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Adrenal Medullary Transplantation to the Caudate Nucleus in Parkinson's Disease: Initial Clinical Results in 18 Patients

Adrenal Medullary Transplantation to the Caudate Nucleus in Parkinson's Disease: Initial Clinical... Abstract • Results from a pilot study of adrenal medullary autotransplantation for Parkinson's disease are presented. Eighteen patients were studied; 12 were followed up for 1 year, and 6 were followed up for 6 months. Four of 12 patients showed distinct improvement in the signs and symptoms of their disease, as assessed using the Columbia Rating Scale, at 1 year; none showed distinct deterioration. The 6 patients who were followed up for only 6 months were an average of 20 years older and generally more severely affected. None distinctly improved. Morbidity was considered to be minor and transient among the first 12 patients, while 4 of the last 6 patients experienced alteration in mental status lasting as long as several months. This problem has led us to conclude that older patients with preexisting cognitive impairment should not be included in future studies until the benefits are more clearly established. However, we believe that the distinct and persistent improvement seen in some of the younger patients warrants the initiation of a welldesigned, randomized, and controlled trial of adrenal medullary autotransplantation for the purpose of confirming these results and assessing the effect of the procedure on the natural progression of Parkinson's disease. References 1. Hornykiewicz O. Brain neurotransmitter changes in Parkinson's disease . In: Marsden CD, Fahn S, eds. Movement Disorders . Stoneham, Mass: Butterworths; 1981:41-58. 2. Burns RS, Lewitt PA, Ebert MH, Parkenberg H, Kopin IJ. The clinical syndrome of striatal dopamine deficiency: parkinsonism induced by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) . N Engl J Med . 1985;312:1418-1421.Crossref 3. Freed WJ, Cannon-Spoor HE, Krauthamer E. Intrastriatal adrenal medulla grafts in rats: long-term survival and behavioral effects . J Neurosurg . 1986;65:664-670.Crossref 4. Freed WJ, Morihisa JM, Spoor E, et al. Transplanted adrenal chromaffin cells in rat brain reduce lesion-induced rotational behaviour . Nature . 1981;292:351-352.Crossref 5. Backlund EO, Granberg PO, Hamberger B, Gedvall G, Seiger A, Olson L. Transplantation of adrenal medullary tissue to striatum in parkinsonism . J Neurosurg . 1985;62:169-173.Crossref 6. Backlund EO, Olson L, Seiger A, Lindvall O. Toward a transplantation therapy in Parkinson's disease . In: Azmitia EC, Bjorklund A, eds. Cell and Tissue Transplantation Into the Adult Brain . New York, NY; New York Academy of Sciences; 1987: 658-670. 7. Madrazo I, Drucker-Colin R, Diaz V, Martinez-Mata J, Torres C, Becerrii JJ. Open microsurgical autograft of adrenal medulla to the right caudate nucleus in two patients with intractable Parkinson's disease . J Neurosurg . 1987;316:831-834. 8. Yahr MD, Duvoisin RC, Schear MJ, Barrett RE, Hoehn MM. Treatment of parkinsonism with levodopa . Arch Neurol . 1969;21:343-354.Crossref 9. Schwab RS, England AC. Projection technique for evaluating surgery in Parkinson's disease . In: Gillingham FJ, Donaldson MC, eds. Third Symposium on Parkinson's Disease . Edinburgh, Scotland: E & S Livingstone; 1969:152-157. 10. Hoehn MM, Yahr MD. Parkinsonism: onset, progression, and mortality . Neurology . 1967;15:427-442.Crossref 11. Meyers R. Surgical experiments in the therapy of certain 'extrapyramidal' diseases: a current evaluation . Acta Psychiatr Neurol . 1951;67( (suppl 13) ):1-42. 12. Sladek JR Jr, Shoulson I. Neural transplantation: a call for patience rather than patients . Science . 1988;240:1386-1388.Crossref 13. Backlund EO. Adrenal-to-brain transplants and Parkinson's disease . JAMA . 1987;258:1891.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Adrenal Medullary Transplantation to the Caudate Nucleus in Parkinson's Disease: Initial Clinical Results in 18 Patients

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References (19)

Publisher
American Medical Association
Copyright
Copyright © 1989 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1989.00520410021016
Publisher site
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Abstract

Abstract • Results from a pilot study of adrenal medullary autotransplantation for Parkinson's disease are presented. Eighteen patients were studied; 12 were followed up for 1 year, and 6 were followed up for 6 months. Four of 12 patients showed distinct improvement in the signs and symptoms of their disease, as assessed using the Columbia Rating Scale, at 1 year; none showed distinct deterioration. The 6 patients who were followed up for only 6 months were an average of 20 years older and generally more severely affected. None distinctly improved. Morbidity was considered to be minor and transient among the first 12 patients, while 4 of the last 6 patients experienced alteration in mental status lasting as long as several months. This problem has led us to conclude that older patients with preexisting cognitive impairment should not be included in future studies until the benefits are more clearly established. However, we believe that the distinct and persistent improvement seen in some of the younger patients warrants the initiation of a welldesigned, randomized, and controlled trial of adrenal medullary autotransplantation for the purpose of confirming these results and assessing the effect of the procedure on the natural progression of Parkinson's disease. References 1. Hornykiewicz O. Brain neurotransmitter changes in Parkinson's disease . In: Marsden CD, Fahn S, eds. Movement Disorders . Stoneham, Mass: Butterworths; 1981:41-58. 2. Burns RS, Lewitt PA, Ebert MH, Parkenberg H, Kopin IJ. The clinical syndrome of striatal dopamine deficiency: parkinsonism induced by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) . N Engl J Med . 1985;312:1418-1421.Crossref 3. Freed WJ, Cannon-Spoor HE, Krauthamer E. Intrastriatal adrenal medulla grafts in rats: long-term survival and behavioral effects . J Neurosurg . 1986;65:664-670.Crossref 4. Freed WJ, Morihisa JM, Spoor E, et al. Transplanted adrenal chromaffin cells in rat brain reduce lesion-induced rotational behaviour . Nature . 1981;292:351-352.Crossref 5. Backlund EO, Granberg PO, Hamberger B, Gedvall G, Seiger A, Olson L. Transplantation of adrenal medullary tissue to striatum in parkinsonism . J Neurosurg . 1985;62:169-173.Crossref 6. Backlund EO, Olson L, Seiger A, Lindvall O. Toward a transplantation therapy in Parkinson's disease . In: Azmitia EC, Bjorklund A, eds. Cell and Tissue Transplantation Into the Adult Brain . New York, NY; New York Academy of Sciences; 1987: 658-670. 7. Madrazo I, Drucker-Colin R, Diaz V, Martinez-Mata J, Torres C, Becerrii JJ. Open microsurgical autograft of adrenal medulla to the right caudate nucleus in two patients with intractable Parkinson's disease . J Neurosurg . 1987;316:831-834. 8. Yahr MD, Duvoisin RC, Schear MJ, Barrett RE, Hoehn MM. Treatment of parkinsonism with levodopa . Arch Neurol . 1969;21:343-354.Crossref 9. Schwab RS, England AC. Projection technique for evaluating surgery in Parkinson's disease . In: Gillingham FJ, Donaldson MC, eds. Third Symposium on Parkinson's Disease . Edinburgh, Scotland: E & S Livingstone; 1969:152-157. 10. Hoehn MM, Yahr MD. Parkinsonism: onset, progression, and mortality . Neurology . 1967;15:427-442.Crossref 11. Meyers R. Surgical experiments in the therapy of certain 'extrapyramidal' diseases: a current evaluation . Acta Psychiatr Neurol . 1951;67( (suppl 13) ):1-42. 12. Sladek JR Jr, Shoulson I. Neural transplantation: a call for patience rather than patients . Science . 1988;240:1386-1388.Crossref 13. Backlund EO. Adrenal-to-brain transplants and Parkinson's disease . JAMA . 1987;258:1891.Crossref

Journal

Archives of Neurology – American Medical Association

Published: May 1, 1989

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