Brain, Vol. 117, No. 3, 487-499, 1994
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Bilateral motor improvement and alteration of L-dopa effect in two patients with Parkinson's disease following intrastriatal transplantation of foetal ventral mesencephalon
1INSERM CJF 91–02 ‘Neuroplasticité et Greffes lntracérébrales’, Faculté de médecine Créteil 2Service de Neurologie Créteil 3Service de Neurochirurgie Créteil 4Service de Neuroradiologie Créteil 5Service de Psychiatrie, Centre Hospitaller Universitalre Henri-Mondor Créteil 6Service Hospitaller Frédéric Joliot DRIPP CEA, Orsay 7Service Hospitaller Frédérlc Jollot CNRS URA Orsay 8Hôspital Esquirol, Saint Maurice France
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Correspondents to: Pr Pierre Cesaro, INSERM CJF 91–02, Faculté, 8 rue du Général Sarrail, 94010 Créteil, France
Several recent reports have suggested that foetal ventral mesencephallc transplants could alleviate motor symptoms in patients with Parkinson's disease. Expectations of future success must be clarified by precise analysis of the extent and limitation of recovery associated with an assessment of function of the graft using (18F]fluorodopa (18F-dopa) PET. Two patients with idiopathic Parkinsons disease, severely impaired despite optimal medication, have been followed 10 and 17 months after stereotaxic unilateral intrastriatal transplantation of neural cells dissociated from human foetal ventral mesencephalon. Analysis of the clinical evolution complied with the protocol established in the ‘Core Assessment Program for Intracerebral Transplantation’. Both patients have benefited from the transplantation in their daily activities and in motor timed tests, although they still exhibit parkinsonian symptoms and require L-dopa therapy. This is associated with a gradual increase in 18F-dopa uptake at the site of grafting. There are two major clinical changes: (i) a bilateral motor improvement for the speed of movements (the quality of movements improved almost exclusively on the side contralateral to the graft); (ii) a change in the outcome of the L-dopa treatment as exemplified by a postoperative transient period of heavy dyskinesias and subsequent additive actions of the two treatments. These results confirm that neural transplantation may be useful for patients with Parkinson's disease. The improvement recorded on the side ipsilateral to the graft does not match that observed on the contralateral side and it is proposed that bilateral transplantation may be necessary. The existence of a transient postoperative period of heavy dyskinesias suggests that the patients may benefit from a controlled decrease of L-dopa intake after grafting.
akinesia; rigidity; dopamine; graft stereotaxy
Received September 14, 1993. Revised January 4, 1994. Accepted February 12, 1994.
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