Bill: It did not have that effect. I think you are a
gifted writer writing about a powerful subject. So
powerful, I was blown-away. Scarey stuff, this
cognitive impairment. But stuff that I feel needs to
come out of the closet. I hope you keep writing.
Carole

--- William Harshaw <[log in to unmask]> wrote:
> Poetic licence.  No intent to injure or hurt. Sorry
> if it had that effect.
>
> Bill
> -----Original Message-----
> From: Carole Hercun <[log in to unmask]>
> To: [log in to unmask]
> <[log in to unmask]>
> Date: Tuesday, August 17, 1999 6:46 AM
> Subject: Re: Reflections ...
>
>
> >"The brain...spoils and rusts". Certainly a
> striking
> >image, but a dark one. Its rather like being hit
> with
> >a truck when you read it as early in the AM as I
> am. I
> >think I was actually struck speechless for a
> moment,
> >especially after all the posts yesterday re:
> cognitive
> >impairment vs. dementia. Poetic license or do you
> feel
> >that damaged by the disease?    Carole H.
> >
> >
> >--- William Harshaw <[log in to unmask]> wrote:
> >>     Reflections on Therapy
> >> for
> >> Parkinson's Disease:
> >> Medication and Neurosurgery
> >> by
> >> Bill Harshaw
> >>
> >> Parkinson's Disease is associated with free
> radicals
> >> which in turn are
> >> associated with the deposition of iron.  The
> human
> >> brain is encased in fat.
> >> For a person with Parkinson's, the brain, which
> is
> >> the source of the highest
> >> creativity and reasoning, spoils and rusts
> >>
> >>  The two procedures I had - the pallidotomy in
> 1993
> >> and deep brain
> >> stimulation the following year - are much in the
> >> news as Parkinson's
> >> patients search out possible ways to mitigate
> their
> >> symptoms and improve the
> >> quality of their lives.  Media accounts of these
> >> procedures focus on the
> >> successes, sometimes spectacular, and give less
> >> coverage to the patients
> >> whose lives have not increased in quality.
> >>
> >>  Neurosurgery as a therapy for Parkinson's
> disease
> >> continues to be both
> >> experimental and controversial. Pallidotomy,
> >> thalamotomy, deep brain
> >> stimulation and foetal transplants haven't yet
> >> reached the status of bypass
> >> surgery for cardiac patients - the gold standard.
> >> But it is useful to
> >> remember that they are all based on what the
> noted
> >> American physician Lewis
> >> Thomas calls ‘halfway technologies'.He does not
> use
> >> this term derisively,
> >> but to point out that they do not represent a
> cure,
> >> only better symptom
> >> management.
> >>
> >>  Foetal transplant surgery is to the doctors an
> >> extension of the current
> >> ‘gold standard' of treatment, ‘dopamine
> replacement
> >> therapy', as represented
> >> by the L-dopa based medications.   However, it
> has a
> >> number of ethical and
> >> moral hurdles to clear before  becoming
> acceptable
> >> to society generally.
> >> The other procedures fall into the general
> category
> >> of what surgeons do
> >> best: "if its broke, fix it" (with apologies to
> Bert
> >> Lance).
> >>
> >>  To put neurosurgery in the context of the
> universe
> >> of treatment for
> >> Parkinson's it is important to remember that
> >> pallidotomy and thalamotomy
> >> have been around for fifty years.  They were the
> >> therapy of choice for
> >> advanced PWPs.untl the mid 1960s when L-dopa was
> >> discovered to be
> >> efficacious.  As L-dopa gained acceptance, its
> >> superiority to all other drug
> >> therapies became apparent.  Neurosurgery went
> into
> >> eclipse, not to have a
> >> renaissance for a quarter century, a period which
> >> saw the development of two
> >> generations of a new type of drug - dopamine
> >> agonists - which increase and
> >> prolong the effectiveness of L-dopa.
> >>  A quarter century's use of L-dopa as the
> medication
> >> of choice demonstrated
> >> its superiority in symptom management; it also
> >> revealed the drug's
> >> shortcomings - dyskinesia and psychiatric
> >> side-effects in advanced patients
> >> who were on high doses being among the more
> >> significant.. In the early
> >> 1990s, technological advances, the
> miniaturization
> >> of surgical instruments,
> >> a more nuanced and comprehensive understanding of
> >> neuroanatomy, a new era in
> >> neuroimaging and the need to provide some sort of
> >> relief to advanced
> >> patients led  to a renewal of interest in
> >> neurosurgery - the old operations
> >> being done more successfully and with greater
> >> precision and the invention of
> >> DBS by Alim Benabid and his colleagues in
> Grenoble
> >> France.  Almost
> >> paralleling the surgical innovation was the
> >> development of a third
> >> generation of agonists which, if they live up to
> >> their press releases, will
> >> provide a meaningful advance on current drug
> >> therapy.  The procedures and
> >> the drugs are at the limit of human knowledge.
> >>
> >>   Foetal transplantation is considered
> separately.
> >> As a class of surgery,
> >> it belongs with organ transplants - heart, lungs,
> >> kidney ... the list goes
> >> on.  It first showed its face in the late 1970s
> and
> >> has been developing
> >> quickly since then.  At times the pace of
> progress
> >> seems slow to patients,
> >> but the rate of change of progress has been
> nothing
> >> short of exponential.
> >> Results of a recent double blind study are every
> bit
> >> as good as were
> >> expected and parallel the results of other the
> types
> >> of surgery   .
> >>
> >>  Comparing the state of therapy for Parkinson's
> >> today to what it was a mere
> >> quarter-century ago, the progress is staggering.
> >> Before L-dopa, the
> >> medications available were a variety of drugs
> which
> >> were serendipitously
> >> found to be beneficial as therapy.  They were
> really
> >> pretty primitive. Now,
> >> there is L-dopa, three generations of agonists,
> >> neurosurgery and a whole new
> >> array of research projects, any one of  which has
> >> the potential to advance
> >> treatment markedly.
> >>
> >>  It should be noted that every therapy has its
> >> drawbacks, called side
> >> effects, which range from the trivial to the
> >> serious.  Some of these side
> >> effects are major enough to prevent certain
> patients
> >> from using some
> >> therapies.  Indeed, there is a website on the
> >> internet devoted to patient
> >> accounts.
> >>
> >>  The implications of these advances on a broad
> field
> >> of new and newly
> >> adapted drug and surgical therapies is that
> >> physicians will have several
>
=== message truncated ===


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