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http://www.kumc.edu/Pulse/breaknews/Break_news100295.html BREAKING NEWS! on Pulse: [Image] For Immediate Release October 2, 1995

KU Medical Center Is First U.S. Site for Pallidal Brain Stimulation for Treatment of Parkinson's

KANSAS CITY, Kan. -- The first pallidal stimulation for the treatment of Parkinson's disease in the United States will be performed Oct. 5 at the University of Kansas Medical Center. Pallidal stimulation involves threading a thin wire electrode into the globus pallidus of the brain, the site of abnormal activity in Parkinson's disease. The electrode, attached to a pulse generator, sends a high-frequency signal to block the brain's overactive impulses that result in the tremor and halting steps of Parkinson's. "This is certainly not a cure for Parkinson's disease; but the pallidal stimulation may offer some relief from its symptoms, which include tremor, slowness, stiffness and gait problems," said William Koller, M.D., Ph.D., chair of neurology at KU Medical Center. "It also appears to decrease some of the drug-induced side effects of Parkinson's, the involuntary movements called dyskinesia." The theory is that brain cells which fire to drive normal movement do not shut off in the Parkinson's disease patient. "The circuit in the brain is overactive in patients with Parkinson's disease," said Steven Wilkinson, M.D., neurosurgeon. "If you disrupt the circuit, you can improve some of the symptoms. Patients are awake during the surgical implantation of the stimulator and its effects are immediate. A microelectrode with a single cell recorder is threaded through the brain so the neurosurgeon can see, as well as hear, which brains cells are firing too rapidly. The area of increased activity is where the electrode is implanted. KU Medical Center has approval to do five pallidal stimulations. The study will be used to determine how to optimize the procedure and how long benefits last. Using current criteria, the first five patients will be relatively young Parkinson's disease patients, who have reached the limits of benefit from drug therapy and who experience significant disability and dyskinesia. "There is no information that pallidal stimulation will halt the progression of the disease; however, it can improve function and patients will be able do more things," Koller said. "We know some patients will have dramatic benefits, but it is yet to be determined how long the benefits will last. " Since January 1994, KU Medical Center has implanted electrode stimulators in 40 patients targeting the brain's thalamus. Thalamus stimulation has caused significant reduction of tremors in patients with essential tremor and the tremor of Parkinson's disease. But for Parkinsonian patients, thalamus stimulation only improves the tremor, not the drug-induced side effects which alternately cause episodes of involuntary movements and muscular rigidity or other Parkinsonian symptoms. One other site in the country, Mount Sinai Hospital, New York, has approval to implant stimulators for Parkinson's disease in a different area of the brain, the subthalamius nucleus. A surgical procedure called a pallidotomy, which actually destroys tissue in the globus pallidus, has been tried at other medical centers for treatment of Parkinson's disease. Pallidotomies first were used 30 years ago but grew out of favor with the advent of Levodopa, the drug of choice for Parkinson's disease. There has been a resurgence of interest in the procedure as patients reach the limits of benefit from Levodopa and also experience "on periods," defined by abnormal movements, and "off periods," defined by rigidity, from long-term use of the drug. Koller said that pallidal stimulation may offer some advantages over the pallidotomy: 1. no brain tissue is destroyed 2. the frequency and strength of stimulation can be adjusted to the needs of each patient 3. the stimulus can be removed if there is an adverse effect and 4. stimulation can be done on both sides of the brain while a pallidotomy can only be done on one side because of risks of speech and swallowing difficulties. Wilkinson and Koller plan to perform pallidotomies after the five pallidal stimulations. "There is a lot of scientific interest and a lot of potential to help Parkinson's disease patients when we have run out of other options," Koller said. "We still need to learn more about these procedures. They are investigational and there are some risks involved." (Story by Peggy Graham, University Relations, 913-588-5240)

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