4-YEAR FOLLOW-UP OF ADRENAL-TO-BRAIN TRANSPLANTS IN PARKINSONS-DISEASE

Objective: Evaluate long-term efficacy of autologous adrenal-to-caudat e transplants in idiopathic Parkinson's disease refractory to medical treatment. Design: Subjects underwent evaluations several times preope ratively on the University of California-Los Angeles Parkinson's Disea se Disability Scale and the Hoehn and Yahr stage of disease. Postopera tively, they were also repeatedly rated on the Unified Parkinson's Dis ease Rating Scale. Setting: Clinical visits and surgery took place at the University of California-Los Angeles Center for the Health Science s. Patients: Three men and one woman, ages 44 to 55 years, were follow ed up for several years preoperatively. At surgery, disease durations ranged from 7 to 16 years. Originally, all patients had a good respons e to levodopa, but for several years preoperatively, they had had fluc tuating responses and a short duration of drug action. Intervention: R ight adrenalectomy was performed through a midline abdominal incision. Open craniotomy exposed the head of the right caudate into which piec es of adrenal medulla, 1 to 2 mm in size, were implanted. Main Outcome Measures: Scores on the three major scales (see ''Design'') were augm ented with the number of hours ''off' per day and severity of abnormal involuntary movements. Disease progression of each patient was compar ed with his own preoperative course and with those of a cohort of pati ents with Parkinson's disease followed up for 14 years who had receive d medical treatment without transplant surgery. Results: After 4 years , transplants continued to be beneficial to three patients and had bee n of brief transient benefit to the fourth. The course of disease was more benign postoperatively than preoperatively and was more slowly pr ogressive than that in the cohort. Conclusion: Improvement was not suf ficient to justify adrenal transplants as routine therapy but does poi nt the way to the use of other dopamine tissue transplantation.