SHORT-TERM AND LONG-TERM SURVIVAL AND FUNCTION OF UNILATERAL INTRASTRIATAL DOPAMINERGIC GRAFTS IN PARKINSONS-DISEASE

Six patients with Parkinson's disease were followed for 10 to 72 month s after human embryonic mesencephalic tissue from four to seven donors was grafted unilaterally into the putamen 14 patients) or putamen plu s caudate (2 patients). After 8 to 12 months, positron emission tomogr aphy showed a 68% increase of 6-L-[F-18]-fluorodopa uptake in the graf ted putamen, no change in the grafted caudate, and minor decreases in nongrafted striatal regions. There was therapeutically valuable improv ement in 4 patients, but only modest changes in the other 2, both of w hom developed atypical features. Patient 4 was without L-dopa from 32 months and had normal fluorodopa uptake in the grafted putamen at 72 m onths. Overall, the L-dopa dose was reduced by a mean of 10 and 20%, ' 'off'' time was reduced by 34 and 44%, and the ''off'' phase Unified P arkinson's Disease Rating Scale motor score by 18 and 26%, and the dur ation of the response to a single L-dopa dose increased by 45 and 58% during the first and second years after surgery, respectively. Rigidit y and hypokinesia improved bilaterally, but mainly contralateral to th e implant. No consistent changes in dyskinesias were observed. We conc lude that transplantation of embryonic mesencephalic tissue leads to h ighly reproducible survival of dopaminergic neurons, inducing clinical ly valuable improvements in most recipients.