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Title: Pedunculopontine Nucleus Deep Brain Stimulation in Parkinson’s Disease: A Clinical Review
Authors: Thevathasan, Wesley
Debu, Bettina
Bloem, Bastiaan
Blahak, Christian
Butson, Christopher
Czernecki, Virgine
Foltynie, Thomas
Fraix, Valerie
Grabli, David
Joint, Carole
Lozano, Andres
Okum, Michael
Ostrem, Jill
Pavese, Nicola
Schrader, Christoph
Tai, Chun-Hwei
Krauss, Joachim
Moro, Elena
Keywords: Deep brain stimulation
Gait freezing
Parkinson's disease
Pedunculopontine nucleus
Issue Date: Sep-2017
Publisher: Wiley
Citation: Thevathasan, W., B. Debu, T. Aziz, B. R. Bloem, C. Blahak, C. Butson, V. Czernecki, T. Foltynie, V. Fraix, D. Grabli, C. Joint, A. M. Lozano, M. S. Okun, J. Ostrem, N. Pavese, C. Schrader, C. H. Tai, J. K. Krauss, and E. Moro. 2017. Pedunculopontine nucleus deep brain stimulation in Parkinson's disease: A clinical review. Movement disorders : official journal of the Movement Disorder Society: 10-20.
Abstract: Pedunculopontine nucleus region deep brain stimulation (DBS) is a promising but experimental therapy for axial motor deficits in Parkinson's disease (PD), particularly gait freezing and falls. Here, we summarise the clinical application and outcomes reported during the past 10 years. The published dataset is limited, comprising fewer than 100 cases. Furthermore, there is great variability in clinical methodology between and within surgical centers. The most common indication has been severe medication refractory gait freezing (often associated with postural instability). Some patients received lone pedunculopontine nucleus DBS (unilateral or bilateral) and some received costimulation of the subthalamic nucleus or internal pallidum. Both rostral and caudal pedunculopontine nucleus subregions have been targeted. However, the spread of stimulation and variance in targeting means that neighboring brain stem regions may be implicated in any response. Low stimulation frequencies are typically employed (20-80 Hertz). The fluctuating nature of gait freezing can confound programming and outcome assessments. Although firm conclusions cannot be drawn on therapeutic efficacy, the literature suggests that medication refractory gait freezing and falls can improve. The impact on postural instability is unclear. Most groups report a lack of benefit on gait or limb akinesia or dopaminergic medication requirements. The key question is whether pedunculopontine nucleus DBS can improve quality of life in PD. So far, the evidence supporting such an effect is minimal. Development of pedunculopontine nucleus DBS to become a reliable, established therapy would likely require a collaborative effort between experienced centres to clarify biomarkers predictive of response and the optimal clinical methodology. (c) 2017 International Parkinson and Movement Disorder Society.
URI: http://repository.bionicsinstitute.org:8080/handle/123456789/312
ISSN: 0885-3185
Appears in Collections:Neurobionics Research Publications

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