Status of Fetal Tissue Transplantation for the Treatment of Advanced Parkinson Disease

Paul E. Greene, M.D., Stanley Fahn, M.D.

Disclosures

Neurosurg Focus. 2002;13(5) 

In This Article

Conclusions

The results of this study indicate that fetal mesencephalic grafts implanted using the aforementioned techniques and without immunosuppression, can be safely performed. In the majority of cases the grafts survived and produced dopamine, as reflected by improved in fluorodopa PET signal. The grafts were also associated with improved motor function in the off-medication state in younger patients but not in patients older than age 60 years, the typical age range for PD. Motor fluctuations in response to medications were the motivation for seeking surgical therapy in our patients, and these did not improve. Finally, some patients, particularly those with the most dramatic improvement, developed disabling dyskinesias and dystonia persisting in the absence of medications, probably caused by the fetal grafts. Examination of PET studies obtained in the patients with dyskinesias suggested that focal excess graft-produced dopamine caused the troublesome involuntary movements. We cannot determine from this study whether alternative techniques of fetal tissue processing or implantation will produce greater benefit without uncontrollable dyskinesias or whether there are some identifiable patients with PD (such as those with early-or mild-stage disease) who might fare better with fetal tissue grafting. Only further controlled studies can answer these questions.

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