area of the brain which develops dopamine
> was increased, to the extent that some patients no longer needed to take
> Sinemet.  However, in the US, use of human cells has been controversial.
> Further, the need for an infinite supply of brain cells for transplantation
> cannot at this time be met.
>      Presently, controlled trials of the use of pig fetal cells have shown
> that porcine cells are, at best, as good as human cells for this purpose.
>
>      Dr. Montgomery, in distinguishing Essential Tremor (ET) from
> Parkinson's Disease, explained that ET tends to involve tremors of the head
> and is familial, unlike Parkinson's.  He noted that, though ET is more
> common than  Parkinson's, research  in development of new treatments for ET
> has lagged, because no animal model is  available; scientists have been
> unable to produce ET in animals. Dr. Montgomery remarked that, though a
> number of medications have been used to treat ET, none has been effective
> for more than a small percentage of patients, and side effects preclude
> their use for many.  However, both Thalamotomy and DBS have proved to be
> useful surgical treatments for ET.
>      Another movement disorder, Multiple Sclerosis, also involves tremor in
> approximately 15-20% of  patients.  Dr. Montgomery, while noting that the
> prognosis for MS is much better now than previously, explained that surgical
> interventions are not as successful for MS, since physicians are reluctant
> to destroy the thalamus, and adjustments of DBS are necessary repeatedly for
> MS patients.
>      In general, Dr. Montgomery noted that the pace of developments in
> treatment of movement disorders is now so rapid that regulatory agencies
> can't keep up with it;  the FDA is years behind, in many instances.
>
> It was notable that each of the speakers was "upbeat" and optimistic about
> the future.
>
>      __________
>
>      Sid Roberts   68/3   <[log in to unmask] >     Youngstown, Ohio
>