Open AccessPedunculopontine Nucleus Deep Brain Stimulation for Parkinsonian Disorders: A Case Series
Author(s) -
Viswas Dayal,
Ali Rajabian,
Marjan Jahanshahi,
Icíar Avilés-Olmos,
Dorothy Cowie,
Amy Peters,
Brian L. Day,
Jonathan A. Hyam,
Harith Akram,
Patricia Limousin,
Marwan Hariz,
Ludvic Zrinzo,
Thomas Foltynie
Publication year - 2020
Publication title -
stereotactic and functional neurosurgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.798
H-Index - 63
eISSN - 1423-0372
pISSN - 1011-6125
DOI - 10.1159/000511978
Subject(s) - deep brain stimulation , pedunculopontine nucleus , progressive supranuclear palsy , gait , levodopa , parkinson's disease , subthalamic nucleus , medicine , physical medicine and rehabilitation , stimulation , movement disorders , refractory (planetary science) , psychology , physical therapy , anesthesia , disease , physics , astrobiology
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.