 
|
|||||||||||||||||
              
|
Pursuing the possible UPMC neurosurgeon's taste for exploration led to groundbreaking stroke research Tuesday, March 30, 1999 By Ellen Mazo, Post-Gazette Staff Writer
Just hours after doctors at UPMC Presbyterian bored a hole through Sylvia Elam's skull so Dr. Douglas Kondziolka could inject new cells into her brain, she was sitting up eating lunch, eager to see her neurosurgeon. Her husband, Ira, gently prodded her when Kondziolka appeared: "Tell the doctor what you told me. You know - what you felt when you were eating lunch."
She raised her hand and gently touched the right side of her face. "I feel something," she said, slowly and deliberately. "My face feels all right. It feels like it's all right."
From the moment Sylvia Elam, now 65, suffered a stroke almost six years ago, she has struggled to regain speech and mobility on her right side, much of which remained numb. With intensive therapy, she relearned speech patterns and how to walk in a limited way. But she had not regained her sense of touch.
Earlier this month, her husband brought her to Pittsburgh from their home in Scottsdale, Ariz., with dreams of a cure.
On March 9, she became the 12th patient to receive a brain cell transplaplant by Kondziolka, the last patient in the first phase of a medical trial to determine the safety of the revolutionary procedure.
"She kept saying to me, 'I can feel my face. I can feel my face,' " Ira Elam said to Kondziolka. "What do you think? Maybe this worked."
"Anything's possible," Kondziolka said. "I'm always willing to be amazed by my patients."
Hope and determination
Kondziolka, who for the first time is giving stroke patients real hope that their damaged brains may be rejuvenated, is as dazzled by his patients' determination as they are by this new procedure.
At only 37, the Canadian-born Kondziolka (pronounced KON-zee-OL-ka) has performed hundreds of intricate brain surgeries at the UPMC Health System. But none has had the impact of this pioneering brain cell transplant that made international news last summer and has drawn inquiries from thousands of stroke patients from around the world.
More than 700,000 Americans are felled by strokes each year, with almost half of the survivors permanently disabled.
Scientists didn't know how risky the procedure could be, whether it could cause brain swelling or even trigger a second stroke.
But so far, reports are encouraging. There have been no ill effects, and even some signs of ever-so-slight improvements in patients. Fists clenched for years have become unclenched. And patients have reported some movement from previously stiff limbs and some minor senses of touch.
It is far too early to know what, if anything, those changes mean, Kondziolka says.
There is no doubt that a lot of people are praying that these cells will produce a kind of magic by growing into neurons that reverse stroke symptoms.
Kondziolka is among them.
Born in Montreal and reared in Toronto, Kondziolka was only 12 years old when doctors in New York City noticed some unusual cells in the tumor of a 22-year-old man with testicular cancer.
What was unusual about the cells was the way they would divide into other kinds of cells. Doctors froze some for future study.
That study began years later, when Layton Bioscience Inc., in Atherton, Calif., developed a chemical process to transform the cells into nerve cells. They found that the neurons, when injected in the brain, began to develop into different types of brain cells.
Scientists tested the cells on monkeys, rats and mice and found that the neuron transplants reversed cognitive and motor deficits in the animals that had suffered strokes.
In early 1997, representatives from the company came to UPMC - ready for surgeons to treat patients.
Kondizolka, who joined Pitt in 1989, attended the meeting. They talked. Kondziolka was intrigued.
"This is exciting, even though we don't really know what to expect," Kondziolka said. "Everybody in neuroscience has been thinking about this for years and years. This made sense for me to try. My practice is high-tech funny stuff, using a computer to probe the brain with minimally invasive surgery. That's why I came here."
UPMC received federal approval in the fall of 1997. Kondziolka was ready to go.
An early fascination
Exploration of possibilities is as much an avocation as it is a vocation for the doctor. With his father an engineer and his mother a teacher, Kondziolka became fascinated as a teen-ager with the study of the brain. Then, during his freshman year at the University of Toronto, Kondziolka decided to study tropical diseases.
Colleagues and friends described the seemingly calm Kondziolka as driven to understand every subject he pursued. Helping out the scientists with some research at the school, Kondziolka discovered a fish parasite on minnows.
The scientists named the parasite Myxobolous Kondziolkai.
During his first year at the university's medical school, Kondziolka was enamored of obstetrics.
"My interests kept changing, but I went back to my original plan - to become a neurosurgeon," he said.
He developed a specialty in radiation oncology and Pitt recruited him for a two-year research program 10 years ago, at a time when many young doctors were entering the increasingly high stakes field of neurosurgery. He began to hone his skills in minimally invasive forms of surgery.
Kondziolka never planned to stay. He became engaged two weeks before arriving in Pittsburgh.
He and his wife Susan, 38, a former operating room scrub nurse, now live in O'Hara with their two sons, Alex, 7, and Max, 5. The family likes to spend winter weekends skiing in nearby Hidden Valley. Kondziolka has embraced the Steelers football team and replaced hockey with golf and skiing as his favorite athletic activities.
"This is home," said Susan Kondziolka.
A slow start
Given the overwhelming interest now from stroke patients, it might be hard to believe that when Kondziolka was ready to perform the first brain cell transplant last year, he couldn't find a patient.
"Nobody had ever put a stroke patient on a list," he said. "We had nowhere to start. Stroke patients are treated when they come into the hospital, and then they're sent home to carry on. It's more rehabilitation than anything."
Moreover, Kondziolka needed a patient who had not had a massive stroke, but one that injured only a portion of the brain.
"We couldn't just inject neurons anywhere. It would be like shooting into the wilderness," he said. "We had to know exactly where we were pointing the cells."
Then one day, the husband of Alma Cerasini, who was 62, arrived at the hospital. He wanted help for his wife, who had lost her ability to move her right side following a stroke in September 1997. The meeting was serendipitous.
The Cerasinis have declined interviews, but Kondziolka reports that the operation was considered a success because Alma Cerasini tolerated it.
Emory University's Dr. David Barrow, president-elect of the Congress of Neurological Surgeons, praised Kondziolka's procedure.
"Yes, it's completely unproven," Barrow said. "So it's important that Doug is the one doing this. He is a scientist. He's not misleading anyone. There's no grandstanding or embellishment."
To the contrary, Kondziolka is careful to emphasize that these are only the early stages of something that could turn out to be miraculous - or that could be nothing more than a dream.
"Just the concept of making brain cells somewhere else, shipping them here and keeping them in a freezer, thawing them, putting them in a tube and walking them to the operating room is a huge achievement," Kondziolka says.
"Once we showed that frozen cells are as good as using fresh cells - that opened up the potential that they could go to everyone. Not just the hospitals with the facilities to make fresh cells."
Pitt is now preparing for the second phase of the transplant trial, which will focus on reversals of stroke. The desks outside his Oakland office are piled high with medical records from stroke victims hoping to be among the 60 patients in the second phase.
Kondziolka expects that by next year trials will be conducted at university centers throughout the United States.
"We hope and pray that this operation can eventually be extended to every stroke victim in the world," said Ira Elam, the husband of the most recent transplant patient.
"It's been a privilege for Sylvia to be patient No. 12. If it hadn't been for Dr. Kondziolka, we wouldn't have had any hope at all. Now, there's hope. And not just for us."
New adventures
In the meantime, Kondziolka's future explorations may not be in the operating room, but at the North Pole.
Intrigued with historical accounts of Arctic adventures, the neurosurgeon traveled there last summer to get a first-hand look at the exquisite landscape and wildlife.
His home study is piled high with pictures, books and maps.
"Doug's already got the boys interested, so I'm sure they'll be going with him at some point," said his wife.
Not surprisingly, she said, he is intrigued with areas still largely unexplored.
|
||||||||||||||||
