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Subject: Long-term Outcomes in PD Fetal Transplants (MovDis Congress 2000) Date: 6/19/2000 E-MOVE reports from the 6th International Congress of Parkinson's Disease and Movement Disorders, held in Barcelona, Spain, 11-15 June 2000. Citation numbers refer to abstract numbers published in Movement Disorders 2000;15 (Supplement 3).Double-blind controlled trial of embryonic dopaminergic tissue transplants in advanced Parkinson's disease S Fahn M114 Fetal transplants for Parkinson's disease can lead to modest improvement in motor scores for younger patients, but at the risk of unpredictable and disabling dyskinesias, according to this platform presentation by Dr. Stanley Fahn. Fahn presented results from a double-blind study and long-term, open-label continuation. Forty patients were randomized to receive either fetal implants or sham surgery. Results at one year showed significant, modest motor improvements as determined by "off" UPDRS scores, in patients younger than age 60, with the majority of improvement in rigidity and bradykinesia. Older patients did no show significant improvement. "Freezing and gait did not improve, and if anything, they got worse in older patients," Fahn said. Two thirds of operated patients, but no sham patients, showed improved PET scans of the putamen, which was correlated with motor improvements in young, but not old, patients. Acute significant adverse events were statistically significantly higher in operated patients, but not related to the procedure, according to Fahn. One patient who died due to accidental injury in a storm showed about 5% cell survival on autopsy. Following the breaking of the blind, 14 sham-operated patients received open-label implantation. Analysis of all operated patients with follow-up of 16-36 months showed younger patients continue to improve. Older patients have shown some improvement, "but follow-up lengths are still short, and there is also no more blind," noted Fahn. Nine of 33 operated patients report being better than before surgery. However, Fahn went on to report the late emergence of unexpected, disabling "off" period dyskinesias in 4 patients. Patients have shown arm and leg dyskinesias that interfere with activities of daily living and walking, as well as facial dystonia. Some patients had difficulty swallowing, with one requiring a gastrostomy tube. "These patients are not on medicines, but are still having dyskinesias. We've never seen that before in Parkinson's disease," Fahn said. Fahn concluded, "We've established the proof of principle, that bradykinesia and rigidity can be helped with surgery. However, we did not anticipate these "runaway dyskinesias," and if I knew they were going to occur, I would not have done the study. Until we can figure out how to prevent or control them in animal studies, I can't recommend this procedure." E-MOVE Editor: Richard Robinson, NASW, WE MOVE
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