Small correction:
Pallidotomy was used 30-40 years ago as th only treatmentfor PD.  Then
sinemet was developed and pallidotomy fell out of use  until it was refined
and used where sinemet etc failed.
Bob Anibal
----- Original Message -----
From: William Harshaw <[log in to unmask]>
To: <[log in to unmask]>
Sent: Saturday, October 09, 1999 1:23 AM
Subject: Re: NEWS: New Surgical Approaches to Parkinson Disease | JAMA |
Vancouver Conference Report


> 1. Pause for a moment and consider how quickly therapies have advanced in
> the past decade.  Pallidotomy had not eve been rediscovered ten years ago.
> DBS was a gleam in Alain Benabid's eye.  I was the first North American
> patient to have DBS on 12.14.94, not even five years ago.
>
> 2. My speculation is, and I would be interested in Charlie, Chris and
Bob's
> reaction,  that DBS works in two separate and distinct ways:
>   i) the actual insertion of the electrode in the GPI/STN moves the brain
> cells sufficiently to cause the circuitry to be altered; and
>   ii) chronic stimulation is 'the icing on the cake' and multiplies
> synergistically the effect of the electrode
> 3. This is why the placement of the electrode must be made with such
> precision and why some patients have less successful results than others
> 4. This is all highly speculative because we only know that DBS works; we
> know neither how nor why it works
> 5. PWPs who have neurosurgery must recognize the point in 4 above and the
> fact that we do not know what the long term risks are
>
> Bill
>
> -----Original Message-----
> From: Chris van der Linden <[log in to unmask]>
> To: [log in to unmask] <[log in to unmask]>
> Date: Friday, October 08, 1999 4:34 PM
> Subject: Re: NEWS: New Surgical Approaches to Parkinson Disease | JAMA |
> Vancouver Conference Report
>
>
> >>
> >> Comparing the results of surgery on two of the three target areas,
> Benabid
> >has found that the main effect of GPI stimulation is to reduce and
control
> >levodopa-induced dyskinesias.
> >>
> >> However, it reduces other PD symptoms only moderately: "In general, STN
> >stimulation improves all the signs and symptoms by more than 60%, while
GPI
> >stimulation improves [them] by less than 60%," Benabid said.
> >
> >As I have stated all along on my recent postings.
> >
> >> "There is a whole new group of adverse effects that are related to the
> >equipment," he said, "including lead breaks, infections, and ulcerations
of
> >the skin. And there is the need to replace the battery, which must be
done
> >under general anesthesia."
> >
> >Replacement of a battery can be done with LOCAL anesthesia.  Out of 90
> >patients I have never seen a lead break.  Three infections of the lead
were
> >seen.  Two ulcerations of the skin.  So very minor complications.
> >
> >
> >> The main alternative to deep brain stimulation is pallidotomy, said
> >Lozano. This procedure has similar efficacy, he said, but involves
creating
> >an irreversible lesion in the brain and is too "risky" to do bilaterally.
> >
> >May be similar efficacy but not long-lasting for several symptoms.
> >
> >Greetings,
> >
> >Chris
> >
>