So many have been asking what future limits might be placed on those having
surgery now. Will there be therapies that may not be available because of
prior history of surgery?
There are current limitations if you have surgery:
(1) Protocols for testing of new medications currently have statements
excluding anyone having had a PD type surgery. This just precludes those
with surgery from participating in these drug studies.
(2) Protocols for testing of new surgical procedures are similar to
medicines, in that they exclude those who have had PD surgery in the past.
The good news is that those who have had surgery in the past have not been
precluded from any drug or surgery currently available. Examples:
Don Berns prior: adrenal transplantation
currently: bilateral pallidotomy
Ken Wilson prior: fetal tissue transplantation
currently: thalamotomy/pallidotomy
The three surgeries: pallidotomy, thalamotomy and fetal tissue
transplantation function in a different areas of the brain: (1) pallidotomy -
globus pallidus interior, (2) thalamotomy - thalamus, (3) fetal tissue
transplantation - putamen. Most of the surgical research is aiming at
replacing the fetal tissue transplantation: the pig tissue, GDNF, genetic
engineering. If any surgery may preclude future surgical therapy, I would
guess it is most likely the fetal tissue transplantation.
Currently there are no medications approved by the FDA that are restricted
due to some form of prior PD therapy.
There was one restriction at one time on those receiving a fetal tissue
transplantation. If they would ever want to redo a fetal tissue
transplantation they must have taken immunosuppressants on prior fetal tissue
transplantation. Now that immunosuppressants are not always used for fetal
tissue transplantation the restriction may have been lifted.
The above is just my observation. I had to evaluate this question three
years ago when I had a pallidotomy. At that time some doctors told their
patients they would not continue to be their doctor if the patient chose a
pallidotomy. Other doctors said that the pallidotomy would preclude any
further surgery ever. Time changes all. My feeling is you do what you have
to do. The decision to have surgery is difficult. The only real information
we have is our daily quality of life. When asked if I would make the same
decision given the same conditions. The answer is YES.
Regards,
Alan Bonander
