BILATERAL FETAL NIGRAL TRANSPLANTATION INTO THE POSTCOMMISSURAL PUTAMEN IN PARKINSONS-DISEASE

We performed fetal nigral tansplantations in 4 Parkinson's disease (PD ) patients. Solid grafts were bilaterally implanted into the postcommi ssural putamen using 3 to 4 donors per side aged 61/2 to 9 weeks postc onception. Transplant deposits were separated by no more than 5 mm in three dimensions. Cyclosporine was employed for a total of 6 months. P atients were evaluated at baseline and at 1, 3, and 6 months postopera tively. Striatal 18-fluorodopa uptake was assessed by positron emissio n tomography at baseline and at 6 months postoperatively. The procedur e was well tolerated in all patients. One patient had a clinically asy mptomatic superficial cortical hemorrhage along the needle tract and a second had transient postoperative confusion and hallucinations. All patients experienced clinically meaningful benefit. Significant improv ement (P < 0.05) was detected in total UPDRS score during the ''off'' state, Schwab-England disability score during the ''off'' state, perce nt ''off'' time, and percent ''on'' time with dyskinesia. Increased st riatal. fluorodopa uptake was observed bilaterally in each patient, wi th mean increases of 53% on the right (P = 0.01) and 33% on the left ( P = 0.08). Our study demonstrated clear and consistent improvement in clinical features and striatal fluorodopa uptake following fetal tissu e transplantation in patients with advanced PD whose condition was not improved preoperatively by drug manipulation These preliminary result s are encouraging and support further studies to evaluate grafting str ategies as a therapy for PD.