NEW YORK, Oct. 14 (UPI) -- A new brain surgery technique from Cuba can provide long-lasting relief from the stiffness and pain suffered by Parkinson's disease patients, which conventional medicines treat only with difficulty, researchers said Monday.
Significant improvements were apparent immediately in most patients after their operations and have lasted as long as two years, the researchers said. The surgery also reduced by 70 percent the need for the drug levadopa, which patients took daily, greatly alleviating side effects of such therapy.
"The (surgery) patients could tolerate going off medication far longer than others. That's a significant cost saving over a lifetime," collaborator Jorge Juncos, a neurologist at Emory University in Atlanta, told United Press International.
Juncos and colleagues presented the Cuban findings at the American Neurological Association's annual meeting. The Cuban research team was unable to attend due to a combination of hurricane damage and difficulty obtaining U.S. visas.
Parkinson's disease attacks the nervous system, afflicting more than 1 million Americans with muscle rigidity, trembling, impaired movement and poor balance. It appears to kill brain cells that produce dopamine, a biochemical that enables people to move normally and smoothly.
The team at the Clinic for Movement Disorders in Havana, led by neurologist Lazaro Alvarez, studied patients in the middle and later stages of Parkinson's disease, some of whom had problems with manual dexterity or posture, symptoms that conventional medications control poorly.
The new procedure surgically destroys two small clusters of brain tissue known as subthalamic nuclei, which normally help control body movements and are overactive in Parkinson's disease.
Although surgery for Parkinson's has been tried before, Juncos explained, only relatively primitive hit-or-miss techniques were available. "It was a bit of a crap shoot," he said. "With its erratic results, (surgery) had fallen out of favor."
Other techniques, which have become more prevalent in the United States and which do lower the risk of significant side effects, include deep brain stimulation. It involves implanting devices similar to cardiac pacemakers that emit electrical pulses to inhibit aberrant brain cells. Effective as deep brain stimulation is, it is quite expensive and the devices are subject to mechanical failures, Juncos said.
"Much of the approaches we follow in the United States are technology-driven," Juncos said. "In Cuba, they don't have access to the technology."
The surgery was developed by electrophysiologist Raul Macia and neurosurgeon Gerardo Lopez. They refined subthalamaic nuclei surgery by mapping out the brain beforehand using magnetic resonance imaging and electrodes, then searing the subthalamic nuclei using probes with millimeter-wide tips that heat quickly.
"It coagulates the proteins. It's like cooking an egg," Juncos said.
The researchers studied 18 patients who had received the procedure. Two years later, those patients fared 50 percent better on movement tests than they had before surgery. They also suffered no permanent defects in speech or thinking.
"We are not satisfied we can recommend this willy-nilly until others get the same results," Juncos cautioned. "The effect you have is going to be irreversible or near-irreversible."
The researchers said they want to compare the procedure against deep brain stimulation in terms of effectiveness and cost. It also remains unclear whether these clinical benefits are derived solely from removal of the subthalamic nucleus or possibly from taking out other surrounding tissue as well.
"It looks like a well-done study," neurologist Arnold Starr at the University of California at Irvine told UPI. Although the results "may be statistically significant for the group, for the individual there may be too much variability," he said.
