- The patient must have previously responded to L dopa well and there should be no dispute about the diagnosis. Parkinson’s plus syndromes which have Parkinson and some other atypical features are not desirable. Nor added dementia etc.
- The patient must have had a proper drug trial and having initially responded now the effects are not satisfactory and various methods of trying to improve medicals results have failed.
- If one of the major problems is drug (L dopa) induced dyskinesia and that is causing it difficult to trat, that is an ideal candidate because undoubtedly one advantage of surgery is that drug induced chorea/dystonia disappears and thus we can use more L dopa for further control.
- The patient must realize that drug treatment will have to continue but control will be smoother. Subsequent failure of surgical affects is also likely.
- The patient must not be too old or too infirm to benefit long term.
- The last stimulus to advance in medicine is of course competition. The best centre in the world is believed to be in France where patients come from all over the world for surgery and doctors to learn the technique. The placement of the lesion is done by Robots. From France we have surgeons who have worked there and come to India and are doing stereotaxy for Parkinson’s in Trivandrum and Mumbai etc. In Pune, the first surgery was done at PIN, but now there are fledging units at JNH, RHC and soon in Poona Hospital. My experience in case is not too impressive. One done in the US failed and has a hemiplegia. Another done in the US is not too happy, though surgeons say the result is satisfactory. Two went earlier to Mumbai and Trivandrum and were turned down. But one last week, I hadn’t sent for surgery, came back after his operation was done! He learned of the surgery, and has taken the chance himself and relations seem happy (I haven’t seen him yet). Patients of Parkinson’s are now regularly asking is not there something else when medicine is no longer useful? And in truth there is. This then is the way medicines advanced in the last half century. An idea (Brain’s) a little luck (chance), Experience (i.e hard work carefully documented) more ideas, Technology, more Technology and Competition (ego, money!) and that is the way medicine goes round and round and spirals forward.
- What of the future of Parkinson’s disease? Long ago I had read that there are stages in the advances in medicals treatment. The halfway stage is one which is difficult to do, very costly, requires expertise and is not available to all. The final stage is one which is simple, cheap and available to all and causes the disease to decline and go. The iron lung for Polio and the distribution of ventilators in all hospitals was the halfway stage for Polio. Now with the Polio vaccine we are at the end goal and target year 200 for eradication is near. Looked at this way CABG, dialysis, transplant, stereotaxy, deep brain stimulation is halfway stage. The end goal appears far away but will come with a medical therapy the nature I do not know. A neuromodulation? a neurotransmitter? a free radial scavenger? a preventive strategy? Once again the wheel of medicine will turn full circle and the museum. And then – then who knows. For was not Chloromycetin the end stages of enteric fever and DDT the end stage for malaria? And small pox vaccine the end stage of small pox.
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