PARKINSON'S DISEASE:WHEN TO CONSIDER SURGERY is a brief one-page
article in the most recent issue (vol. 7, # 10, December 1995) of
the Johns Hopkins Medical Letter HEALTH AFTER 50. Quoting -
hopefully without too many typos - the article in rather
simplistic observations states:
"Surgery for Parkinson's disease is a favorite media topic that
periodically raises hope for the one out of every 100 Americans
over age 60 who live with the tremor, muscle stiffness, slow
movement, and impaired balance caused by this common neurological
disorder.
Drug therapy can usually provide relief for 10 to 15 years. Its
linchpin is levodopa (usually called L-dopa), a medication with a
chemical formula similar to dopamine (a chemicalmessinger
produced in the brain). When L-dopa reaches the brain, it is
converted into dopamine and used to control movement. But
L-dopa therapy often causes nausea, and eventually leads to
involuntary arm and leg movements (dyskinesia) and to frequent
and dramatic fluctuations in symptoms. These side effects can be
limited by taking L-dopa with other drugs, such as carbidopa
(sold together with levodopa as Sinemet). Other important
treatment measures include exercise to help maintain strength and
dexterity, and sometimes dietary changes because certain
amino acids found in proteins can hinder the absorption of
L-dopa.
SURGICAL OPTIONS
Surgery, once a mainstay of treatment, was abandoned in the
1960's, when L-dopa therapy was introduced. However, improved
techniques, as well as the,limitations of drug treatment, have
prompted a return to the operating theater. Of the three
procedures available, the two most established - thalamotomy and
pallidotomy - require the destruction of ceratin brain cells
that interfere with normal movement. These cells can be
identified by using electricity to stimulate various areas of the
brain ( a procedure called brain mapping). The technique is also
used to identify cells that control sight and other senses,
so that they won't be inadvertently destroyed during surgery.
Candidates must be relatively young (usually under age 65 or 70),
in otherwise good health, and have the specific symptoms a
particular technique is designed to address [article is
accompanied by a box describing the surgical options thalamotomy,
pallidotomy, and fetal tissue implantation, which begins by
asserting 'Surgery can be a reasonable choice - but only if you
have the specific symptoms for which a procedure was developed,
and only when medication produces intolerable side effects or can
no longer provide adequate control of symptoms.'].
When appropriate,
surgery often relieves symptoms and decreases the need for
medication, but it's not a cure - nor does it stop progression.
If you're considering surgery, chooose an institution that has
been involved in research and specializes in the procedure you
want. It should provide you with a neurologist who specializes
in Parkinson's, and a neuro-surgeon experienced in the procedure.
Four of the most-active centers are: The University of Colorado
at Denver (303-270-6927); New York's Columbia University
(212-305-5779); Johns Hopkins (410-955-8795); and Emory
University in Atlanta (404-727-4085). Colorado and Columbia are
recruiting patients for a fetal tissue transplantation study
funded by the National Institutes of Health. Johns Hopkins and
Emory are known for their work in thalamotomy and pallidotomy.
Other prominent centers include New York University Medical
Center, Baylor College of Medicine in Houston, The Mayo Clinic in
Rochester, MN, and Loma Linda University Medical Center in Loma
Linda, CA."
Sid, pd 4yrs, dx 2, 66
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| Sid Roberts [log in to unmask] |
| Youngstown State History Department |
| University Youngstown, OH 44555 |
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