Toggle Main Menu Toggle Search

Open Access padlockePrints

Pedunculopontine nucleus deep brain stimulation in Parkinson's disease: A clinical review

Lookup NU author(s): Professor Nicola Pavese

Downloads

Full text for this publication is not currently held within this repository. Alternative links are provided below where available.


Abstract

© 2017 International Parkinson and Movement Disorder Society 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. © 2017 International Parkinson and Movement Disorder Society.


Publication metadata

Author(s): Thevathasan W, Debu B, Aziz T, Bloem BR, Blahak C, Butson C, Czernecki V, Foltynie T, Fraix V, Grabli D, Joint C, Lozano AM, Okun MS, Ostrem J, Pavese N, Schrader C, Tai C-H, Krauss JK, Moro E

Publication type: Review

Publication status: Published

Journal: Movement Disorders

Year: 2018

Volume: 33

Issue: 1

Pages: 10-20

Print publication date: 01/01/2018

Online publication date: 28/09/2017

Acceptance date: 14/06/2017

ISSN (print): 0885-3185

ISSN (electronic): 1531-8257

Publisher: John Wiley and Sons Inc.

URL: https://doi.org/10.1002/mds.27098

DOI: 10.1002/mds.27098


Actions

Find at Newcastle University icon    Link to this publication


Share