Parkinson’s Patient Gets Brain Graft : UCI Surgeons Try Again After 1st Experimental Surgery Failed
Three months after a woman with Parkinson’s disease died following brain graft surgery, UC Irvine neurosurgeons have performed the experimental procedure again--this time on a 44-year-old San Bernardino County man.
Daniel P. O’Rourke, a contractor from Big Bear Lake stricken by Parkinson’s disease 12 years ago whose condition was steadily worsening, was reported in critical but stable condition under intensive care Friday. He underwent six hours of surgery Thursday at UCI Medical Center in Orange.
“He’s awake. He’s talking to his family. . . . I talked to him and he recognized me,” said Dr. Ronald F. Young, chief of neurosurgery at the medical center and one of four surgeons participating in the complicated operation.
Gland Implanted
The surgery, in which a portion of O’Rourke’s adrenal gland was implanted in his brain, was the latest of more than 50 similar operations performed around the world in the past year in an attempt to reverse the slurred speech, slowed body movements and tremors that often characterize Parkinson’s patients.
Patients with Parkinson’s are deficient in a chemical called dopamine that is normally produced in the brain. A medicine called L-Dopa, a synthetic form of dopamine, can relieve symptoms of the disease, but for O’Rourke and many Parkinson’s patients, the medicine gradually becomes less effective over the years.
O’Rourke’s son Jamie, 23, a senior at San Diego State University, said his father was doing well Friday afternoon and asked his family for a beer.
Although some family members tried to talk O’Rourke out of the risky surgery, Jamie said he and his father agreed several months ago that the operation was probably O’Rourke’s only hope to reverse the progressively disabling disease.
An outdoorsman who loves hunting, fishing and golf, O’Rourke was increasingly disabled by the disease, Jamie O’Rourke said. “He’s had tremors every day for the last year. It was getting to where it was affecting him doing anything.” He said his father hoped that the experimental surgery would help him and eventually other Parkinson’s patients as well.
Just before O’Rourke got on the gurney to be wheeled to the operating room, he was nervous but cheerful, his son said. He waved goodby to his family and announced: “I’m doing this to improve my golf game.”
Doctors actually performed two major surgeries--first removing the adrenal gland from O’Rourke’s abdomen, then cutting open his skull and implanting small portions of the adrenal gland deep within the brain in a cavity called the lateral ventricle.
Young and the other doctors are hoping that the grafted adrenal cells will secrete dopamine--or stimulate other brain cells to produce dopamine--and reverse the course of the disease.
The technique, sometimes called a brain graft or “brain transplant,” was performed by Swedish doctors in the early 1970s with disappointing results.
But international interest in the procedure was reawakened last April when Mexico City neurosurgeon Ignacio Navarro Madrazo and neurobiologist Rene Drucker-Colin reported in the New England Journal of Medicine that two patients with Parkinson’s disease had improved dramatically after brain graft surgery. One of the patients, completely disabled before surgery, was able to speak clearly and dress, bathe and feed himself afterward, they reported.
Seeking to replicate Madrazo and Drucker-Colin’s technique, Young and neurosurgeon Leslie Cahan received permission from UCI’s Human Subjects Protection Committee to perform five experimental brain grafts.
They performed their first brain graft Dec. 18 on a 60-year-old San Bernardino County woman. Though the operation went smoothly and the woman appeared to be recovering, she suddenly suffered cardiac arrest Dec. 31 and died.
The final report of the autopsy, released in mid-February, failed to reveal exactly why she died, Young said. But that death prompted Young and Cahan to postpone similar surgeries while they tried to determine what had happened.
After talking to neurosurgeons around the country, Young learned that “virtually everybody in the country (who performed this brain graft surgery) has had unexplained problems.”
The Mexico City team has operated on 40 patients and had four deaths, Young said. A team from New York University performed brain grafts on several Parkinson’s patients in the past year, one of whom is still comatose, Young said.
Informed of Risks
Also, a University of Tennessee team that performed brain grafts on 10 patients reported that after the operation several of them inhaled food and developed pneumonia, Young said. In addition, the team reported that the experimental surgery apparently failed to reverse the patients’ Parkinson’s symptoms.
After that inquiry, Young and Cahan sent a copy of the autopsy to the Human Subject Protection Committee and decided to go ahead with another brain graft.
O’Rourke and his family were informed of the risks of the surgery, Young said. Although at the last minute some family members “tried to talk him out of it, he was insistent that this was what he wanted to do,” he said.
If O’Rourke recovers without incident, he should be out of intensive care in four to five days and released from the hospital in about 10 days, Young said. But it may be several months before doctors will know if the surgery will help reverse his tremors and other symptoms of Parkinson’s disease.
