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Tuesday, March 25, an update of a pallidal stimulation operation, performed in October 1996, was presented on several TV stations in the Minneapolis, MN area. Since I have not seen any coverage of this on the List, I have typed copies of two newspaper articles discussing that particular operation. These appear below: ***** Quoted from March 27 Mankato Free Press: " MINNEAPOLIS (AP) - Last fall, surgeons implanted an experimental device deep inside the brain of Bob Zgonc, hoping to ease the uncontrollable tremors and painful muscle cramps of his Parkinson's disease. So far it is working. The former state trooper had been totally disabled and unable to care for himself. Now he drives, hunts, fishes, shovels his sidewalk, goes for walks and takes his grandchildren sledding. He has his independence back. Zgonc, 59, of Chisholm [MN] is one of an estimated 1 million to 1.5 million Americans with Parkinson's. He got his implant in October at the University of Minnesota Hospital, but researchers waited until this week to anounce details because they wanted to make sure it was a success. It's pretty dramatic," said Walter Low, a neurosurgery professor. Surgeons implanted an electrode in the pallidum area deep in Zgonc's brain and a battery-powered stimulator near his collarbone. The device was developed and manufactured by Medtronic Inc. of Fridley. The device remains experimental and approval from the federal Food and Drug Administration for its widespread use is probably five or six years away. And insurance companies won't pay for the procedure until it's approved by the FDA. So Zgonc's neighbors on the Iron Range helped raise nearly $20,000 for his treatment. About 3,000 people attended a spaghetti dinner. His former colleagues in the State Patrol added substantial contributions. Zgonc's was Minnesota's first pallidal stimulation operation and, as far as university neurosurgeons know, only the third in the country. The others were at the University of Kansas. Researchers are trying stimulators in the pallidum because they have had success in treating Parkinson's by surgically destroying some tissue in that part of the brain. That led them to believe the area is the source of the brain's malfunction in Parkinson's patients. The advantage of the stimulator over surgery is that surgery is irreversible. It destroys the brain cells, making whatever happens - including unfavorable results - irreversible." ***** The following article is quoted from the March 26 Minneapolis Star Tribune: "Device to block Parkinson's tremors is successful, experimental and pricey. Community fund drive helps patient receive implant. By Gordon Slovut Star Tribune Staff Writer "When his neighbors in Chisholm, Minn., learned last year that Bob Zgonc needed nearly $20,000 for an experimental brain operation to treat his Parkinson's disease, they raised the money. More that 3,000 attended a spaghetti dinner fund-raiser. An appeal in the Chisholm Free-Press brought contributions from Chisholm High School graduates and others across the country. Former fellow officers in the State Patrol added substantial contributions. Zgonc, 59, one of 1.5 million Americans with Parkinson's disease, got the operation in October. So far, it's working. The uncontrollable and disabling spasms, typical of the disease, have disappeared since surgeons implanted an electrode in the pallidum area deep in his brain and a battery-powered stimulator near his collarbone. The device was developed and manufactured by Medtronic Inc. of Fridley. Others won't be so lucky. If they don't have the $16,000 to 18,000 needed to pay hospital costs - or a community to raise it for them - the experimental procedure will be out of reach. Insurance companies won't pay for the procedure unless it is approved by the Food and Drug Administration (FDA), said Dr. Robert Maxwell, chief of neurosurgery at the University fo Minnesota. Approval is probably five or six years away. The lengthy approval process is standard for the FDA. It must be certain that a new medical device and procedure is safe and effective for wide-scale use. Zgonc was Minnesota's first pallidal simulation operation and, as far as university neurosurgeons know, and only the third in the country. The others were performed at the University of Kansas, one of two FDA approvbed sites for tests of the procedure. Earlier this month an FDA advisory committee recommended approval of the use of the Medtronic device to stimulate the thalamus, a part of the brain near the pallidum. FDA approval for use of the device in that part of the brain is expected shortly. Implanting the electrode in the thalamus appears to correct some of Parkinson's symptoms - tremors - by blocking or overriding signals that cause the tremors. In one study, the device halted tremors in about half of 120 European Parkinson's patients, and most of the rest improved. But it did nothing for the other symptoms of late Parkinson's, the writhing and other debilitating symptoms that occur in some patients about six years after they begin treatment with the drug L-dopa. For that, the pallidum must be stimulated, but until researchers can prove that it works, the FDA won't approval it. Dr. Walter Low, professor of neurosurgery at the university and co-principal investigator with Maxwell, said that neurosurgeons should not do the pallidum procedure unless it is part of the FDA-approved research projects. There are too many unknowns, he said. Researchers are trying the stimulators in the pallidum because there has been broad success with surgically destroying some tissue in the pallidum, leading medical experts to believe that the area is the source of the brain's malfunction in Parkinson's patients. The advantage of the stimulation over surgery is that surgery is irreversible - including unfoavoralbe results - irreversible. But as soon as current to the electrode is turned off, the stimulator's effect on brain cells disappears, making the procedure completely reversible, Maxwell said. Maxwell said he hopes to do one procedure per month until enough evidence has been accumulated to persuade the FDA to approve the procedure. Medtronics will donate each of the $10,000 to $12,000 devices used for the trial. But Parkinson's patients must find a way to pay their own hospitalization costs, and that means that most people who have Parkinson's must wait. Zgonc, however, who had been tatally disabled and unable to care for himslef, is fine now. He hunts, fishes, shovels his sidewalk, and goes for walks. He has his independence back. When Maxwell implanted the eletrode in Zgonc's brain last October, he ran wires from the electrode to a pacemaker-like battery pack he implanted in the flesh just below Zgonc's collarbone. The pack sends out signals that block or override wayward brain signals that cause the spasms and tremors of Parkinson's. Although they knew it was a risky operation, Zgonc and wife did not hesitate when offered the chance to have the surgery after a Hibbing neurologist referred them to the university. Zgonc had been completely disabled by the disease and the side effects of L-dopa, the drug that had controlled his symptoms for several years. 'We grabbed for the brass ring,' said Zgonc's wife, Sharon. Zgonc, who passes a powerful magnet over the implanted device to switch it on in the morning and off at night, said a security device in a department store once turned the device off. The device set off a security device at one store, making it appear he was stealing something, he said. 'I almost got pinched [as a shoplifter], ' he said. He said he has no way of knowing whether it is on or off unless he holds a small radio near it. If the device is on, he hears static. If it is off, there is no static. His wife said the stimulator is so powerful it 'will ruin your credit cards, making them so they don't work.' When Zgonc placed a hotel's magnetized key card in his shirt pocket, the device 'wiped' out the code. Zgonc said he's not sure what security detectors used at airports will do to his device - or what his device might do to them - but he isn't going to fly, he said. Zgonc said other Parkinson's patients seem apprehensive about surgery. Several have told him that they are afraid to have it done. His wife said she and her husband never had a second thought after they heard about the procedure. Hospital personnel told them the device might work for just one year. 'I said that be just fine,' she said, because that would be a good year they wouldn't have had otherwise." ***** This may be something worth keeping an eye on!? :) Forrest