Pedunculopontine Nucleus Deep Brain Stimulation in Parkinson’s Disease: A Clinical Review

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dc.contributor.authorThevathasan, Wesley
dc.contributor.authorDebu, Bettina
dc.contributor.authorBloem, Bastiaan
dc.contributor.authorBlahak, Christian
dc.contributor.authorButson, Christopher
dc.contributor.authorCzernecki, Virgine
dc.contributor.authorFoltynie, Thomas
dc.contributor.authorFraix, Valerie
dc.contributor.authorGrabli, David
dc.contributor.authorJoint, Carole
dc.contributor.authorLozano, Andres
dc.contributor.authorOkum, Michael
dc.contributor.authorOstrem, Jill
dc.contributor.authorPavese, Nicola
dc.contributor.authorSchrader, Christoph
dc.contributor.authorTai, Chun-Hwei
dc.contributor.authorKrauss, Joachim
dc.contributor.authorMoro, Elena
dc.date.accessioned2018-08-01T06:22:20Z
dc.date.available2018-08-01T06:22:20Z
dc.date.issued2017-09
dc.description.abstractPedunculopontine 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.en_US
dc.description.sponsorshipThe Movement Disorders Society PPN DBS Working Group in collaboration with the World Society for Stereotactic and Functional Neurosurgery was supported by an unrestricted educational grant from Medtronic.en_US
dc.identifier.citationThevathasan, 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.en_US
dc.identifier.issn0885-3185
dc.identifier.urihttp://repository.bionicsinstitute.org:8080/handle/123456789/312
dc.language.isoenen_US
dc.publisherWileyen_US
dc.subjectDeep brain stimulationen_US
dc.subjectGait freezingen_US
dc.subjectParkinson's diseaseen_US
dc.subjectPedunculopontine nucleusen_US
dc.titlePedunculopontine Nucleus Deep Brain Stimulation in Parkinson’s Disease: A Clinical Reviewen_US
dc.typeArticleen_US
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