Authors
Defer GL. Geny C. Ricolfi F. Fenelon G. Monfort JC. Remy P.
Villafane G. Jeny R. Samson Y. Keravel Y. Gaston A. Degos JD.
Peschanski M. Cesaro P. Nguyen JP.
Title
Long-term outcome of unilaterally transplanted parkinsonian patients. I.
Clinical approach.
Source
Brain. 119 ( Pt 1):41-50, 1996 Feb.
Abstract
Five patients with Parkinson's disease, unilaterally transplanted with
foetal mesencephalic cells into putamen (n=1) or putamen and caudate
(n=4), were followed throughout a period of 15-36 months after surgery,
according to the recommendations of the core assessment programme for
intracerebral transplantations (CAPIT). All these patients exhibited an
increase in the fluorodopa uptake in the grafted putamen, which was most
significant in the first and last patient of the series. Long-term
bilateral improvement of skilled hand movements was observed, starting
between the third and sixth month after grafting, and confirmed by the
statistical analysis of CAPIT timed tests. A mild to moderate effect on
the amount of 'off' time and 'on-off' fluctuations was observed, whereas,
apart from one case, no other clear effect on gait, walking and speech was
found. One patient included in the study, already suffering slight
cognitive impairment, clearly exhibited progression of a dementia process
after surgery. Daily living activities were clearly improved in only one
of the other four patients. At the end of the study period, all patients
needed L-dopa therapy at a similar or higher dose than before grafting,
but, in most of them, other dopaminergic drugs were reduced or stopped.
All patients exhibited bilateral dyskinesias before grafting that were
greatly decreased in intensity a few months after surgery. Delayed
asymmetrical dyskinesias, occurring on the side displaying the better
motor improvement, i.e. contralateral to the graft, were observed in three
patients. These results suggest that neural transplants may influence two
central mechanisms involved in motor function and the onset of
dyskinesias. These effects are likely to occur through complex
interactions with the post-synaptic dopaminergic receptors. The occurrence
of dyskinesias might simply reflect increased presynaptic storage and
release of dopamine. Alternatively, it might, in part, represent some
other long-term deleterious effect of the graft. Since PET-scan data
indicate that the reinnervation obtained is sub-optimal, it will be of
interest to obtain a larger and denser reinnervation of the host striatum
and to try, thereafter, to reduce the dose of L-dopa.
[log in to unmask] That man may last, but never lives,
Who much receives, but nothing gives;
HomeBoy #Parkinsons Whom none can love, whom none can thank,--
Creation's blot, creation's blank.
John Cottingham Thomas Gibbons (1720-1785): When Jesus dwelt.
