Experimental Parkinson’s Surgery Set at Scripps

A team of surgeons at Scripps Clinic and Research Foundation in San Diego will begin treating Parkinson’s disease patients this month with an experimental form of brain surgery that has sparked controversy worldwide.

The private, nonprofit biomedical research facility announced Monday that its first adrenal gland transplant is scheduled for a week from today, when Scripps surgeons intend to remove the gland from a 63-year-old man’s flank and transplant it to his brain.

The procedure will be the first ever done in San Diego County. The operation was first performed in the United States in April at Vanderbilt University in Tennessee and has since been done at Los Angeles County-USC Medical Center.

It was pioneered by doctors at Centro Medico la Raza in Mexico City. Those surgeons and others in Beijing have reported dramatic improvements in most of the 27 patients on which they have tried the procedure.

Afflicts 1.5 Million

Parkinson’s disease afflicts an estimated 1.5 million Americans, most of them over age 50, causing severe tremors and difficulty in movement. It is caused by a deficiency of the brain hormone dopamine, which helps transmit messages between brain cells.

The adrenal gland, which is attached to the top of the kidneys, also produces dopamine. Researchers hope that, by transplanting all or part of an adrenal gland to the brain, they might make it possible for dopamine to reach the brain cells.

Officials at Scripps said Monday that their first patient will be a 63-year-old man with a five-year history of deterioration from Parkinson’s. They said traditional medication has failed and he is confined to a wheelchair or walker. The man’s identity was not disclosed.

Dr. Brian Copeland, the Scripps neurosurgeon who will perform the operation, said that in addition to removing the gland from the man’s flank, the procedure entails cutting a piece of bone out of his scalp and making a hole in his brain to get access to its center.

Transplant to Cavity

There, in a fluid-filled cavity called the brain ventricle, Copeland said, he will transplant the gland. At the base of the cavity is the so-called basal ganglion, the area affected by Parkinson’s disease.

Copeland said he and other researchers at Scripps intend to measure the patient’s brain chemicals monthly. If the operation is successful, and the gland takes root and functions, dopamine and other chemicals should appear in his spinal fluid.

“We anticipate it will take four to six weeks before we see some growth,” said Copeland. He said it could take two years of performing the procedure on other Parkinson’s patients before his team would have an idea whether the procedure could be effective in the long run.

A second operation on another Parkinson’s patient is scheduled for Sept. 15, said Andrew Jowers, a spokesman for Scripps. A third patient is also waiting for the procedure but no date has been set.

UCSD Discloses Plans

Researchers at UC San Diego School of Medicine also intend to begin doing adrenal tissue transplants this fall. Leslie Franz, a spokeswoman for the school, said Monday that the plans of Dr. Hoi S. U have gained the approval of the university’s Human Subjects Committee for such an operation, but no date has been set.

The adrenal gland transfer technique has been tested extensively over the past decade in animals such as rats and mice, in which Parkinson’s disease manifests itself differently than it does in humans. Many scientists have argued for expanded animal and primate testing before trying the procedure on humans in the United States.

In the animal tests, researchers found the procedure especially successful when they used adrenal tissue from fetuses, Copeland said. However, he said, there are grave ethical and legal constraints against using human fetal tissue in the United States.

Copeland and others predict that researchers abroad will shortly begin testing the procedure on humans using fetal tissue. Anti-abortion groups, fearing the possibility of medical research being used to justify abortion, intend to fiercely opose such practices in this country.

Copeland said the procedure being tried at Scripps, using the patient’s own adrenal gland, is allowed only for patients for whom conventional treatments have failed. “It would never be used on a patient who has not had a trial of medicines,” he said.