Multicenter Study of Autologous Adrenal Medullary Transplantation to the Corpus Striatum in Patients with Advanced Parkinson's Disease

Christopher G. Goetz, C. Warren Olanow, William C. Koller, Richard D. Penn, Carl Cardella, Robert Morantz, Glenn Stebbins, Caroline M. Tanner, Harold L. Klawans, Kathleen M. Shannon, Cynthia L. Comella, Thomas Witt, Michael Waxman, Lisa Gauger, David Cahill

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245 Scopus citations

Abstract

In 19 patients with severe Parkinson's disease, we replicated the surgical procedures developed by Madrazo et al. for transplantation of the adrenal medulla to the striatum, and followed them for six months after operation. We monitored their motor function with the use of standardized scales and determined the amount and quality of “on” and “off” time (the hours of the waking day when the anti-parkinsonism medications were effective and ineffective, respectively). We found significant improvement in focal areas of motor function. The mean percentage of on time during the day increased from 47.6 percent to 75.0 percent (P = 0.012); the mean percentage of on time without chorea increased from 26.6 percent to 59.2 percent (P = 0.006); the mean severity of off time decreased as assessed by both the Activities of Daily Living subscale of the Unified Parkinson's Disease Scale (P = 0.002) and the Schwab and England scale (P = 0.037). In contrast to the finding of Madrazo et al., however, the dosages of anti-parkinsonism medications could not be decreased and postoperative morbidity was substantial. Despite cautious optimism, we conclude that the wide-spread use of this procedure outside of research centers is premature, since the improvement we found was slighter than in the previous cases. (N Engl J Med 1989; 320: 337–41.), MADRAZO and colleagues reported successful amelioration of Parkinson's disease in two patients treated by means of transplantation of the adrenal medulla to the right caudate nucleus.1 Both these incapacitated patients had dramatic and continued improvement in the symptoms of tremor, speech impairment, and difficulties in balance. Additional patients in a larger series studied by these authors were examined by another investigator, who corroborated the finding of postoperative improvement and reported that in some patients anti-parkinsonism medications could be substantially reduced or even discontinued.2,3 Because of the clinical importance of these reports, our three study centers developed similar protocols to test….

Original languageEnglish
Pages (from-to)337-341
Number of pages5
JournalNew England Journal of Medicine
Volume320
Issue number6
DOIs
StatePublished - 9 Feb 1989
Externally publishedYes

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