Parkinson's Surgery Improves Movement
New Technique Allows Most Patients to Decrease Medication
Oct. 14, 2002 -- Surgeons have refined a procedure for Parkinson's disease -- one that gives long-term relief from the shakiness that we've seen in actor Michael J. Fox and others.
The effects seem to be long-term, without complications, plus patients need less medication, reports Jorge Juncos, MD, associate professor of neurology and co-director of the movement disorders program at Emory University School of Medicine in Atlanta.
Two years after the procedure, "the patients are still doing well," says Juncos: "They're showing significant improvement in tremor, slowness, ability to walk and stand upright, fine motor dexterity -- all the cardinal features of Parkinson's," he tells WebMD. "Some patients can reduce their medication by 70% -- very dramatic. And some patients are able to come off medications altogether."
Also, the patients seem to have stabilized. "There's very minimal progression of the disease," Juncos tells WebMD.
Juncos presented his paper at the annual American Neurological Association meeting in New York. The study was conducted in Cuba and the procedure was performed by neurosurgeons Lazaro Alvarez, MD, and Raul Macias, MD. Juncos assisted with imaging studies, data analysis, and reporting.
Nearly one million Americans have Parkinson's disease. The degenerative brain disorder causes slowness of movement, tremor, and muscle rigidity that gets worse as the disease progresses.
What causes Parkinson's? No one seems to know, but a progressive death of nerve cells causes an imbalance in the section of the brain that directs movement. And while drugs such as L-dopa can restore some of the brain balance and diminish symptoms, it has only temporary effects.
L-dopa itself has been blamed for some of the movement problems that plague people with Parkinson's.
In recent years, neurosurgeons have used a technique called deep-brain stimulation in the brain, which involves implanting a device similar to a heart pacemaker. The pulses the stimulator emits can inhibit the overactive areas of the brain. However, deep-brain stimulation is expensive and the "pacemaker" is subject to mechanical complications.
In the past few years, new techniques have allowed more precision and improved on the safety of the surgery.
Last year, Juncos and his colleagues from Cuba and Spain reported they could safely destroy the small cluster of brain cells that causes the slowness and shakiness. In two surgical procedures spaced about a year apart they destroyed nerve cells first on one side of the brain, then on the other side.
This year, surgeons showed that both procedures could be performed in the same surgery -- greatly reducing the patient's risks and costs.
It also provides "a more immediate result," says Juncos.
This small study involved 11 people with moderate to advanced Parkinson's; average age was 59. Each had the double-sided procedure, called subthalamotomy.
In the first months, some patients had movement problems. However, those disappeared when the L-dopa medication was reduced. Overall, there was a 50% improvement in symptoms two years after the procedure, Juncos reports. Patients also had no permanent memory problems or speech deterioration, he adds.