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"Brain Cell Transplants Help Parkinson's Patients" and now we have...
Skull Surgery Fails for Parkinson's
By JANET McCONNAUGHEY, Associated Press Writer
March 7, 2001 An experimental treatment for Parkinson's in which holes
are drilled in the skull and cells from aborted fetuses are implanted in
the brain does not cure the disease, according to a controversial new
study.
The study had raised ethical questions because some participants, for
the sake of comparison, underwent sham surgery in which mere
indentations were drilled in their heads.
The implanted stem cells - cells that can develop into many types of
tissue - survived and grew into the right kind of brain cells. But they
did not help patients older than 60.
Younger patients - who make up about 40 percent of the 60,000 people
diagnosed each year in the United States - improved a bit, but only for
a year.
After that, the cells apparently did their job too well in some
patients, causing excess movements because they produced more of the
needed nerve transmitter dopamine than the body could use.
"There was tremendous hope that stem cell therapy could be a cure. This
study really points out the problems we have to solve before that can
happen,'' said neurologist Dr. J. William Langston, founder of the
Parkinson's Institute in Sunnyvale, Calif.
The study was conducted by doctors at Columbia University and the
University of Colorado and was published in Thursday's New England
Journal of Medicine.
Dr. Curt R. Freed, who led the study as director of the University Of
Colorado Neurotransplantation Center for Parkinson's Disease, has begun
work to see if he gets better results by dripping the cells into other
parts of the brain. Langston said the results indicate that stem cell
research for Parkinson's should go back to the animal laboratory.
Parkinson's disease whose sufferers include former Attorney General
Janet Reno and actor Michael J. Fox, is a progressive brain disease
marked by tremors, stiffness, slowness and loss of balance. The
symptoms grow as the brain loses cells that produce dopamine, a
transmitter that carries messages to the nerve cells controlling motion.
Medicine can reduce or eliminate some symptoms for a while by helping
the brain produce more dopamine. But after four to eight years, the
medicine itself causes tremors and other side effects, and eventually it
no longer helps. The patient cannot move, speak or swallow.
In the new study, 20 patients received the operation, in which four
holes are drilled in the skull. Twenty others underwent sham surgery, in
which the drill did not go all the way through. Fourteen of the 20 in
the sham-surgery group got real transplants later.
(Fox underwent a different type of surgery - a thalamotomy, a
decades-old operation that destroys overactive, tremor-causing nerve
cells by burning or freezing a pea-size spot in the brain.)
Some doctors said that because of the pain and the risk of
complications, it is unethical to perform sham operations, even
though patients knew ahead of time they had only a 50-50 chance of
getting a transplant.
Others said sham surgery is the only way to get a valid comparison and
account for the so-called placebo effect, in which patients feel better
simply because they are being treated, even if the treatment is a dummy
medicine, such as a flour pill or a water injection.
None of the patients in the Parkinson's suffered any ill effects from
the sham surgery.
Langston said the study showed that the procedure itself is safe and
that the grafts survive.
"It was a pioneering study and one that I think was desperately needed
in the field,'' he said. ``It was the first really controlled trial of
this type of surgery.''
On the Net:
University of Colorado School of Medicine: http://www.uchsc.edu/
Parkinson's Institute: http://www.parkinsonsinstitute.org/
New England Journal of Medicine: http://www.nejm.org
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Copyright © 2001 The Associated Press.
--
Judith Richards, London, Ontario, Canada
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