This study is designed to assess the efficacy of adrenal medullary autografts in patients with severe Parkinson's disease. The patients selected will have Stage IV disease, but still show some response to oral dopamine replacement therapy. They will undergo extensive testing pre-operatively including gait, posture, reaction time, speech, and neuro-psychiatric assessment. Cavities will be created in the right caudate nucleus via a transcallosal approach, and a ventricular reservoir placed. Two weeks later one adrenal gland will be removed, and placed into the preformed cavity. The pre-operative testing will be repeated at regular intervals after implantation. CSF biochemistry and 6-fluorodopa PET studies will also be part of the testing carried out. One patient has been studied thus far. He has shown mild improvement with reduction of the severity of his on/off fluctuations. In addition, he has had a lessening of the dyskinesias which limit his tolerance for oral therapy. The CSF studies have revealed an elevation of enkephalin compared to preoperatively. Other patients are under evaluation for entry into the protocol.
