Brain Storms by Jon Palfreman

Author:Jon Palfreman
Language: eng
Format: epub
ISBN: 9780374711856
Publisher: Farrar, Straus and Giroux

11

THE DESCENDANTS

Chance favors the prepared mind.

—Louis Pasteur, 1854

After he helped pioneer L-dopa therapy in the 1960s with individuals like patient 3, Roger Duvoisin went on to spend much of his career puzzling over the issue of whether Parkinson’s disease was primarily environmental or genetic. Duvoisin’s hunch was that environmental factors, such as pesticides and air and water pollution, caused Parkinson’s disease, and he held this view even before MPTP was discovered in the frozen addicts’ street drugs. While it was true that in some rare families a Parkinson’s-like condition appeared to be inherited, the vast majority of regular Parkinson’s cases—which neurologists called “sporadic” Parkinson’s disease, to indicate that it occurred without a discernible pattern or specific cause—did not seem to be genetic in origin. In addition, a series of studies involving identical twins (one of which Duvoisin headed)—the gold standard for detecting heritable traits—had failed to find evidence that Parkinson’s had a clear genetic component.

So the discovery of MPTP in the 1980s seemed to clinch the matter for Duvoisin. As he recalls, “That seemed to say there was no genetics involved.”

Then something happened that made him change his mind.

It all began with a routine office visit. In the spring of 1986 (the year my Nova documentary was broadcast), the neurologist Larry Golbe—Duvoisin’s junior colleague at the Robert Wood Johnson Medical School—conducted a clinical examination of a forty-eight-year-old northern New Jersey fire chief named David. Golbe observed that the fire chief’s movements were slow and restrained. Golbe had asked David to participate in a finger-tapping exercise (a common way for researchers to detect abnormal movements), and although David started the exercise with no trouble, he soon ran out of energy, and his finger taps got smaller and eventually petered out. When he stood up, this once athletic man now bent forward, with a stooped gait. When he walked, he didn’t swing his arms, but shuffled along with small steps. When Golbe tried to bend David’s arms and legs at the elbow and the knee, he was met with resistance. David’s face was expressionless, and he never blinked.

Golbe flipped through the chart, scanning his patient’s medical history. Ten years earlier, at the age of thirty-eight, the fire chief had reported stiffness and slowness in his left hand, and soon after he was indeed diagnosed with Parkinson’s. David was treated with Sinemet, the carbidopa-levodopa combination that replaced some of his missing dopamine. For a while, the chief responded. But over time the medicine became less effective, as we’ve seen in the cases of countless people with Parkinson’s, including Joan Samuelson, Michael J. Fox, and Tom Graboys. After a decade of drug therapy, David needed to take Sinemet every two hours to avoid freezing up. And even then, the medicine’s effects sometimes suddenly switched off, and he became rigid as a statue. David also showed clear signs of dementia while he was “off,” as well as postural instability, and manifested a festinating gait when he was “on.” Golbe enrolled David in a new study

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