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Fox faces tough fight, but doctors offer hope Prognosis: Actor Michael J. Fox, who visits Baltimore today, has Parkinson's disease, but recent research in the field is promising.


If any actor seemed forever young, it was Michael J. Fox. Even at 37, the star of "Spin City" seemed capable of riding back to the future on a skateboard.

Now he tells us he has Parkinson's disease, a progressive brain disorder that in time brings a shuffling gait, trembling hands, a stooped posture and stiff movements. As he arrives in Baltimore today to promote the Port Discovery children's museum at an invitation-only celebration, fans are still trying to process how Fox managed to keep his disease private for seven years -- looking youthful all the way.

When he first heard about Fox's illness, Dr. Paul S. Fishman, a Parkinson's specialist at the University of Maryland Medical Center, made a point of watching "Spin City" to see whether the energetic actor showed any signs of the disease. What he saw was a man who was well practiced at controlling -- even hiding -- his symptoms.

"The behavior I noticed was behavior to conceal a Parkinson's tremor," said Fishman, a neurologist. "My hunch is that he's been doing this for years. It's become second nature."

Fox, like thousands of other patients, has learned strategies to control the hand tremor that is one of the most troubling and embarrassing aspects of Parkinson's. Patients learn that the tremor occurs mainly when the hand is at rest. Put the hand in motion and the tremor stops.

"You rarely see him with his hand just hanging loosely by his side," sasy Fishman. "He'll have it in his pocket, and then when it comes out, it will always be in motion. Then, it will go back in. Watch a clip of 'Spin City' and what you'll see is that that hand is virtually never sitting still in plain sight."

Fox is the latest in a series of celebrities to visit Port Discovery during a weeklong celebration that will set the stage for the museum's grand opening on Dec. 29. After a tour, he will be the host of a breakfast for donors who have given more than $1,500.

Parkinson's generally is regarded as a disease afflicting people much older than Fox. This is partly true. Most of the estimated 1 million Americans with Parkinson's are over 60. But it strikes younger people, too; about 5 percent are under 40 when diagnosed. This translates into 50,000 people -- not a small number.

In recent interviews given to People magazine and ABC's Barbara Walters, Fox said he does not plan to let the disease curtail his acting career anytime soon. He underwent a brain operation in March 1997 to calm a sometimes-violent hand tremor, but a less dramatic one can return without warning, forcing him to delay rehearsals and appearances.

Parkinson's is caused by the destruction of brain cells that produce dopamine, a chemical that plays a vital role in regulating the way people move. Symptoms worsen with time as more cells die. Surgery and medication can bring years of relief -- but they cannot reverse the underlying disease.

Neurologists agree that Fox, who is surely receiving top-notch treatment, will probably be able to function for years. They also agree that he will not be able to escape a steady deterioration unless new treatments are found.

"Each individual patient is a little different, but my sense taking care of young patients is that they tend to do very well for a long period of time," said Dr. Ted M. Dawson, who runs the Parkinson's program at Johns Hopkins Hospital. "But once you've had it, you tend to develop complications -- both from the disease progressing and from the requirement for increased medications that lead to side effects."

Fortunately, Parkinson's is one of the most promising areas of neurological research. Without hoped-for advances, "in another seven or eight years, he [Fox] is going to be freezing when he walks," said Hopkins neurosurgeon Frederick A. Lenz. "By the time he's 15 years into the disease, he's going to have a significant gait problem with involvement on both sides of the body. His feet could feel glued to the ground. He'll move his upper body and feel like his feet can't move."

At present, patients can control their disease with medication and surgery. Fox takes a drug that restores the brain's vanishing supply of dopamine. The drug, however, cannot keep up with Parkinson's progression. In addition, medications produce a side

effect called dyskinesia, involuntary movements that can be just as troubling as serious tremors.

Patients sometimes choose surgery when medications fail. Surgeons burn off a tiny area of brain tissue responsible for the electrical misfiring that triggers symptoms. An operation known as a pallidotomy is most effective against dyskinesia and slowed movement, said Lenz. Thalamotomy -- the operation Fox had -- works better against tremors. The operations get their names from the regions of the brain they target: the globus pallidus and the thalamus.

Surgery relieves symptoms in the vast majority of cases, but is not without risks. Despite sophisticated brain mapping, surgeons can harm tissue responsible for other functions. In a small number of cases, a patient can end up blind or paralyzed.

In the last year, U.S. surgeons have begun to offer an alternative: electrical stimulators that jam faulty brain signals with high-frequency current. A thin wire implanted deep within the brain receives its current from a battery that's placed under the skin near the collarbone.

"The advantage is that you're not destroying tissue," said Dawson. "Five years from now, we might have a treatment where want that tissue intact. The problem is, you've got an in-dwelling electrode in the brain." The long-term consequences remain unclear.

In Denver, surgeons are experimenting with implanting fetal nerve cells in the brain. They hope the cells will supply the brain with an ongoing source of dopamine that will relieve if not cure the disease. Doctors at Hopkins and the University of Wisconsin are looking for ways to turn laboratory-grown "stem cells" into dopamine-supplying brain cells that are ready for transplant.

Dr. Solomon Snyder, Hopkins' renowned chief of neuroscience, says he might have found a way to regenerate dopamine cells with compounds called "neuroimmunophilin ligands." Experiments have looked promising in animals, and the human trials are scheduled to start next year.

The possibilities don't make Parkinson's any less scary, but have brought hope. Recent progress makes it hard to predict what's in store for a young patient like Fox.

"The therapeutic landscape has changed, and continues to change," said Fishman.

Pub Date: 12/12/98

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