Reaching Down the Rabbit Hole: Extraordinary Journeys into the Human Brain

by Allan H. Ropper

Ever since the name of the surgeon of Hoxton Square was attached to the disease over a century ago, there have been precious few breakthroughs in the treatment of Parkinson’s—two to be exact, each one a game changer. The first was the accidental discovery that the surgical destruction of a structure known as the globus pallidus could short-circuit the signals that caused Parkinsonian tremor and rigidity. Irving Cooper, a young neurosurgeon toiling in semi-obscurity in the Bronx, perfected the technique—called a pallidotomy—in the early 1950s. His results were so dramatic and unexpected that he was accused of faking his data, and was nearly drummed out of the profession. But by the mid-1950s, the pallidotomy became the standard of care. Over the next decade, Dr. Cooper and a few other neurosurgeons experimented with alternative lesioning techniques, notably the thalamotomy—the destruction of a pea-sized portion of the thalamus, another deep-brain structure—that also proved effective in eliminating tremors. Then one morning in the fall of 1968, after having performed over six thousand of these procedures, as many as six per day, Dr. Cooper walked into his clinic and announced that all such surgeries would stop, effective immediately. The reason was the arrival of a nonsurgical alternative: the drug called L-dopa, the secret ingredient of Sinemet.