eprintid: 10025034
rev_number: 27
eprint_status: archive
userid: 608
dir: disk0/10/02/50/34
datestamp: 2017-10-19 13:56:09
lastmod: 2021-09-20 00:17:52
status_changed: 2018-01-22 15:20:23
type: article
metadata_visibility: show
creators_name: Thevathasan, W
creators_name: Debu, B
creators_name: Aziz, T
creators_name: Bloem, BR
creators_name: Blahak, C
creators_name: Butson, C
creators_name: Czernecki, V
creators_name: Foltynie, T
creators_name: Fraix, V
creators_name: Grabli, D
creators_name: Joint, C
creators_name: Lozano, AM
creators_name: Okun, MS
creators_name: Ostrem, J
creators_name: Pavese, N
creators_name: Schrader, C
creators_name: Tai, C-H
creators_name: Krauss, JK
creators_name: Moro, E
creators_name: Movement Disorders Society PPN DBS Working Groupin collaboration, .
title: Pedunculopontine nucleus deep brain stimulation in Parkinson's disease: A clinical review
ispublished: pub
divisions: UCL
divisions: B02
divisions: C07
divisions: D07
divisions: F84
keywords: Parkinson's disease, deep brain stimulation, gait freezing, pedunculopontine nucleus
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. © 2017 International Parkinson and Movement Disorder Society.
date: 2017-09-28
date_type: published
official_url: http://doi.org/10.1002/mds.27098
language: eng
article_type_text: Journal Article
verified: verified_manual
elements_id: 1426656
doi: 10.1002/mds.27098
lyricists_name: Foltynie, Thomas
lyricists_id: TFOLT83
actors_name: Foltynie, Thomas
actors_id: TFOLT83
actors_role: owner
full_text_status: restricted
publication: Movement Disorders
volume: 33
number: 1
pagerange: 10-20
event_location: United States
issn: 1531-8257
citation:        Thevathasan, W;    Debu, B;    Aziz, T;    Bloem, BR;    Blahak, C;    Butson, C;    Czernecki, V;                                                     ... Movement Disorders Society PPN DBS Working Groupin collaboration, .; + view all <#>        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;  Movement Disorders Society PPN DBS Working Groupin collaboration, .;   - view fewer <#>    (2017)    Pedunculopontine nucleus deep brain stimulation in Parkinson's disease: A clinical review.                   Movement Disorders , 33  (1)   pp. 10-20.    10.1002/mds.27098 <https://doi.org/10.1002/mds.27098>.      
 
document_url: https://discovery.ucl.ac.uk/id/eprint/10025034/1/PPN%20PAPER%20without%20tracked%20changes%20020417.docx