Pedunculopontine nucleus deep brain stimulation in Parkinson's disease

• Verfasst von: Thevathasan, Wesley [VerfasserIn]
• Verfasst von: Blahak, Christian [VerfasserIn]
• Titel: Pedunculopontine nucleus deep brain stimulation in Parkinson's disease
• Titelzusatz: a clinical review
• Verf.angabe: Wesley Thevathasan, Bettina Debu, Tipu Aziz, Bastian R. Bloem, Christian Blahak, Christopher Butson, Virginie Czernecki, Thomas Foltynie, Valerie Fraix, David Grabli, Carole Joint, Andres M. Lozano, Michael S. Okun, Jill Ostrem, Nicola Pavese, Christoph Schrader, Chun‐Hwei Tai, Joachim K. Krauss, and Elena Moro, on behalf of the Movement Disorders Society PPN DBS Working Group in collaboration with the World Society for Stereotactic and Functional Neurosurgery
• Jahr: 2018
• Umfang: 11 S.
• Fussnoten: Gesehen am 12.04.2018 ; Article was first published online on 28 September 2017 ; Christian Blahak is a member of the PPN DBS Working Group
• Titel Quelle: Enthalten in: Movement disorders
• Ort Quelle: New York, NY : Wiley, 1986
• Jahr Quelle: 2018
• Band/Heft Quelle: 33(2018), 1, Seite 10-20
• ISSN Quelle: 1531-8257
• DOI: doi:10.1002/mds.27098
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: deep brain stimulation
• Sach-SW: gait freezing
• Sach-SW: Parkinson's disease
• Sach-SW: pedunculopontine nucleus
• K10plus-PPN: 1571961232

Abstract

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.