Preliminary report on adrenal-brain transplantation for parkinsonism in man.
The attempt to restore lost neurological function through grafting of catecholaminergic tissue into the striatum is a dramatic new experimental treatment approach for parkinsonism. We have grafted autologous adrenal medullary tissue into the right caudate nucleus in 12 patients with advanced Parkinson's disease (10 males, 2 females, mean age 53 years, mean Hoehn and Yahr stage 'off' medications 4.2) applying a transcortical technique similar to that of Madrazo as modified by Allen using right adrenalectomy performed via a flank approach. There have been no deaths, surgical complications, or serious postoperative morbidity. Modified Columbia Parkinson's disease ratings of patients off all dopaminergic agents for 72 h revealed 22% improvement (p less than 0.01) 3-6 months postoperatively (n = 10) and 22% improvement (p less than 0.01) 7-12 months later (n = 9). Postoperative dyskinesias necessitated reduction of L-dopa by 11% and of carbidopa by 29%. Analysis of lumbar cerebrospinal fluid biogenic amine metabolites following a 4-day 'drug holiday' revealed that homovanillic acid increased to 159% of preoperative levels (p less than 0.01) 3-6 months (n = 9) and to 197% of preoperative levels (p less than 0.02) 7-12 months postoperatively (n = 5). We have observed a mild to moderate improvement persisting up to 1 year with this therapeutic approach, but further study is needed.
Bakay
R A
RA
Department of Neurology, Veterans Administration Medical Center, Atlanta, Ga.
Watts
R L
RL
Freeman
A
A
Iuvone
P M
PM
Watts
N
N
Graham
S D
SD
D000313:Adrenal Medulla / Q000637:transplantation*; D000328:Adult; D000368:Aged; D002421:Caudate Nucleus / Q000601:surgery*; D004298:Dopamine / Q000502:physiology; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009460:Neurologic Examination; D010300:Parkinson Disease / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis*
D004298:Dopamine