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July 10, 1996

A 61-Year-Old Man With Parkinson's Disease

Author Affiliations

Case Western Reserve University School of Medicine MetroHealth Medical Center Cleveland, Ohio

JAMA. 1996;276(2):104. doi:10.1001/jama.1996.03540020026023

To the Editor.  —I must take exception to the discussion by Dr Olanow1 of the presumed clinical benefits and improvements that resulted from fetal tissue transplantation in patients with PD. Landau2 has addressed this topic.The clinical improvement described in the patients who received transplants, based almost exclusively on clinical criteria, differs very little from that reported earlier with adrenal gland grafting. This technology has subsequently proven to be of no value.Olanow mentions the measured increases in "striatal fluorodopa uptake," using positron-emission tomography (PET) scanning, but, at present, it is not known whether this is indicative of dopamine production by the graft or is an irritative effect on the surrounding brain. He reinforces his belief in the success of this method by mentioning the single autopsy case3 that demonstrated some cellular survival in the fetal brain graft. No neuropathologist would argue that this was evidence of "robust graft survival,"