Thanks a lot. Great report. Sid Roberts wrote: > On Sunday August 23, the Cleveland Clinic Foundation sponsored a > symposium, "New Discoveries: Parkinson's Disease and Tremor Disorders". > Speakers from the Cleveland Clinic included: Gene H Barnett, M.D., Vice > Chairman, Department of Neurosurgery; R. Stanley Burns, M.D., Director, > Movement Disorders Program; and Erwin B. Montgomery, M.D., Director of > Research, Movement Disorders Program. Ray Watts, M.D., Associate Professor, > Department of Neurology at Emory University School of Medicine, also spoke. > (William C. Koller, M.D., Ph.D., of the University of Kansas Medical Center, > scheduled to speak, was unable to appear.) Each spoke for about 20 minutes > and a question and answer period followed. > > Dr. Montgomery, in his opening remarks, noted that a research project > concerning the genetic factor in Parkinson's Disease will be conducted at > the Clinic. To aid in this project, the Clinic is seeking as participants, > families in which more than one member has Parkinson's Disease. Anyone > meeting this criterion is urged to contact the Cleveland Clinic Movement > Disorders Program, Department of Neurology, at 216-445-1108, or call the > Clinic at 1-800-223-2273. > > Dr. Burns, speaking on New Medications for Parkinson's Disease, > centered his remarks on Mirapex, Requip, and Tasmar, all introduced within > the last year or so. He explained that Mirapex, which he described as "the > simplest of the drugs to use", produces the effect of dopamine, but is a > synthetic agent, as opposed to levadopa (Sinemet), a natural chemical. Dr. > Burns noted that Mirapex is a long-acting drug which complements Sinemet in > aiding tremor, balance, and postural problems, but also has some unique > properties, providing both anti-depressant and anti-fatigue effects. He > remarked that the "down side" of the drug is its capacity to cause > confusion, hallucinations, psychosis and paranoia in some patients, and > noted that, for these reasons, its use should be monitored. > Dr. Burns characterized Requip as a "sister to Mirapex", with the > distinction of more difficulty in adjusting dosage, but less likelihood of > producing side effects. > Tasmar was described by Burns as a complex drug with no intrinsic > anti-Parkinson's Disease activity. By itself, Tasmar will do nothing, he > noted; Tasmar must be used in combination with Sinemet. As the newest drug, > learning how to adjust dosage is key , and it will take longer to optimize > its effect. Tasmar's primary benefit is decreasing fluctuations (on/off > periods); its primary challenge will be refinement in its use. > Dr. Burns commented on new drugs now in the laboratory stage, noting > that the goal is to improve the function of dopamine-producing cells still > intact and to reduce the rate of progression of the disease. > > Dr. Barnett, speaking on Surgical Options for Movement Disorders, > stated that surgery for Parkinson's Disease was not new, but was popular in > the '50's and '60's, with thalamotomy being the most used, but then > abandoned. In l992, the surgical treatment, pallidotomy, was developed, and > interest in fetal transplant of dopamine-producing cells increased. In > 1997, the deep brain stimulation procedure was approved by the FDA. > Presently, thalamotomy is the procedure preferred for control of > tremor. Pallidotomy, which destroys selected cells in the thalamus, globus > pallidum, and sub-thalamic nucleus which have become hyper-active due to the > death of cells in the substantia nigra, is more effective for other symptoms > such as dyskinesea. > The newest development, deep brain stimulation (DBS), implants electrodes in > the brain, connected to a pacemaker located under the clavicle. > Dr. Barnett distinguished DBS from the pallidotomy procedure by noting > that the gamma knife, used in the pallidotomy, is "often but not always" > perfect, and involves destruction of cells, whereas DBS is both adjustable > and reversible. > > Dr. Ray Watts, discussing the future of surgery for Parkinson's > Disease, explained that the fundamental problem is the death of > dopamine-producing cells, and that the goal is to stop progression of the > loss of such cells and, ideally, to restore their function. > Early Swedish experiments in transplanting human fetal > dopamine-producing cells found the area of the brain which develops dopamine > was increased, to the extent that some patients no longer needed to take > Sinemet. However, in the US, use of human cells has been controversial. > Further, the need for an infinite supply of brain cells for transplantation > cannot at this time be met. > Presently, controlled trials of the use of pig fetal cells have shown > that porcine cells are, at best, as good as human cells for this purpose. > > Dr. Montgomery, in distinguishing Essential Tremor (ET) from > Parkinson's Disease, explained that ET tends to involve tremors of the head > and is familial, unlike Parkinson's. He noted that, though ET is more > common than Parkinson's, research in development of new treatments for ET > has lagged, because no animal model is available; scientists have been > unable to produce ET in animals. Dr. Montgomery remarked that, though a > number of medications have been used to treat ET, none has been effective > for more than a small percentage of patients, and side effects preclude > their use for many. However, both Thalamotomy and DBS have proved to be > useful surgical treatments for ET. > Another movement disorder, Multiple Sclerosis, also involves tremor in > approximately 15-20% of patients. Dr. Montgomery, while noting that the > prognosis for MS is much better now than previously, explained that surgical > interventions are not as successful for MS, since physicians are reluctant > to destroy the thalamus, and adjustments of DBS are necessary repeatedly for > MS patients. > In general, Dr. Montgomery noted that the pace of developments in > treatment of movement disorders is now so rapid that regulatory agencies > can't keep up with it; the FDA is years behind, in many instances. > > It was notable that each of the speakers was "upbeat" and optimistic about > the future. > > __________ > > Sid Roberts 68/3 <[log in to unmask] > Youngstown, Ohio >