A Hole In His Head

Medical Procedure Helps Patient Afflicted With Parkinson's Disease

Parkinson's disease is a heartbreaking illness that causes frozen, stone-faced stillness in those afflicted. Correspondent Morley Safer reports on the story of one man, Fred Amphlett of Bristol, England, who had been a prisoner of Parkinson's for years.

When Safer first met him in 1995, he was about to undergo an operation called a pallidotomy, once used by doctors to ease the agonies of Parkinson's. It was not a cure, nor was it for everyone. But for Amphlett, it was his last hope.

"I think eating has become one of the real curses of Parkinson's disease," said Amphlett, 48. "The more conscious you become, the worse it gets."

Amphlett has had Parkinson's disease since he was 35. His mind is alert, but his body is in an agony of lurching, uncontrollable movement.

To give Amphlett this amount of control, which still leaves him barely able to control his body, he must be given 20 injections a day and at least 10 pills each day. Most of his movements - a sort of jigging about - are caused by the drug, not the disease. It's a side effect of the drug, and this is where the worry comes in.

But he's caught in a Catch 22 situation. "Gradually, the side effects outweigh the benefits of the drug," said Amphlett. "If I don't take the drugs, I just come to a stop."

Without drugs, he's a virtual zombie. In Parkinson's disease, the part of the brain that allows for easy movement shuts down and the body becomes frozen. The drugs break that spell, but produce something almost as hellish.

Amphlett has reached the end of the line as far as any further medication is concerned. His only hope is an operation called a pallidotomy. In his case, it's two separate procedures – one for each side of his brain.

The theory is that by destroying a very small part of one overactive area of the brain called the globus pallidus, Amphlett could be freed of both the frozen and writhing episodes.

The first step is an MRI, magnetic resonance imaging -- images of the brain that will become the surgeon's map.

Next, a metal frame is attached. Then, a CAT scan is done, which shows the position of the frame in relation to the skull. The pictures are then matched to the MRI images of Amphlett's brain. Together, they allow the surgeon to calculate the exact position of the target, the globus pallidus.

"We have to be accurate to within a millimeter. Otherwise, going too deep by a millimeter will damage his vision. And if I go too much towards the midline by a millimeter, then it could get a paralysis," said Dr. Stephen Gill, who performed the surgery.

Amphlett was under only local anesthetic. He had to remain fully conscious so that his physical responses, especially sight and movement, could be monitored.

The electrode was adjusted so that its tip will hit the target. Because it is blunt, it pushes through the soft brain tissue without damaging it. The brain also does not feel any pain. As the temperature rises, the electrode begins to destroy the target brain tissue. Ninety seconds later, the procedure is compelete.

For the first time in years, Amphlett's body is naturally at rest. How does he feel? "Not bad at all," said Amphlett. Then miraculously, he is able to get off the operating table and walk quite calmly down the hall of the hospital.

"Fred has a very advanced disease. He was one of the worst cases that I've had to operate on. I think that the major thing he's going to see is he's going to be functioning much better," said Gill. "He's going to be able to do things that he couldn't do before. I hope he's going to be able to sleep at night and have a fairly normal existence, be able to feed himself and really, a changed man."

That was nine years ago. How is Amphlett doing today?

His condition is no less incredible than the surgery that helped him achieve it.

The simple act of shaving would have been practically lethal for Amphlett before his surgery. But today, he lives a full and mostly independent life. An aide comes a few times a week to help out in this small Bristol apartment. She also helps arrange the daily cocktail of medications he takes using an intravenous pump. And there are dozens of injections.

The drugs that were the source of so much trouble before his surgery now enable him to go out in public, where he could be any other shopper in the local grocery. But Parkinson's disease remains a relentless and progressive disease. Several years after surgery gave him his life back, the disease took away something else – his voice.

"Parkinson's affects every muscle in your body, the muscles that [are] needed to speak are affected radically," said Amphlett. The operation Amphlett endured has become a neurosurgical relic, replaced by more sophisticated procedures.

This is the best that Amphlett can hope for, but despite the challenges of Parkinson's, he remains endlessly positive.

"I am a happy-go-lucky sort of chap and I enjoy every minute of every day," he says.