3 ■ FALL 1995 ISSUE ■ 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