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FALL 1995 ISSUE
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SINAI HOSPITAL
Pallidotomy — Alternative
Treatment for Parkinson's
113
arkinson's Disease is a rel-
atively common neurolog-
ical disorder, affecting
more than 500,000 Amer-
icans with problems such
as tremors, gait problems,
stiff limbs, slowness of movements
or incoordination. Over the past
30 years, a variety of medications
have been developed to treat these
symptoms. In the best of circum-
stances, these drugs can be quite
helpful. However, patients often suf-
fer side effects. In the search for new
ways to relieve these symptoms, a
surgical procedure has been redis-
covered that is especially effective
for patients who do not respond well
to medications.
According to Peter LeWitt, MD,
professor of neurology at the Wayne
State University School of Medicine
and Sinai neurologist, "Recent at-
tention has focused on a particular
portion of the brain called the globus
pallidus . Pallidotomy is the name
for the brain surgery used to treat
Parkinson's. It is not a new proce-
dure; it was first implemented in the
1940s and used regularly for two
decades. However, the discovery of
highly effective drugs such as
L-DOPA caused most doctors to
abandon surgery in favor of phar-
maceutical treatments."
Studies, though, recently turned
the tide by indicating that pallido-
tomy is helpful for people with
various problems of severe Parkin-
son's. Circuits of the brain which
selectively generate the problemat-
ic symptoms of Parkinson's are
accessible to surgical treatment.
By interrupting these pathways,
Parkinson's interference with nor-
mal movement can be relieved im-
mediately. Pallidotomy is carried
out with a tiny electrical probe that
is placed with high precision in the
brain. New developments in brain-
mapping devices such as MRIs and
CT scans have enabled surgeons to
produce far more precise and local-
ized results than in previous years.
There are several
types of impairment
that might occur from
this surgery, including
temporary or perma
nent visual problems or
weakness on one side of
the body. Occasionally,
symptoms of Parkin-
son's Disease return shortly after
surgery. However, in many in-
stances the results are very favor-
able.
Drs. LeWitt and Richard Trosch
are actively working to bring this
new treatment approach to the
Detroit metropolitan area.
-
Management of People
continued from page 1
treating Parkinson's and the other
diseases as well."
Drs. Trosch, LeWitt, and their col-
leagues at the Sinai Clinical Neuro-
science Center have this experience,
providing a unique service to south-
eastern Michigan. The two neurol-
ogists subspeciali zed in Parkinson's
in their training and research. The
Sinai Center, which is associated
with a large, international Parkin-
son's study consortium, has been des-
ignated a National Parkinson's
Disease Foundation Center of Ex-
cellence, one of only 17 in the Unit-
ed States and 26 worldwide. Both
doctors are actively involved in re-
search into the causes and new treat-
ments of Parkinson's.
They never run out of challenges
posed by the array of symptoms pre-
sented by people with Parkinson's.
Some of these are emotional, social,
and psychological. To further sup-
port their patients, the Clinical Neu-
roscience Center employs full-time
nurse clinicians who work with pa-
tients on the phone in between
visits as well as face-to-face in the
clinic. "Our nurses understand the
frustrations with the symptoms,
the emotional ups and downs, and
the problems with medications very,
very well. They offer our patients
great support," says Dr. LeWitt.
Finally, notes Dr. Trosch, the Cen-
ter takes a very active interest in in-
forming patients about the disease
and educating them about living
with it. "The patients who do best
are those who understand their
Parkinson's and know what to ex-
pect. We try to help them in every
possible way with this important
educational goal."
HealthNews
HealthNews is published as a community service to provide up-to-date
information about Sinai Hospital, its physicians and services.
Founded in 1953, Sinai Hospital is a 598-bed tertiary care facility on a
36-acre campus centrally located in metropolitan Detroit. Michigan's only
Jewish-sponsored hospital, Sinai has numerous satellite locations through-
out the area.
HealthNews is produced by Sinai Hospital's Corporate Communications/
Marketing Department. For more information, please write Sinai Hospital
Corporate Communications/Marketing, 6767 W. Outer Drive, Detroit,
Michigan 48235.
Copyright 1995 by Sinai Hospital.
qinal
S PEC IAL ADVERTI SEMENT
that Parkinson's is very treatable,"
says Dr. LeWitt. "In fact, we have
found that most symptoms of Parkin-
son's stop getting worse after three-
to-five years, and in the majority of
cases the disease doesn't progress
much after that time. The challenge
to us is choosing the right combina-
tion of medications for optimal symp-
tom relief as well as dealing with the
possible side effects of those med-
ications."
Another major challenge with
Parkinson's is correctly diagnosing
it to begin with. "There is no x ray,
blood test, CAT scan or any other
medical tool we know of that will tell
you for certain that an individual has
Parkinson's Disease," notes Dr.
Trosch. "As physicians, we have to
be very observant and piece togeth-
er a lot of information to identify a
true Parkinson's patient. A lot of oth-
er problems look and act like Parkin-
son's. These may be treatable in
different ways, or even curable. That
is why you need a doctor with a lot
of experience in recognizing and