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The "(see box)" comment in this post of the first half of the JHMI article refers to the info in my "JHMI PD #2" post. Source: Page 6 of the December 1995 issue of "Health After 50", by the John Hopkins Medical Institute of Baltimore, MD. Parkinson's Disease: When to Consider Surgery 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 (also called L-dopa), a medication with a chemical formula similar to dopamine (a chemical messenger produced in the brain). When L-dopa reaches the brain, it's converted into dopamine and used to control movement. But L-dopa therapy often causes nausea, and exentually 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 1960s, 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 certain 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 (see box). 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, choose 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 neurosurgeon 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.