scholarly journals Pedunculopontine Nucleus Deep Brain Stimulation for Parkinsonian Disorders: A Case Series

2020 ◽  
pp. 1-8
Author(s):  
Viswas Dayal ◽  
Ali Rajabian ◽  
Marjan Jahanshahi ◽  
Iciar Aviles-Olmos ◽  
Dorothy Cowie ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Freezing Of Gait ◽  
Case Series ◽  
Pedunculopontine Nucleus ◽  
Future Research ◽  
Patient Reported ◽  
Parkinsonian Disorders ◽  
Deep Brain ◽  
Diurnal Cycling

<b><i>Background:</i></b> 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. <b><i>Objectives:</i></b> To summarize the clinical outcomes of PPN-DBS-treated patients at our centre and elicit any patterns that may guide future research. <b><i>Materials and Methods:</i></b> 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. <b><i>Results:</i></b> 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. <b><i>Conclusions:</i></b> 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.

Deep Brain Stimulation of the Pedunculopontine Nucleus in a Patient with Freezing of Gait

2011 ◽  
Vol 89 (4) ◽  
pp. 214-219 ◽  
Author(s):  
Feridun Acar ◽  
Göksemin Acar ◽  
Levent Sinan Bir ◽  
Bengi Gedik ◽  
Attila Oğuzhanoğlu
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Freezing Of Gait ◽  
Pedunculopontine Nucleus ◽  
Deep Brain ◽  
Stimulation Of

scholarly journals Efficacy and Safety of Pedunculopontine Nuclei (PPN) Deep Brain Stimulation in the Treatment of Gait Disorders: A Meta-Analysis of Clinical Studies

2015 ◽  
Vol 43 (1) ◽  
pp. 120-126 ◽  
Author(s):  
Laleh Golestanirad ◽  
Behzad Elahi ◽  
Simon J. Graham ◽  
Sunit Das ◽  
Lawrence L. Wald
Keyword(s):  
Deep Brain Stimulation ◽  
Parkinson Disease ◽  
Brain Stimulation ◽  
Meta Analysis ◽  
Freezing Of Gait ◽  
Pedunculopontine Nucleus ◽  
Postural Instability ◽  
Internal Globus Pallidus ◽  
Motor Abnormalities ◽  
Deep Brain

AbstractBackground: Pedunculopontine nucleus (PPN) has complex reciprocal connections with basal ganglia, especially with internal globus pallidus and substantia nigra, and it has been postulated that PPN stimulation may improve gait instability and freezing of gait. In this meta-analysis, we will assess the evidence for PPN deep brain stimulation in treatment of gait and motor abnormalities especially focusing on Parkinson disease patients. Methods: PubMed and Scopus electronic databases were searched for related studies published before February 2014. Medline (1966-2014), Embase (1974-2010), CINAHL, Web of Science, Scopus bibliographic, and Google Scholar databases (1960-2014) were also searched for studies investigating effect of PPN deep brain stimulation in treatment of postural and postural instability and total of ten studies met the inclusion criteria for this analysis. Results: Our findings showed a significant improvement in postural instability (p<0.001) and motor symptoms of Parkinson disease on and off medications (p<0.05), but failed to show improvement in freezing of gait. Conclusions: Despite significant improvement in postural instability observed in included studies, evidence from current literature is not sufficient to generalize these findings to the majority of patients.

scholarly journals Case series: New‐onset freezing of gait in combined use of deep brain stimulation and Levodopa

2021 ◽  
Vol 9 (8) ◽  
Author(s):  
Mehri Salari ◽  
Zahra Aminzade ◽  
Reza Jalili khoshnood ◽  
Sepand Tehrani Fateh
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Freezing Of Gait ◽  
Case Series ◽  
Combined Use ◽  
Deep Brain ◽  
New Onset

Modulation of attentional processing by deep brain stimulation of the pedunculopontine nucleus region in patients with parkinsonian disorders.

2015 ◽  
Vol 29 (4) ◽  
pp. 632-637 ◽  
Author(s):  
Julia Fischer ◽  
Kati Schwiecker ◽  
Verena Bittner ◽  
Hans-Jochen Heinze ◽  
Jürgen Voges ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Pedunculopontine Nucleus ◽  
Attentional Processing ◽  
Parkinsonian Disorders ◽  
Deep Brain ◽  
Stimulation Of

scholarly journals Tractography patterns of pedunculopontine nucleus deep brain stimulation

2021 ◽  
Author(s):  
Ashley L. B. Raghu ◽  
Tariq Parker ◽  
Amir P. Divanbeighi Zand ◽  
Stephen Payne ◽  
Jesper Andersson ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Cortical Thickness ◽  
Brain Stimulation ◽  
Diffusion Tensor ◽  
Freezing Of Gait ◽  
Structural Connectivity ◽  
Pedunculopontine Nucleus ◽  
Precentral Gyrus ◽  
Superior Cerebellar Peduncle ◽  
Deep Brain

AbstractDeep brain stimulation of the pedunculopontine nucleus is a promising surgical procedure for the treatment of Parkinsonian gait and balance dysfunction. It has, however, produced mixed clinical results that are poorly understood. We used tractography with the aim to rationalise this heterogeneity. A cohort of eight patients with postural instability and gait disturbance (Parkinson’s disease subtype) underwent pre-operative structural and diffusion MRI, then progressed to deep brain stimulation targeting the pedunculopontine nucleus. Pre-operative and follow-up assessments were carried out using the Gait and Falls Questionnaire, and Freezing of Gait Questionnaire. Probabilistic diffusion tensor tractography was carried out between the stimulating electrodes and both cortical and cerebellar regions of a priori interest. Cortical surface reconstructions were carried out to measure cortical thickness in relevant areas. Structural connectivity between stimulating electrode and precentral gyrus (r = 0.81, p = 0.01), Brodmann areas 1 (r = 0.78, p = 0.02) and 2 (r = 0.76, p = 0.03) were correlated with clinical improvement. A negative correlation was also observed for the superior cerebellar peduncle (r = −0.76, p = 0.03). Lower cortical thickness of the left parietal lobe and bilateral premotor cortices were associated with greater pre-operative severity of symptoms. Both motor and sensory structural connectivity of the stimulated surgical target characterises the clinical benefit, or lack thereof, from surgery. In what is a challenging region of brainstem to effectively target, these results provide insights into how this can be better achieved. The mechanisms of action are likely to have both motor and sensory components, commensurate with the probable nature of the underlying dysfunction.

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