Study says surgery helps Parkinson's patients
TORONTO (Nov 25, 1995 - 03:45 EST) -- Some patients with
Parkinson's disease are showing significant improvement after
undergoing a surgical procedure abandoned 30 years ago. It
involves drilling a hole through the skull to destroy abnormal
neurons in the brain.
The procedure, known as a pallidotomy, has been performed on
80 patients at the Toronto Hospital in the past three years.
A study of the first 14 patients show the virtual elimination
of involuntary body movements such as flailing and jerking that
are side effects of medication to treat the illness.
Certain symptoms of Parkinson's, such as muscle stiffness and
slowness of movement, showed a 40 percent improvement after the
surgery. Balance was also shown to improve. The results of the
Toronto study will be published in the British medical journal
Lancet.
Parkinson's is a progressive disease, but some patients have
said after the surgery that "it's like a clock turned back
five years," said Dr. Andres Lozano, a neurosurgeon and
principal investigator of the study.
"Some of my patients are playing pool, curling or going
dancing for the first time in years," he said, referring to
the increased independence of patients who are able to do more
for themselves.
"We don't know how long the improvements will last."
Dr. Anthony Lang, professor of neurology at the University
of Toronto and director of the Movement Disorders Centre at
the Toronto Hospital, said the surgery is not a replacement for
medication.
William Berman, 43, was diagnosed with Parkinson's about 12
years ago. He is going sailing with friends, something he said
he could not have dreamed of until his pallidotomy last July.
At certain times before the surgery, he was "stuck in a chair
(and) could hardly move."
He says, "There's no particular part of my life that hasn't
been touched" by the improvement from the surgery.
Pallidotomies were abandoned as drug treatment for Parkinson's
came into use. But the surgery has been revived for several
reasons, including side effects associated with prolonged use
of the medication and advances in neurosurgery that pinpoint,
with a high degree of precision, target areas in the brain of
a Parkinson's patient.
Patients must be awake and fully alert during the procedure
(their scalp is frozen) to help identify areas of the brain
that control vision and movement, since injury to these areas
during surgery could cause blindness or paralysis.
These areas happen to be very close to the globus pallidus,
the part of the brain with overactive cells in people with
Parkinson's. These cells are destroyed by an electrical current
that heats up the tip of a tiny electrode. The surgery requires
four to five hours. With the patient awake on the operating
table, the effect can be known immediately.
As the cells are destroyed, Dr. Lazano said, "movements start
to become more fluid and rigidity is melted away."
Those who benefit most from the surgery are usually the
younger patients, those who respond well to medication, have
their full cognitive functions and have greater symptoms on
one side of the body.
Toronto Globe and Mail
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