Ed Huschka & Ed Partridge
Thank you for pointing out my typo a couple of days ago in
my introduction. The correct date should be Dec. 2 1993. Ed
Partridge, it would be fine with me to have you post my message
on other bulletin boards.
Andrew Shubin & Meredith Chaney
I did have my Pallidotomy at Loma Linda by Dr. Iacono. You
may contact them at 909-796-4822. The operation is covered by
Medicare and costs about $20,000 for a unilateral and $27,500 for
a bilateral. The operation is considered therapeutic and is not
experimental.
Currently Dr. Iacono is the only surgeon doing bilateral
Pallidotomies on a regular basis.
If you send me your Mom and Dad's address I will be glad to
send them a brochure on the Loma Linda program.
Bob Newbrough
Here is a little background information on the Pallidotomy.
Years ago observant doctors noted that Parkinson patients who had
a stroke in a particular area of the brain experienced some
relief from their symptoms.
With the serendipitous discovery and identification of MPTP
(Dr Langston, San Jose, CA early 1980's) as a parkinsonian
inducing chemical, research scientists had the means for creating
a parkinsonian animal model.
Through pursuant studies researchers noted that one of the
critical abnormalities in animal models of Parkinson's disease is
an increased amount of electrical activity in the globus pallidus
of the brain. By cutting the pallidofugal fibers as they travel
from the globus pallidus to the thalamus the abnormal signal
causing the signs and symptoms of Parkinson's disease is short-
circuited.
To understand how a pallidotomy works think of the brain as
containing a series of interconnected electrical circuits. In
the parkinsonian one of these circuits is overly active because
there is not enough of the neurotransmitter dopamine to regulate
the electrical activity. A lesion (small hole)is created on the
electrical pathway between the globus pallidus and the
subthalamic nucleus. Thus, using this metaphor, the overly
active circuit is cut.
Through a procedure technically known as a Postero-Ventral
Pallidotomy, a probe will be inserted into a very precise
location of the globus pallidus approximately four inches beneath
the top of the head. The patient remains conscious under a local
anesthetic. When the probe is in the correct position,
immediately adjacent to the optic nerve a small electrical charge
will be transmitted to the tip of the probe.
If the probe is too deep the patient will experience his/her
very own fireworks display and the probe will be slightly
withdrawn. When it is properly located there will be a slight
twitch in the cheek or tongue. At that moment heat will be
generated to the probe tip and a small lesion will be created.
A simplistic explanation is this procedure creates lesions
of pallidofugal fibers leaving the globus pallidus on the way to
the thalamus. Rough Translation - An overly active neuronal
pathway which results in abnormal and extra-kinetic movements, is
severed. Although the Pallidotomy is not a cure it can eliminate
many of the manifestations. The results are instantaneous and
appear to be long lasting.
History
Similar surgical procedures have been available since the
early 1940's, however refinement in surgical technique, increased
knowledge, the development of a parkinson induced animal model,
and monumental advances in technology (CAT scans and MRI's), now
enable very precise identification and hitting of the target in
the globus pallidus.
Dr Robert Iacono (Loma Linda University Medical Center)
states, "The beneficial effects of Postero-Ventral Pallidotomy on
akinesia, postural instability, stooped posture, freezing, on-off
phenomenon as well as tremor, rigidity, dystonia and dyskinesia
are superior to the results reported for fetal graft
implantation, best pharmacologic results, or conventional
stereotactic procedures."
Don Berns <[log in to unmask]>
