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Please accept my apologies for sending illegible attachments yesterday. I am still looking through old floppies and will send appropriate stuff like this rather than via attachments. The first three pages (of six) of the article follow: Hope From a Knife - - Surgery for Parkinson's Brings Success Stories In Face of Skepticism - - Patients Tell of Great Relief Operation to Cut A Spot Deep in the Brain - - Rediscovering an Old Idea - - By DAVID STIPP Staff Reporter of THE WALL STREET JOURNAL - - Edward Weinberger has had Parkinson's disease for 13 years. His symptoms grew steadily more frequent and agonizing: painful periods of near paralysis and, at times, uncontrollable tremors. He tried drug after drug, with dwindling benefits. By last year, "I couldn't go out for more than a half hour without freezing up," says the 52-year-old New York investment banker. "I couldn't get out of bed by myself or turn over. I hadn't driven a car for 10 years. Sometimes I couldn't talk, and choked" on food. Then he saw an electrifying report by a Swedish neurosurgeon named Lauri Laitinen, who had threaded a probe deep into the brains of 38 Parkinson's patients and burned out a sliver of hyperactive neurons in an area called the pallidum. Some 92% had "complete or almost complete relief of rigidity" after this "pallidotomy" operation, while 81% had "excellent or good long-lasting tremor relief," said the 1992 report in the Journal of Neurosurgery. "A good test of the procedure," Dr. Laitinen wrote separately, "is to have the patient dance after surgery." ----- ----- A Changed Man ----- ----- Last fall, Mr. Weinberger flew to Stockholm for a pallidotomy by Dr. Laitinen. While in surgery - done under local anesthetic - "I went from a state of total rigidity to feeling all of a sudden released," Mr. Weinberger says. "Two days after I was walking through the streets of Stockholm as a tourist. I could drive. I could go out for a drink and read at night. It was so miraculous, I didn't quite believe it." With little notice, hundreds of Parkinson 's patients have grasped at this surgical straw over the past two years - most, it appears, with startlingly good results. The procedure isn't a cure. It sometimes doesn't help, and when it does, symptoms are usually lessened rather than eradicated. It poses a risk of bleeding in the brain, which can paralyze or kill. But some doctors say pallidotomy is the most promising Parkinson's treatment since the 1960s advent of L-dopa, the drug that inspired the book and subsequent movie "Awakenings." "I was very, very skeptical when I first heard Laitinen's claims," says Patrick Kelly, a New York University neurosurgeon. "Even when I saw the results the first couple of times, I thought it was a fluke. But I've become a believer." Dr. Kelly has now performed about 30 pallidotomies himself. ----- ----- Waiting List ----- ----- Another neurosurgeon, Robert Iacono of Loma Linda University in California, has done almost 500 of the operations since hearing Dr. Laitinen's results: It's a real revolution," he contends. "I've seen dozens of wheelchair-bound patients become almost completely functional." Demand is exploding for the operation as stories about its benefits filter out through patients support groups. Some of the 20 or so U.S. medical centers that offer the surgery have year-long waiting lists. Dozens of Americans have flown to Sweden for it, although Dr. Laitinen also has a backlog. Parkinson's disease afflicts roughly a million Americans. Some doctors say perhaps 100,000 of them currently would be good candidates for the surgery, generally the ones whose drugs are failing them but who don't yet have major brain damage from the disease. Many more patients, perhaps most people who get Parkinson's, may need the surgery as they lose benefit from drugs, proponents add. L-dopa generally becomes less effective over time and often itself causes uncontrollable limb spasms, facial tics and other problems. "All (patients) fail eventually" to respond well to L-dopa, Dr. Kelly says. "Many of them could become candidates for pallidotomy." ----- ----- Plenty of Doubters ----- ----- Such thinking has ignited a momentous debate: On one side are neurosurgeons and hopeful patients who are convinced the surgery can help many; on the other side are doctors and health-maintenance organizations saying it is a hyped, experimental treatment that doesn't warrant insurance coverage. (Many non-HMO insurers, including major Medicare contractors, do cover the $20,000-to-$40,000 operation.) Some people with Parkinson's say they quit their primary doctors in a huff after the surgery, adding that the physicians opposed it and sometimes later refused to acknowledge its benefits. "My neurologist was totally against it," says Lenore Rabjohns, a San Diego resident whose former HMO doesn't pay for the surgery. Paying out of pocket, she had Dr. Laitinen do the procedure on both sides of her brain - each side has a pallidum giving "immense relief from Parkinson s symptoms," she says. "When I went back to my neurologist, he said it was just a placebo effect." Neurologists, the main specialists for Parkinson's, tend to be the most skeptical. Their main tools are drugs, and they often regard surgeons as willing to cut first and ask questions later. "There's benefit to be derived from pallidotomy for very carefully selected patients," says Robert Feldman, a neurologist at Boston University. But I wouldn't refer patients to Iacono. I don't think he's thinking critically. He's thinking surgically. Please Turn to Page A8, Column 1 - - Hope From a Knife: Parkinson's Patients Claim Relief After Operation to Cut a Spot Deep in the Brain - - Continued From First Page - - Dr. Iacono, the operation's leading U.S. proponent, has become a lightning rod for skeptics. Some of his patients recently posted "testimonials" about benefits of the surgery on the Internet that "almost sound like snake oil," says Robert Fink, a neurosurgeon in Berkeley, Calif., who doesn't do pallidotomies. Replies Dr. Iacono: The benefits of the surgery "are very dramatic, and neurologists just can't stand it. Their mildly positive statements about it are a form of apathy that's malignant. There are some good reasons for caution, though. What causes Parkinson's disease, first identified in 1817, remains a mystery, as does the precise mechanism of relief afforded by pallidotomies. The progressive disease often causes a confusing array of symptoms that can dramatically worsen or improve several times a day - providing fertile ground for oversold remedies and outright quackery. The average age of onset is 57, but some 30% of cases are diagnosed before age 50. Parkinson's typically starts with weakness in a limb or a slight hand. tremor, then worsens over five, 10 or 20 years, potentially ending in paralysis, dementia and early death. Parkinson's sufferers often have impassive faces, speak in soft monotones and walk with small, shuffling steps, hunched forward. They suffer insomnia, excruciating pain from rigid muscles, depression, nightmares and hallucinations from Parkinson's drugs, one of which is chemically similar to LSD. The disease inflicts both the inability to move and uncontrollable movement, from slight tremors to wild flopping that can dislocate joints. ----- ----- Other Initiatives