Trial Parkinson’s Operations Done at 2 S.D. Hospitals

Teams of surgeons at two San Diego hospitals simultaneously performed experimental brain surgery on two patients Tuesday, transplanting parts of the adrenal gland to the brain in an attempt to cure Parkinson’s disease.

The procedure, first done in the United States in April and never tried previously in San Diego County, represents the first time that doctors have grafted new tissue into the brain in hopes of generating missing chemicals.

The purpose of the transplants is to try to produce dopamine, a brain hormone lacking in people with Parkinson’s. The adrenal gland, attached to the top of the kidneys, also produces dopamine and may continue to do so when implanted in the brain.

“If this works and proves to be effective, it opens up a whole host of things to be considered,” said Dr. Brian Copeland, a neurosurgeon who performed the procedure Tuesday at Scripps Clinic & Research Foundation. Copeland said other diseases, such as Huntington’s disease, might be subject to similar treatment if it is shown that transplanted tissue will take root and function in the brain.

Causes Tremors

Parkinson’s disease afflicts an estimated 1.5 million Americans, most of them over age 50. The absence of dopamine, which helps transmit messages between brain cells, causes severe tremors and difficulty in movement.

Conventional treatments for Parkinson’s center on a drug called L-dopa, which replaces the missing dopamine. But most patients develop a tolerance for the drug, requiring increasing amounts until it ceases to be effective.

On Tuesday, Copeland and Dr. Karl Herwig, a Scripps urologist, removed the left adrenal gland from the flank of a 56-year-old Southern California man, pared off its outer layer, and placed its core in a small repository in the center of his brain.

The operation took an hour and 55 minutes. Herwig removed the gland while Copeland cut a hole in the skull and a pathway into the brain. The adrenal tissue remained outside the body for less than five minutes, Copeland said.

No Complications

He said the operation went smoothly and there were no complications. However, he said he will not know for at least four to six weeks whether the tissue has taken root and is generating the chemicals that could restore the patient’s brain function.

“I would not be surprised if we find that in some cases the adrenal takes and grows and in others it does not,” said Copeland. He said Scripps plans to perform a second transplant on another patient next Tuesday and has several patients under consideration.

Meanwhile, surgeons at UC San Diego Medical Center performed a similar operation on an woman with Parkinson’s disease. Sheri Smith, a hospital spokeswoman, said Tuesday afternoon that the patient, whose identity was not disclosed, was in satisfactory condition.

UCSD officials declined Tuesday to give further details about the surgery, which was led by Dr. Hoi Sang U and had been expected to last four to five hours. Smith said details will be available at a press conference scheduled for this morning.

Hospital officials said the timing of the two operations was coincidental.

Earlier this year, UCSD officials had said they were planning an adrenal transplant for the fall. When Scripps announced last week that it would do its first on Tuesday, UCSD officials insisted that they still had not set a date.

One UCSD official said the center had planned to do the operation quietly, waiting to go public when the outcome was clear. When Scripps elected to operate the same day, the university decided to release its information simultaneously.

“The thinking was that we were going to go about this in a very careful way . . . without regard to who in San Diego did it first or who made the biggest splash,” said Nancy Stringer, a UCSD spokeswoman.

Adrenal tissue transplantation was pioneered by doctors at Centro Medico La Raza in Mexico City. Those surgeons and others in Beijing have reported dramatic improvements in most of the patients on whom they have tried the procedure.

Other Operations

It was first done in the United States in April at Vanderbilt University in Nashville. Since then, it has been done in Chicago, New York City and Tampa, Fla. In July, surgeons at Los Angeles County-USC Medical Center performed the first implant in California.

According to Copeland, he placed pieces of the core of the adrenal gland in the patient’s brain in a “bed” little larger than the eraser on the tip of a pencil. He then used a combination of blood clotting materials as a “biologic epoxy” to hold the graft in place.

Finally, he covered the hole and the graft and replaced the small chunk of skull he had removed to reach the brain. The surgeons left a catheter running from the graft to outside the skull under the skin, to remove excess fluid from the bed.

That catheter will allow the patient’s doctors to study fluid from around the graft to see whether the adrenal tissue is generating brain chemicals such as dopamine. Those tests should indicate whether the graft is having the desired effect.

The patient, who has not been identified, is expected to remain hospitalized for a week to 10 days. Copeland said the man may return to work in four to six weeks but will be expected to return to Scripps monthly for follow-up work.

Before the operation, the man feared that he was on the verge of losing his job because of difficulties walking and writing, Copeland said. His speech had slowed, in spite of four medications he had taken over the seven years.

“We’re hoping that he will be functional and able to maintain his job at work,” Copeland said. “ . . . One would guess that this isn’t going to be a complete cure. A more realistic goal is to get functional improvements.”

Scripps had announced last week that it intended to perform its first adrenal tissue transplant on a 63-year-old man. Copeland said the hospital instead decided to operate first on the 56-year-old and will do the other patient next Tuesday.