Just watched a television show called "Frontiers of Medicine," which
included a segment on the renewal of interest in pallidotomies, as
evidenced by the work of Drs.. Richard Lehman and Evangelia Tzanakou of the
Robert Wood Johnson Medical Center in New Jersey.
The website that shows the text of this segment can not be referenced
easily by a URL, and I don't understand why. Go to
http://www.frontiersofmedicine.com then choose Search, and enter
Parkinson's. The broadcast to which I refer is program #12, transcript #3.
The site is an interesting one to explore, as it is supported by the
Medtronic Foundation and has a number of Parkinsonian references. Curious,
isn't it, that the manufacturers of Activa, the Deep Brain Stimulator,
would be pushing their "competition."
For those who do not have browsing capabilities, here is the text from this
show:
Show #12- Transcript #3
Hosted By: LouisW. Sullivan, M.D.
Parkinson's Disease
NARRATOR:
Parkinson's Disease is a neurological disorder that
slowly robs its sufferers of their quality of life.
It afflicts
between a million and a million-and-a-half American,
including some of our most prominent leaders,
entertainers and athletes. The cause of the disease is
unknown, but it leads to degeneration in the part of the
brain that produces dopamine.
Dopamine is a chemical that enables people to move
normally and smoothly; without enough of it, sufferers
experience rigidity, tremors, poor balance, slowness of
movement, and other debilitating symptoms. While there
are many drugs that can increase dopamine to help
control the disease's symptoms, they all lose
effectiveness over time. The most common drug, L-dopa,
appears to become ineffective after a decade or less of
use.
This leaves long-term sufferers with a difficult
decision:
Allow Parkinson's Disease to progressively control more
and more of their life, or undergo brain surgery. One
surgery that had fallen into disfavor but has recently
seen its popularity revived is pallidotomy. In this
operation, doctors go on a search-and-destroy mission
to locate the cells causing movement difficulties and
eliminate them. Once the cells are gone, so are the
symptoms.
NARRATOR:
The new popularity of pallidotomy comes from recent
advances that enable doctors to pinpoint more precisely
the location of the offending cell cluster. Dr. Richard
Lehman at Robert Wood Johnson University Hospital in
New Brunswick, New Jersey, has teamed up with Prof.
Evangelia Tzanakou from neighboring Rutgers University
to better address the targeting concerns. Professor
Tzanakou, who is a trained physicist, has come up with
a new, more accurate method to find the cells that are
responsible for a patient's symptoms. With an electrode
that is more traditionally used for measuring seismic
activity, she measures a patient's brain electroactivity.
When she finds a peak in the activity, she has found the
cluster that needs to be treated. The cluster is then
displayed on a 3-D model of the patient's brain that
shows the doctor where the cluster is located.
NARRATOR:
Dr. Lehman then uses radio waves to burn the cluster
and leave a lesion. Once the lesion has been made,
Professor Tzanakou takes another reading of the same
area. If the cluster has been properly destroyed, her
measurement will indicate zero activity for that cluster.
However, if there is significant residual
electroactivity, Dr.
Lehman will continue to make lesions until the cluster
has been eliminated. But because the new technique is
so accurate, Dr. Lehman is rarely required to make
multiple lesions.
NARRATOR:
The new procedure also allows the doctor to check the
outcome of the procedure immediately. This means that
Dr. Lehman can be positive that he has solved the
problem before he closes the patient's head. Professor
Tzanakou is hopeful that other doctors will adopt her
targeting method. Until other facilities become equipped
and trained to use her measurement software, she does
plan to offer her services via another form of
technology -
the Internet. Beginning this summer, she will take part
via the Internet in several pallidotomies scheduled
in the
United Kingdom. Doctor Tzanakou does have to keep
her schedule open for Dr. Lehman however; because of
the improved outcomes, Dr. Lehman have vowed not to
perform any operations without using Dr. Tzanakou's
measurements.
NARRATOR:While it might seem strange for a physicist
with a laptop computer to hold the key to a safer, more
accurate surgical procedure, it does show that when
great minds set out to solve medical problems, their
solutions will be on the frontiers of better medicine.
