Jacob Drollinger wrote:
> But, was it actually the SUB-thalamic nucleus stimulator, or was it the pallidal stimulator or just the thalamic stimulator that was approved. If you don't already know, there is a big difference in the sub-thalamic nucleus and the other parts of the basal ganglia.
If someone could please clarify, it would be greatly appreciated.<
New procedure offers hope for Parkinson's victims
Copyright 1998 Nando.net/The Associated Press
WASHINGTON (June 5, 1998) -- Parkinson's disease was rapidly crippling
Karen Stephani: She had to use a wheelchair, and muscle spasms in her
neck left her head bobbing so wildly that "in a restaurant, food would
fall out of my mouth."
Exhausted and embarrassed, the once-active 55-year-old seldom left her
Minnesota home -- until, desperate, she tried an experimental brain
implant. Now Stephani is suddenly so healthy that she's stored away her
wheelchair and is dusting off her water skis.
"I was instantly better," said Stephani, four months after surgeons
drilled a hole in her skull and implanted a device that essentially
blocked the motor-control symptoms of Parkinson's disease. "It was the
most exhilarating experience to all of a sudden feel your
life isn't over; it's just beginning."
Doctors don't know just why a device that sends small, continual
electrical shocks to deep brain tissue would fight Parkinson's -- it
doesn't stop the brain-cell death that characterizes the devastating and
incurable disease.
But European doctors are reporting dramatic effects. And although this
new procedure has not yet won Food and Drug Administration approval,
Americans are beginning to clamor for it.
"I don't want to be gushy, but it's very exciting," said Mark Stacy,
director of the Muhammad Ali Parkinson's Research Center in Phoenix.
The implant already is sold for another brain operation. The FDA has
approved placing Medtronic Inc.'s Activa device inside the thalamus to
stop uncontrollable tremors, including some caused by Parkinson's.
But French surgeons discovered that putting the implant into deeper,
more delicate brain tissue worked far better: It could block the
rigidity, slow movement, impaired balance and even the uncontrollable
muscle jerks that imprison advanced Parkinson's patients inside
alternately frozen and robot-like bodies.
"The results were truly spectacular," said Alim-Louis Benabid of the
University of Grenoble, France, who developed the surgery and has
operated on about 250 people. "Cured would mean the disease is gone and
the disease is not gone, of course. But ... the suppression of symptoms
is so strong they look like they're almost cured."
Last month, Medtronic won European Union approval to implant its
pacemaker-like device into the subthalamic nucleus or the globus
pallidus, regions that control the worst Parkinson's symptoms.
Next month, Medtronic will meet with the FDA to discuss approving
Activa Parkinson's therapy here. Without FDA approval, insurance will
not pay for the operation -- even though doctors already can offer the
surgery since the same device is sold for FDA-approved tremor therapy.
That means patients like Stephani, who can pay for the
$25,000 to $35,000 surgery themselves, can try the procedure today.
Parkinson's drugs initially control the disease, but their
effectiveness quickly wanes. Since the 1950s, neurosurgeons have offered
a risky alternative: burning lesions into parts of the brain to destroy
the defective tissue that caused certain symptoms.
But it didn't control Parkinson's worst problems.
In the early 1990s, French and U.S. scientists studying monkeys
discovered that targeting other brain tissue worked far better but was
too delicate to burn. "That was not thinkable," Benabid said. "It's
quite dangerous."
By then, Activa was showing good experimental results against tremors
-- so Benabid studied whether this "deep brain stimulation" would work
better if he moved it to the more intriguing brain region.
A study of 76 advanced patients from Europe and the United States found
the amount of time their bodies functioned normally doubled after the
implant. Many are out of wheelchairs and able to live independently
again; some have returned to work, Benabid said.
The relief "appears to last a very long time," said Warren Olanow of
New York's Mount Sinai Medical Center, who helped Benabid develop the
surgery.
Importantly, the electrical shocks do not destroy brain tissue. So "if
it ever turns out we have a better treatment, you can stop it and
nothing's broken," Olanow added.
By LAURAN NEERGAARD, AP Medical Writer
--
Judith Richards, London, Ontario, Canada
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