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Transplantation of Embryonic Dopamine Neurons for Severe Parkinson's Disease Abstract Background. Transplantation of human embryonic dopamine neurons into the brains of patients with Parkinson's disease has proved beneficial in open clinical trials. However, whether this intervention would be more effective than sham surgery in a controlled trial is not known. Methods. We randomly assigned 40 patients who were 34 to 75 years of age and had severe Parkinson's disease (mean duration, 14 years) to receive a transplant of nerve cells or undergo sham surgery; all were to be followed in a double-blind manner for one year. In the transplant recipients, cultured mesencephalic tissue from four embryos was implanted into the putamen bilaterally. In the patients who underwent sham surgery, holes were drilled in the skull but the dura was not penetrated. *The primary outcome was a subjective global rating of the change in the severity of disease, scored on a scale of -3.0 to 3.0 at one year, with negative scores indicating a worsening of symptoms and positive scores an improvement. Results. The mean (±SD) scores on the global rating scale for improvement or deterioration at one year were 0.0±2.1 in the transplantation group and -0.4±1.7 in the sham-surgery group. Among younger patients (60 years old or younger), standardized tests of Parkinson's disease revealed significant improvement in the transplantation group as compared with the sham-surgery group when patients were tested in the morning before receiving medication (P=0.01 for scores on the Unified Parkinson's Disease Rating Scale; P=0.006 for the Schwab and England score). There was no significant improvement in older patients in the transplantation group. Fiber outgrowth from the transplanted neurons was detected in 17 of the 20 patients in the transplantation group, as indicated by an increase in 18F-fluorodopa uptake on positron-emission tomography or postmortem examination. After improvement in the first year, dystonia and dyskinesias recurred in 15 percent of the patients who received transplants, even after reduction or discontinuation of the dose of levodopa. Conclusions. Human embryonic dopamine-neuron transplants survive in patients with severe Parkinson's disease and result in some clinical benefit in younger but not in older patients. N Engl J Med 2001;344:710-9. Curt R. Freed, Paul E. Greene, Robert E. Breeze, Wei-Yann Tsai, William DuMouchel, Richard Kao, Sandra Dillon, Howard Winfield, Sharon Culver, John Q. Trojanowski, David Eidelberg, Stanley Fahn From the University of Colorado School of Medicine, Denver (C.R.F., R.E.B., S.C.); Columbia University College of Physicians and Surgeons, New York (P.E.G., W.-Y.T., R.K., S.D., H.W., S.F.); AT&T Shannon Laboratory, Florham Park, N.J. (W.D.); University of Pennsylvania Medical Center, Philadelphia (J.Q.T.); and North Shore University Hospital, Manhasset, N.Y. (D.E.). Address reprint requests to Dr. Freed at the Division of Clinical Pharmacology, C-237, University of Colorado School of Medicine, 4200 E. Ninth Ave., Denver, CO 80262, or at [log in to unmask] Copyright 2001 by the Massachusetts Medical Society. All rights reserved. http://www.nejm.org/content/2001/0344/0010/0710.asp janet paterson, an akinetic rigid subtype parkie 53 now / 44 dx cd / 43 onset cd / 41 dx pd / 37 onset pd TEL: 613 256 8340 SMAIL: PO Box 171 Almonte Ontario K0A 1A0 Canada EMAIL: [log in to unmask] URL: http://www.geocities.com/janet313/