With the success of experimental subthalamic lesioning, the obvious
next step was to begin precise radiation therapy treatment to the same area
in humans. To accomplish this, DeLong turned to his neurosurgical
partners, particularly as he transferred his practice and lab to Emory
University. Immediately, the results were positive.
Neurosurgeons had been performing “functional surgical intervention”
for epilepsy patients in the few years before the first “pallidotomy”
(selective lesioning of a part of the basal ganglia) at Emory in 1992.
Previous attempts at thermally damaging parts of the brain, had, on
occasion, led to disastrous results, leaving patients drooling, depressed,
and barely speaking. And because these interventions had been performed
with intentional permanent destruction, there was no going back. DeLong
had reasons to be optimistic in 1992, however, including the assurance that
the precision of brain imaging and electrophysiological mapping
techniques were considerably better than they had been in the decades
before.
Experimental surgery is at once defined by bold and visionary
practitioners, desperate patients, courageous families, and the (necessary)
passage of time to prove its efficacy. The initial slow trickle of patients in
the preliminary years turns into an ever-growing influx of patients who are
unwilling to be victimized by their disease. Pioneering surgeons mandate
that the original cohort of patients be followed for a few years before it
seems prudent to conduct a comparative study, which then requires a few
years to organize and enroll enough patients to draft a manuscript. Many
months of editorial jousting are consumed before publication is finally
achieved. Thus, it is no surprise that a decade passes before a randomized
study of an experimental operation (versus medical treatment alone)
appears in a medical journal, which is the timeline that occurred in the
case of pallidotomy. The Emory group published their article in 2003,
revealing the superiority of surgical intervention over medical treatment
in PD.^29
During the 1980s, DeLong and his partners became expert in passing
tiny electrodes into the deepest parts of the brain. These wires were meant
for monitoring the firing pattern of the neurons at the tip of the electrode.
What if a surgeon intentionally left the electrode in place, and then, boldly,
experimented with the application of an electrical current at various
frequencies? Probably impossible to perform in America, the land of