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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 >