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Bill: It did not have that effect. I think you are a gifted writer writing about a powerful subject. So powerful, I was blown-away. Scarey stuff, this cognitive impairment. But stuff that I feel needs to come out of the closet. I hope you keep writing. Carole --- William Harshaw <[log in to unmask]> wrote: > Poetic licence. No intent to injure or hurt. Sorry > if it had that effect. > > Bill > -----Original Message----- > From: Carole Hercun <[log in to unmask]> > To: [log in to unmask] > <[log in to unmask]> > Date: Tuesday, August 17, 1999 6:46 AM > Subject: Re: Reflections ... > > > >"The brain...spoils and rusts". Certainly a > striking > >image, but a dark one. Its rather like being hit > with > >a truck when you read it as early in the AM as I > am. I > >think I was actually struck speechless for a > moment, > >especially after all the posts yesterday re: > cognitive > >impairment vs. dementia. Poetic license or do you > feel > >that damaged by the disease? Carole H. > > > > > >--- William Harshaw <[log in to unmask]> wrote: > >> Reflections on Therapy > >> for > >> Parkinson's Disease: > >> Medication and Neurosurgery > >> by > >> Bill Harshaw > >> > >> Parkinson's Disease is associated with free > radicals > >> which in turn are > >> associated with the deposition of iron. The > human > >> brain is encased in fat. > >> For a person with Parkinson's, the brain, which > is > >> the source of the highest > >> creativity and reasoning, spoils and rusts > >> > >> The two procedures I had - the pallidotomy in > 1993 > >> and deep brain > >> stimulation the following year - are much in the > >> news as Parkinson's > >> patients search out possible ways to mitigate > their > >> symptoms and improve the > >> quality of their lives. Media accounts of these > >> procedures focus on the > >> successes, sometimes spectacular, and give less > >> coverage to the patients > >> whose lives have not increased in quality. > >> > >> Neurosurgery as a therapy for Parkinson's > disease > >> continues to be both > >> experimental and controversial. Pallidotomy, > >> thalamotomy, deep brain > >> stimulation and foetal transplants haven't yet > >> reached the status of bypass > >> surgery for cardiac patients - the gold standard. > >> But it is useful to > >> remember that they are all based on what the > noted > >> American physician Lewis > >> Thomas calls ‘halfway technologies'.He does not > use > >> this term derisively, > >> but to point out that they do not represent a > cure, > >> only better symptom > >> management. > >> > >> Foetal transplant surgery is to the doctors an > >> extension of the current > >> ‘gold standard' of treatment, ‘dopamine > replacement > >> therapy', as represented > >> by the L-dopa based medications. However, it > has a > >> number of ethical and > >> moral hurdles to clear before becoming > acceptable > >> to society generally. > >> The other procedures fall into the general > category > >> of what surgeons do > >> best: "if its broke, fix it" (with apologies to > Bert > >> Lance). > >> > >> To put neurosurgery in the context of the > universe > >> of treatment for > >> Parkinson's it is important to remember that > >> pallidotomy and thalamotomy > >> have been around for fifty years. They were the > >> therapy of choice for > >> advanced PWPs.untl the mid 1960s when L-dopa was > >> discovered to be > >> efficacious. As L-dopa gained acceptance, its > >> superiority to all other drug > >> therapies became apparent. Neurosurgery went > into > >> eclipse, not to have a > >> renaissance for a quarter century, a period which > >> saw the development of two > >> generations of a new type of drug - dopamine > >> agonists - which increase and > >> prolong the effectiveness of L-dopa. > >> A quarter century's use of L-dopa as the > medication > >> of choice demonstrated > >> its superiority in symptom management; it also > >> revealed the drug's > >> shortcomings - dyskinesia and psychiatric > >> side-effects in advanced patients > >> who were on high doses being among the more > >> significant.. In the early > >> 1990s, technological advances, the > miniaturization > >> of surgical instruments, > >> a more nuanced and comprehensive understanding of > >> neuroanatomy, a new era in > >> neuroimaging and the need to provide some sort of > >> relief to advanced > >> patients led to a renewal of interest in > >> neurosurgery - the old operations > >> being done more successfully and with greater > >> precision and the invention of > >> DBS by Alim Benabid and his colleagues in > Grenoble > >> France. Almost > >> paralleling the surgical innovation was the > >> development of a third > >> generation of agonists which, if they live up to > >> their press releases, will > >> provide a meaningful advance on current drug > >> therapy. The procedures and > >> the drugs are at the limit of human knowledge. > >> > >> Foetal transplantation is considered > separately. > >> As a class of surgery, > >> it belongs with organ transplants - heart, lungs, > >> kidney ... the list goes > >> on. It first showed its face in the late 1970s > and > >> has been developing > >> quickly since then. At times the pace of > progress > >> seems slow to patients, > >> but the rate of change of progress has been > nothing > >> short of exponential. > >> Results of a recent double blind study are every > bit > >> as good as were > >> expected and parallel the results of other the > types > >> of surgery . > >> > >> Comparing the state of therapy for Parkinson's > >> today to what it was a mere > >> quarter-century ago, the progress is staggering. > >> Before L-dopa, the > >> medications available were a variety of drugs > which > >> were serendipitously > >> found to be beneficial as therapy. They were > really > >> pretty primitive. Now, > >> there is L-dopa, three generations of agonists, > >> neurosurgery and a whole new > >> array of research projects, any one of which has > >> the potential to advance > >> treatment markedly. > >> > >> It should be noted that every therapy has its > >> drawbacks, called side > >> effects, which range from the trivial to the > >> serious. Some of these side > >> effects are major enough to prevent certain > patients > >> from using some > >> therapies. Indeed, there is a website on the > >> internet devoted to patient > >> accounts. > >> > >> The implications of these advances on a broad > field > >> of new and newly > >> adapted drug and surgical therapies is that > >> physicians will have several > === message truncated === _________________________________________________________ Do You Yahoo!? Get your free @yahoo.com address at http://mail.yahoo.com