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Pedunculopontine nucleus deep brain stimulation for parkinsonian disorders : a case series

Dayal, Viswas (författare)
Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
Rajabian, Ali (författare)
Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
Jahanshahi, Marjan (författare)
Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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Aviles-Olmos, Iciar (författare)
Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
Cowie, Dorothy (författare)
Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
Peters, Amy (författare)
Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
Day, Brian (författare)
Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
Hyam, Jonathan (författare)
Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
Akram, Harith (författare)
Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
Limousin, Patricia (författare)
Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
Hariz, Marwan (författare)
Umeå universitet,Neurovetenskaper,Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
Zrinzo, Ludvic (författare)
Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
Foltynie, Thomas (författare)
Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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 (creator_code:org_t)
2020-12-04
2021
Engelska.
Ingår i: Stereotactic and Functional Neurosurgery. - : S. Karger. - 1011-6125 .- 1423-0372. ; 99:4, s. 287-294
  • Tidskriftsartikel (refereegranskat)
Abstract Ämnesord
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  • Background: Deep brain stimulation (DBS) of the pedunculopontine nucleus (PPN) has been investigated for the treatment of levodopa-refractory gait dysfunction in parkinsonian disorders, with equivocal results so far.Objectives: To summarize the clinical outcomes of PPN-DBS-treated patients at our centre and elicit any patterns that may guide future research.Materials and Methods: Pre- and post-operative objective overall motor and gait subsection scores as well as patient-reported outcomes were recorded for 6 PPN-DBS-treated patients, 3 with Parkinson's disease (PD), and 3 with progressive supranuclear palsy (PSP). Electrodes were implanted unilaterally in the first 3 patients and bilaterally in the latter 3, using an MRI-guided MRI-verified technique. Stimulation was initiated at 20-30 Hz and optimized in an iterative manner.Results: Unilaterally treated patients did not demonstrate significant improvements in gait questionnaires, UPDRS-III or PSPRS scores or their respective gait subsections. This contrasted with at least an initial response in bilaterally treated patients. Diurnal cycling of stimulation in a PD patient with habituation to the initial benefit reproduced substantial improvements in freezing of gait (FOG) 3 years post-operatively. Among the PSP patients, 1 with a parkinsonian subtype had a sustained improvement in FOG while another with Richardson syndrome (PSP-RS) did not benefit.Conclusions: PPN-DBS remains an investigational treatment for levodopa-refractory FOG. This series corroborates some previously reported findings: bilateral stimulation may be more effective than unilateral stimulation; the response in PSP patients may depend on the disease subtype; and diurnal cycling of stimulation to overcome habituation merits further investigation.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Neurologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Neurology (hsv//eng)

Nyckelord

Deep brain stimulation
Pedunculopontine nucleus
Parkinson's disease
Progressive supranuclear palsy
Freezing of gait

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