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Clinical, biochemical, and neuropathologic findings following transplantation of adrenal medulla to the caudate nucleus for treatment of Parkinson's disease

Department of Neurology, Baylor College of Medicine and the Methodist Hospital, Houston, TX (Drs. Jankovic, Pirozzolo, and Schneider)
Department of Neurosurgery, Baylor College of Medicine and the Methodist Hospital, Houston, TX (Drs. Grossman and Zhu, and S. Martin)
Department of Pathology, Baylor College of Medicine and the Methodist Hospital, Houston, TX (Dr. Goodman)
Department of Urology, Baylor College of Medicine and the Methodist Hospital, Houston, TX (Dr. Scardino)
Department of Medicine, Baylor College of Medicine and the Methodist Hospital, Houston, TX (Drs. Garber and Jhingran)

We transplanted autologous adrenal medullary tissue into the caudate nucleus of 3 patients with advanced Parkinson's disease. The 1st patient, a 59-year-old man with parkinsonian symptoms for 15 years, had mild improvement in his motor functioning after the operation. However, his postoperative course was characterized by prolonged drowsiness and complex visual hallucinations. The patient died suddenly 8 months after the transplant, and an autopsy revealed coronary atherosclerosis. Examination of the graft site showed necrotic adrenal medullary tissue surrounded by inflammatory cells. The 2nd patient, a 50-year-old man with a 21-year history of parkinsonian symptoms, unproved the most after the procedure. The 3rd patient, a 43-year-old man with 12 years of parkinsonian symptoms, had mild improvement in his motor functioning. CSF homovanillic acid increased postoperatively in the 3 patients, but then returned to preoperative levels in all except the 2nd patient. The anatomic, neurochemical, and physiologic basis for the modest clinical improvement shown in these patients is not yet understood.

Address correspondence and reprint requests to Dr. Jankovic, Department of Neurology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030.

Received January 18, 1989. Accepted for publication in final form March 23, 1989.

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