TY - JOUR
T1 - Multicenter Study of Autologous Adrenal Medullary Transplantation to the Corpus Striatum in Patients with Advanced Parkinson's Disease
AU - Goetz, Christopher G.
AU - Olanow, C. Warren
AU - Koller, William C.
AU - Penn, Richard D.
AU - Cardella, Carl
AU - Morantz, Robert
AU - Stebbins, Glenn
AU - Tanner, Caroline M.
AU - Klawans, Harold L.
AU - Shannon, Kathleen M.
AU - Comella, Cynthia L.
AU - Witt, Thomas
AU - Waxman, Michael
AU - Gauger, Lisa
AU - Cahill, David
PY - 1989/2/9
Y1 - 1989/2/9
N2 - 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….
AB - 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….
UR - http://www.scopus.com/inward/record.url?scp=0024508902&partnerID=8YFLogxK
U2 - 10.1056/NEJM198902093200601
DO - 10.1056/NEJM198902093200601
M3 - Article
C2 - 2643770
AN - SCOPUS:0024508902
SN - 0028-4793
VL - 320
SP - 337
EP - 341
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 6
ER -