great article. i'd hate to think i had to lay still
for eight hours. i wish my mom could have had this
option.

--- Meir Weiss <[log in to unmask]> wrote:

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https://www.hadassah.org/pageframe.asp?section=news&page=per.html&header
> =per&size=50
> Medicine:
> Brainstorm for Parkinson's
> By Wendy Elliman
>
> It's a disabling disease, but Hadassah physicians
> have developed a
> deep-brain stimulation technique that ameliorates
> Parkinson's symptoms.
>
>
> Photo by Debbi Cooper
>
> Larisa Korvan is hoping desperately that Hadassah
> neurosurgeon Zvi
> Israel will add her to his waiting list. Although
> the procedure for
> which she hopes to qualify is only a few years old,
> although its cost is
> not covered by her health insurance, and although it
> will require her
> spending at least eight waking hours lying
> rock-still while surgeons
> drill her skull and reach into her brain, she wants
> this as much as she
> has ever wanted anything. "My Parkinson's symptoms
> were beginning while
> I was still in Ukraine," she says. "But it wasn't
> until after we moved
> to Israel 12 years ago that they became bad enough
> for me to take
> notice."
> Steady progression of the disease has now frozen
> Korvan's face into the
> typical, expressionless mask of Parkinson's disease.
> It has made her
> muscles rigid, her balance poor and all but taken
> away her fine-motor
> control. She suffers constant tremors and increasing
> difficulty in
> walking.
>
> While medication controlled the symptoms of this
> chronic movement
> disorder for several years, their side effects have
> become almost as
> debilitating as the illness itself.
>
> "I'm only in my sixties," she says. "I have children
> and grandchildren
> to live for. This new procedure is my only
> solution."
>
> A decade ago, as Korvan's illness was taking hold,
> this solution did not
> exist for her or for millions of others (about a
> million and a half in
> the United States; about two per thousand in Israel)
> afflicted by the
> crippling, progressive neurodegenerative disorder.
> Its development owes
> much to the work of Israeli physiologist Dr. Hagai
> Bergman of the Hebrew
> University-Hadassah Medical School, a member of the
> team that would be
> involved in Korvan's treatment. It was Dr. Bergman,
> probing the
> subthalamic nucleus, an area deep in the brain only
> millimeters in
> diameter, who discovered it to be overactive in
> Parkinson's disease and
> that when inactivated, all major symptoms are
> ameliorated.
>
> "Neurosurgeons have been searching for surgical
> solutions to Parkinson's
> for a hundred years," says Dr. Israel, of the
> neurosurgery department at
> the Hadassah-Hebrew University Medical Center at Ein
> Karem. "Parkinson's
> surgery, however, hit a long hiatus in 1967 with the
> appearance of
> L-dopa. L-dopa is a very successful medication but
> it, too, has side
> effects and ultimately loses its effectiveness."
>
> In 1982, a chance occurrence set in motion a shift
> back to surgery, but
> in a new form that has already restored to thousands
> of Parkinson's
> victims their quality of life. In that year,
> California emergency rooms
> were suddenly seeing young patients suffering an
> acute and irreversible
> syndrome that resembled Parkinson's. It turned out
> all were drug users
> who had bought from a batch in which a certain
> chemical had been mixed.
> The chemical was isolated and used to create, for
> the first time, a
> laboratory model of Parkinson's. Investigation could
> now begin in
> earnest.
>
> Among the researchers was Dr. Bergman, then in the
> United States doing
> postdoctoral study. Working with monkeys, he ablated
> or burned away the
> overactive subthalamic nucleus and strikingly
> reduced their Parkinson's
> symptoms. In 1993, ablation was replaced by the less
> risky procedure of
> delivering electrical stimuli to the subthalamic
> nucleus via implanted
> electrodes.
>
> The Food and Drug Administration approved this
> technique in 2001, and
> the three years since have seen an exponential
> growth in this therapy
> worldwide.
>
> In summer 2001, Dr. Israel returned to Israel
> following a two-year
> fellowship at the Oregon Health and Sciences
> University in Portland.
> Armed mainly with determination-no additional budget
> was available-he
> set about creating a deep-brain stimulation program
> that has made
> Hadassah Israel's leading functional neurosurgery
> center.
>
> "I started by building a multidisciplinary team,"
> Dr. Israel explains.
> "It comprises myself, three neurologists, a
> neuropsychologist, a
> physiotherapist and Dr. Bergman. It's a team that
> has proven very
> productive in both research and clinical work."
>
> His next step was acquiring the equipment. A
> $180,000 grant from the
> Nash Family Foundation bought microrecording
> equipment. The navigation
> computer, which the team uses to locate the
> subthalamic nucleus,
> however, dates from 1997. "To calculate programming
> coordinates and
> design a treatment plan should take 10 minutes," Dr.
> Israel says. "It
> often takes up to two hours because of this dated
> hardware. We need
> $130,000 to replace it."
>
> In January 2003, the team performed its first
> deep-brain stimulation.
> Like the 15 performed since then, this treatment,
> which still is too new
> to have more than a 10-year follow-up, was a
> complete success.
> "Neurologists tend to be very conservative," says
> Dr. Israel, "but we're
> receiving referrals from all Israel's major
> neurology centers, as well
> as referrals from abroad."
>
> The number of applicants increased in spring 2004,
> when Israel
> Television showed one of Dr. Israel's Parkinson's
> patients prior to
> surgery and again two weeks afterward. The dramatic
> improvement
> generated over a hundred inquiries a day for the
> week following the
> broadcast-Larisa Korvan's among them.
>
> "This treatment isn't appropriate for all patients,"
> says Dr. Israel.
> "We must be careful in our selection. Depression,
> dementia or other
> illnesses will exclude some. Age may exclude others,
> although we try not
> to make it a limiting factor."
>
> None of this applies to Korvan. If her wish is
> realized, she will be
> admitted to Hadassah the day before the procedure
> and her medication
> will be halted. At 6:30 the next morning she will go
> to the operating
> room, where a three-dimensional frame will be fitted
> around the outside
> of her head. Her brain will be scanned and the image
> obtained combined
>
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