[RLSmi]

Several of you on the forum already know about the news reports on a recent publication by neurosurgeon Dr. Paul Jannetta and colleagues. Yesterday, I sat down and talked with a neurosurgeon friend who trained with Dr. Jannetta. We discussed the article and I thought I would post what we reviewed in the article and some of my friend's thoughts about it.

Dr. Jannetta is best known for pioneering the development of what was at the time (mid to late 1980's) a bold surgical procedure performed at the base of the brain for treating trigeminal neuralgia, or TN. The rationale for the procedure, microvascular decompression, or MVD, is based on Jannetta's theory that pulsatile pressure exerted on the trigeminal nerve by an impinging artery causes the excruciating pain of TN. In the operation, through a small opening in the skull at the brain base, the offending artery is gently loosened from the nerve and a small teflon felt "cushion" is placed between them. The openings are then closed and sutured. MVD is currently recognized as the most effective treatment for trigeminal neuralgia.

The recent article, entitled "On the etiology of Parkinson's Disease", includes the description of the treatment of one of Dr. Jannetta's patients, a 60 year old woman suffering from trigeminal neuralgia who also had Parkinson's disease.

Prior to this patients' surgery for TN, Jannetta noticed on the patient's MRI a distortion of the left peduncle, a large bundle of nerves containing many connections to the basal ganglia, known to be where much of Parkinson's pathology is centered. This observation was discussed with the patient and her spouse. Dr. Jannetta was apparently given permission, in addition to the usual treatment for her TN, to do what he felt could be safely done to also help her Parkinson's symptoms. In the operation, after decompression of her trigeminal nerve, Jannetta dissected away the left central cerebral artery from the left peduncle in which it was found to be essentially buried. After inserting a teflon pad between the separated structures, the wound was closed in the usual way.

When the patient awoke from anesthesia, the masked facies and stare was absent, and within a few hours, her tremor was also gone. Within a few days, all of her Parkinson's symptoms as well as her trigeminal neuralgia pain were eliminated. 18 months following the surgery her Parkinson's symptoms returned in full force. Subsquent MRI analysis revealed distortion of her right peduncle. No account of follow up surgery is mentioned in the article.

Much of the article described a subsequent study by the group in which MRI studies of 20 Parkinson's patients were compared to those of a group of 20 healthy controls. The MRIs of the groups were evaluated in a blinded fashion by qualified radiologists for the presence of visible distortions of their peduncles. 78% of the PD group were found to have distortion of one or both of their peduncles. By contrast, only 10% of the controls (2 individuals) had the distortions, and one of those was later diagnosed with Parkinson's.

The apparently strong association of the observed anatomical peduncular distortions with Parkinson's was obvious, and suggestive of a potential surgical treatment for the disease.

My neurosurgeon friend routinely performs the microvascular decompression operation for trigeminal neuralgia which he learned under Dr. Janetta. He is extremely complementary of Dr. Jannetta's reputation and grateful for his mentorship, however he remains less than enthusiastic about the prospects of MVD becoming anything like a routine treatment for Parkinson's. His view of the invasive nature of the procedure, compared with the more proven and developed deep brain stimulation approach is the basis of that opinion.

Robert

[paula_w]

i wonder what the risks are and how many operations he has done? the idea of nerves clumped together is very rational and i'm interested in his clinical trial information. were you given any yet?

[reverett123]

As I noted yesterday, I have developed a keen interest in the role of blood pressure in my brain. I wonder if there is a tie here? Any thing which increases intracranial pressure is suspect - whether errant vasculature or a blow to the head.

[olsen]

I may have posted this before so forgive if so. there is n alternative therapy termed "Atlas profilax" which repositions the 1st cervical vertebrae to decrease pressure on vascular and nerve structures. requires no anesthesia nor invasive proceduresthou not covered by insurance. admittedly a bit weird though have friend. whose migraines werecompletely alleviated with 2treatments. tempted to give this a try thou must convince my husband.

[johnt]

If peduncle compression is in many people the cause of PD, what, if any, is the role of dopamine? Why does levodopa often relieve some symptoms?

John

[paula_w]

here's the PDF. it looks like a thorough study -scroll down

www.pagepress.org/journals/index.php/ni/article/download/ni.../pdf

1. File Format: PDF/Adobe Acrobat -
   by PJ Jannetta - 2011
   Jul 31, 2011 – The. MRI study showed that 73.7 percent of. Parkinson's ...
   

[moondaughter]

Originally Posted by olsen

I may have posted this before so forgive if so. there is n alternative therapy termed "Atlas profilax" which repositions the 1st cervical vertebrae to decrease pressure on vascular and nerve structures. requires no anesthesia nor invasive proceduresthou not covered by insurance. admittedly a bit weird though have friend. whose migraines werecompletely alleviated with 2treatments. tempted to give this a try thou must convince my husband.

NUCCA and Blair are also techniques for repositioning the atlas however require a lot more treatments. My husband prevented back and neck surgery and my son recovered from sports injuries with NUCCA adjustments.

for the first time (my shoulder has been dropped since i was 13 years old and probably before that)my dropped shoulder evened out after an interactive adjustment session last week with my nucca doc adjusting my atlas then my dentist adjusting the mouth guard which slightly opens my mouth....the adjustment only held for a day but i'm hoping i've got it coming my way . i am breathing easier and these procedures are non invasive - next my massage therapist will work with the dentist......see if we can coax the muscles next and get them to release tension and memory...not a quick fix but brings me towards wholeness. the profilax treatment looks a bit more radical to me - guess i just have the habit of doing things gradually.

the atlas (not the sacrum) is the base of the spine and functions as its foundation .

are there any genetic abberations that reflect a luxated atlas in pd?

md

[moondaughter]

Originally Posted by olsen

I may have posted this before so forgive if so. there is n alternative therapy termed "Atlas profilax" which repositions the 1st cervical vertebrae to decrease pressure on vascular and nerve structures. requires no anesthesia nor invasive proceduresthou not covered by insurance. admittedly a bit weird though have friend. whose migraines werecompletely alleviated with 2treatments. tempted to give this a try thou must convince my husband.

er

I'm finding some interesting concepts researching the Atlas profilax method - it has been outliawed here in Oregon for non-chiropracters...but i found this link on Tibetan Rites for those of you yoga enthusiasts that encourage better circulation to the brain.

http://www.mkprojects.com/pf_TibetanRites.htm

no wonder we are all so left brain dominant ....the atlas cradles our skull -we are alll walking around constantly compensating...no wonder we only use a small portion of our brain and locked into fight or flight.

please keep us posted if you decide to do this Madelyn!

md

[lurkingforacure]

RLSmi,

Your neurosurgeon friend is mixing apples and oranges, IMHO. MVD may well be a cure for at least some PWP; all DBS does is manage symptoms (and sometimes not even that, or that well). They are not the same at all and to say DBS is better and preferred over MVD because it is not as invasive (true) or dangerous (probably also true, depending on how the DBS goes), misses the point. Entirely.

I now see why some neurosurgeons are mocking Jannetta on this: liability, pure and simple. MVD around the peduncle, which is what would be involved for us, is much more risky in terms of where you are operating (the life support center, we were told). What neurosurgeon wants to take that on, when he can do a DBS and make almost as much money (or more, I haven't price-shopped this!) with way less risk?

This adds a whole new layer of explanation as to why some things may not be pursued, or if they are pursued, will be available only on a limited basis, by a very limited number of doctors. I hope Jannetta will not be the only neurosurgeon brave enough to step up and help PWP with MVD, assuming it works, of course.

[paula_w]

Originally Posted by lurkingforacure

RLSmi,

Your neurosurgeon friend is mixing apples and oranges, IMHO. MVD may well be a cure for at least some PWP; all DBS does is manage symptoms (and sometimes not even that, or that well). They are not the same at all and to say DBS is better and preferred over MVD because it is not as invasive (true) or dangerous (probably also true, depending on how the DBS goes), misses the point. Entirely.

I now see why some neurosurgeons are mocking Jannetta on this: liability, pure and simple. MVD around the peduncle, which is what would be involved for us, is much more risky in terms of where you are operating (the life support center, we were told). What neurosurgeon wants to take that on, when he can do a DBS and make almost as much money (or more, I haven't price-shopped this!) with way less risk?

This adds a whole new layer of explanation as to why some things may not be pursued, or if they are pursued, will be available only on a limited basis, by a very limited number of doctors. I hope Jannetta will not be the only neurosurgeon brave enough to step up and help PWP with MVD, assuming it works, of course.

i'm kind of confused - are they saying that the vascular compressions progress from one side to the other?