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From: Brian Collins [log in to unmask] To: [log in to unmask] Subject: Pallidotomy and future drug therapy I think this subject was first mentioned by Claude Dungan on June 2, and although there have been several responses, I feel that it might be worth some further debate. The main question that was being asked (or should I say the point which sparked my interest) was: If I have a Pallidotomy, will I then be unable to benefit from as-yet undefined drug/implant/whatever therapy which may come along? Of course, when the question is put in that way, there are very few people who would give a definitive answer, but we could perhaps speculate a little: 1) As I understand it, PD tremor occurs because in the complex motor control and feed-back nervous system, the *go* signal is weakened by the loss of dopamine-producing cells in the Substantia Nigra, whereas the feedback system is still broadcasting at full volume, resulting in the *go* signal being swamped. The Pallidotomy operation partially weakens the return signals so that they provide a better match to the *go* signal, thus reducing the tremor. 2) The question that then strikes me is: What happens if the application of say a new growth factor, or fetal cell transplant restores the *go* signal to full volume - do we get the tremor back because of the miss-match with the previously-weakened feedback system? Well maybe, but I would think that if the Substantia nigra can be replaced and persuaded to integrate with the signalling system, then the weakened pallidus or thalamus area could probably be strenghthened or rejuvenated to match. 3)My personal feelings on Pallidotomy are instinctively negative, but it may be that is because I am coping well enough at the moment. We must all make our own decision based on our personal Quality of Life, and if my speculations are at all accurate then the worry about jeopardising future treatments should come fairly well down the list, and I have to admit that at least Pallidotomy is here and now, whereas the other treatments are still pie in the sky. 4) The messages that I have seen so far from people who have had the operation have been generally positive, but the number of responses can hardly be called a valid statistical sample. What is clear to me is that the Pallidotomy operation is not a magic cure-all, but rather another treatment to be integrated with the many other procedures which we have come to terms with in the long course of the disease. 5)Well, I must have made at least three or four contentious statements in there. Does anyone want to shoot me down? (In our usual friendly way, of course) Regards, Brian Collins.