October 8, 1997
BOSTON (CNN) -- An operation that burns a tiny hole deep in the brain has
proven successful at relieving some of the symptoms of Parkinson's disease
for at least two years.
The surgery, known as pallidotomy, destroys part of the brain responsible
for involuntary movements, according to the study, published in Thursday's
edition of the New England Journal of Medicine.
The surgery is radical, almost unthinkable. While the patient is awake,
surgeons use electrical current to destroy overactive brain cells that cause
the erratic body movements characteristics of Parkinson's.
Doctors used the treatment briefly in the 1950s, but it fell out of favor
when the medicine l-dopa seemed to do a better job at relieving the
symptoms. But l-dopa has turned out to have serious long-term side effects.
To keep l-dopa working as long as possible with minimal side effects,
doctors often take patients off the drug for a while.
The surgery relieves some of the symptoms of the disease itself, which can
include tremors and stiffness, as well as uncontrollable arm and leg
movements triggered by the medicines like l-dopa.
'Substantial improvement in motor skills'
The target of the surgery is one of a pair of grape-size structures deep in
the brain called the globus pallidus. This part of the brain helps control
movement and can be overactive in Parkinson's disease.
In the latest study, doctors treated 40 patients and followed them for up
to two years. It found that the patients showed significant improvement both
while taking medications and while off them.
Two years after the pallidotomy surgery, "we found a substantial
improvement in motor skills and activities of daily living," said Dr.
Anthony Lang of Toronto Hospital, the chief author of the study.
The surgery, combined with the on-off l-dopa treatments, allowed
"approximately half the patients who had been dependent on assistance in
activities of daily living ... before surgery became independent after
surgery," the researchers report.
'I felt like I woke up'
Four years ago Terrie Whitling was offered the opportunity to become one of
the first patients to undergo the improved pallidotomy technique. But there
were no guarantees.
"I would say over and over again to all my family and friends, 'I just want
my life back,'" she says.
She took the offer and says, "I felt the difference immediately. I felt it
on the operating table. What did it feel like? it felt like I woke up."
About half of the patients in the study who needed help taking care of
themselves before the surgery were able to live independently six months
after surgery. Two years later, they were still able to feed and dress
themselves.
But not all the effects were long-lasting. Stable walking faded after six
months, and jerky movements caused by l-dopa treatment returned after a year
or two.
Lang says the Parkinson's sufferers who would benefit most from the surgery
are those who have more symptoms on one side of the body.
"The disease is progressive," Whitling said, "so naturally I'm not quite as
good as I was immediately after surgery. But I'm still within 85 to 90
percent of that initial improvement."
'It gave me life again'
She still has to take medications, but because of the pallidotomy, they
work better.
"I would not be here today if I had not had the surgery," Whitling said.
"It's the best thing that ever could have happened to me. It gave me life
again."
Correspondent Rhonda Rowland and Reuters contributed to this report.
