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Small correction: Pallidotomy was used 30-40 years ago as th only treatmentfor PD. Then sinemet was developed and pallidotomy fell out of use until it was refined and used where sinemet etc failed. Bob Anibal ----- Original Message ----- From: William Harshaw <[log in to unmask]> To: <[log in to unmask]> Sent: Saturday, October 09, 1999 1:23 AM Subject: Re: NEWS: New Surgical Approaches to Parkinson Disease | JAMA | Vancouver Conference Report > 1. Pause for a moment and consider how quickly therapies have advanced in > the past decade. Pallidotomy had not eve been rediscovered ten years ago. > DBS was a gleam in Alain Benabid's eye. I was the first North American > patient to have DBS on 12.14.94, not even five years ago. > > 2. My speculation is, and I would be interested in Charlie, Chris and Bob's > reaction, that DBS works in two separate and distinct ways: > i) the actual insertion of the electrode in the GPI/STN moves the brain > cells sufficiently to cause the circuitry to be altered; and > ii) chronic stimulation is 'the icing on the cake' and multiplies > synergistically the effect of the electrode > 3. This is why the placement of the electrode must be made with such > precision and why some patients have less successful results than others > 4. This is all highly speculative because we only know that DBS works; we > know neither how nor why it works > 5. PWPs who have neurosurgery must recognize the point in 4 above and the > fact that we do not know what the long term risks are > > Bill > > -----Original Message----- > From: Chris van der Linden <[log in to unmask]> > To: [log in to unmask] <[log in to unmask]> > Date: Friday, October 08, 1999 4:34 PM > Subject: Re: NEWS: New Surgical Approaches to Parkinson Disease | JAMA | > Vancouver Conference Report > > > >> > >> Comparing the results of surgery on two of the three target areas, > Benabid > >has found that the main effect of GPI stimulation is to reduce and control > >levodopa-induced dyskinesias. > >> > >> However, it reduces other PD symptoms only moderately: "In general, STN > >stimulation improves all the signs and symptoms by more than 60%, while GPI > >stimulation improves [them] by less than 60%," Benabid said. > > > >As I have stated all along on my recent postings. > > > >> "There is a whole new group of adverse effects that are related to the > >equipment," he said, "including lead breaks, infections, and ulcerations of > >the skin. And there is the need to replace the battery, which must be done > >under general anesthesia." > > > >Replacement of a battery can be done with LOCAL anesthesia. Out of 90 > >patients I have never seen a lead break. Three infections of the lead were > >seen. Two ulcerations of the skin. So very minor complications. > > > > > >> The main alternative to deep brain stimulation is pallidotomy, said > >Lozano. This procedure has similar efficacy, he said, but involves creating > >an irreversible lesion in the brain and is too "risky" to do bilaterally. > > > >May be similar efficacy but not long-lasting for several symptoms. > > > >Greetings, > > > >Chris > > >